Effect of single-session dual-tDCS before physical therapy on lower-limb performance in sub-acute stroke patients: A randomized sham-controlled crossover study

Klomjai, Wanalee; Aneksan, Benchaporn; Pheungphrarattanatrai, Anuchai; Chantanachai, Thanwarat; Choowong, Nattha; Bunleukhet, Soontaree; Auvichayapat, Paradee; Nilanon, Yongchai; Hiengkaew, Vimonwan

doi:10.1016/j.rehab.2018.04.005

Cited by 38 publications

(45 citation statements)

References 35 publications

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“…Among the 14 studies included in the final analysis, 13 of them were randomized controlled trials. Five studies adopted cross-over design (Table 2) ( van Asseldonk and Boonstra, 2016 ; Saeys et al ., 2015 ; Klomjai et al ., 2018 ; Manji et al ., 2018 ; Utarapichat and Kitisomprayoonkul, 2018 ). However, two of the 14 studies ( Danzl et al ., 2013 ; van Asseldonk and Boonstra, 2016 ) did not reply upon the data request.…”

Section: Resultsmentioning

confidence: 99%

“…Among 14 studies, two studies reported some of the adverse events associated with tDCS ( Leon et al ., 2017 ; Klomjai et al ., 2018 ). Among them, with patients in both studies reported transitory itching and tingling during tDCS.…”

Section: Resultsmentioning

confidence: 99%

“…Among them, with patients in both studies reported transitory itching and tingling during tDCS. In addition, one subject experienced mild headache after tDCS and resolved without any treatment within 24 h ( Klomjai et al ., 2018 ). Furthermore, one patient was excluded due to mild headache during and after stimulation ( Leon et al ., 2017 ).…”

Section: Resultsmentioning

confidence: 99%

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Transcranial direct current stimulation for improving ambulation after stroke: a systematic review and meta-analysis

Tien

Chen

et al. 2020

International Journal of Rehabilitation Research

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Achieving a sufficient level of functional ambulation remains to be a challenge to most stroke survivors. Different modes of transcranial direct current stimulation (tDCS) have been applied for improving various aspects of walking and mobility following stroke. However, systematic reviews before 2017 provided only general effects of tDCS on limited walking outcomes. Therefore, the aims of this study were to update the evidence of tDCS for improving walking and mobility after stroke with emphasis on individual outcomes and to delineate the effects of different modes of tDCS in subgroup analysis. The systematic search of PubMed, Medline, PEDro, Scopus, and Cochrane databases for studies published up to January 2019 identified 14 eligible reports. The PEDro scale indicated a good methodological quality of the included studies (score 6.8). The meta-analysis of primary outcomes revealed that active tDCS had no better effect than sham on walking speed [n = 7, standardized mean difference (SMD) = 0.189, P = 0.252] and 6-minute walking distance (n = 3, SMD = 0.209, P = 0.453). Among the secondary outcomes, significant positive effects were found on functional ambulation category (FAC) (n = 5, SMD = 0.542, P = 0.008), Rivermead Mobility Index (n = 3, SMD = 0.699, P = 0.008), and timed up and go test (TUG) (n = 5, SMD = 0.676, P = 0.001), whereas non-significant positive effects were found on Tinetti test (n = 3, SMD = 0.441, P = 0.062) and Berg Balance Scale (n = 2, SMD = 0.408, P = 0.177). In subgroup analyses, anodal tDCS had significant positive effects on FAC (n = 4, SMD = 0.611, P = 0.005) and dual-hemispheric tDCS on TUG (n = 2, SMD = 1.090, P = 0.000). The results provide up-to-date evidence of variable effects of tDCS on walking and functional mobility after stroke.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Transcranial direct current stimulation for improving ambulation after stroke: a systematic review and meta-analysis

Tien

Chen

et al. 2020

International Journal of Rehabilitation Research

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“…Similarly, a single session of anodal tDCS (2 mA, 10 min) to M1 was found to enhance tracking error for an ankle task [49]. Using a slightly different montage known as dual-tDCS with the anode over the ipsilesional M1 and cathode over the contralesional cortex, a single session of tDCS (2 mA, 20 min) prior to conventional physical therapy was found to improve sit-to-stand performance [50]. However, similar to healthy adults, there appears to be some variability in response to tDCS.…”

Section: Transcranial Direct Current Stimulation To Improve Lower Limmentioning

confidence: 96%

“…However, very few studies have investigated tDCS induced changes in impairment or activity-based measures directly related to gait or balance. Early evidence suggests that tDCS may have capacity to modify gait and balance outcomes in people with stroke [50,52], with these improvements likely to be more important for restoring mobility capacity and activities of daily living following stroke than highly sensitive assessments such as tracking error on an ankle tracing task.…”

Section: Quantifying Response To Tdcs Applicationmentioning

confidence: 99%

Transcranial Direct Current Stimulation to Facilitate Lower Limb Recovery Following Stroke: Current Evidence and Future Directions

Gowan

2020

Brain Sciences

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Stroke remains a global leading cause of disability. Novel treatment approaches are required to alleviate impairment and promote greater functional recovery. One potential candidate is transcranial direct current stimulation (tDCS), which is thought to non-invasively promote neuroplasticity within the human cortex by transiently altering the resting membrane potential of cortical neurons. To date, much work involving tDCS has focused on upper limb recovery following stroke. However, lower limb rehabilitation is important for regaining mobility, balance, and independence and could equally benefit from tDCS. The purpose of this review is to discuss tDCS as a technique to modulate brain activity and promote recovery of lower limb function following stroke. Preliminary evidence from both healthy adults and stroke survivors indicates that tDCS is a promising intervention to support recovery of lower limb function. Studies provide some indication of both behavioral and physiological changes in brain activity following tDCS. However, much work still remains to be performed to demonstrate the clinical potential of this neuromodulatory intervention. Future studies should consider treatment targets based on individual lesion characteristics, stage of recovery (acute vs. chronic), and residual white matter integrity while accounting for known determinants and biomarkers of tDCS response.

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Transcranial direct current stimulation (tDCS) for improving activities of daily living, and physical and cognitive functioning, in people after stroke

Elsner

Kügler

Pohl

et al. 2020

Cochrane Database of Systematic Reviews

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Effect of single-session dual-tDCS before physical therapy on lower-limb performance in sub-acute stroke patients: A randomized sham-controlled crossover study

Cited by 38 publications

References 35 publications

Transcranial direct current stimulation for improving ambulation after stroke: a systematic review and meta-analysis

Transcranial direct current stimulation for improving ambulation after stroke: a systematic review and meta-analysis

Transcranial Direct Current Stimulation to Facilitate Lower Limb Recovery Following Stroke: Current Evidence and Future Directions

Transcranial direct current stimulation (tDCS) for improving activities of daily living, and physical and cognitive functioning, in people after stroke

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