Effects of two different protocols of cerebellar transcranial direct current stimulation combined with transcutaneous spinal direct current stimulation on robot-assisted gait training in patients with chronic supratentorial stroke: A single blind, randomized controlled trial

Abstract

Background: The neural organization of locomotion involves motor patterns generated by spinal interneuronal networks and supraspinal structures, which are approachable by noninvasive stimulation techniques. Recent evidences supported the hypothesis that transcranial direct current stimulation (combined with transcutaneous spinal direct current stimulation) may actually enhance the effects of robot-assisted gait training in chronic stroke patients. The cerebellum has many connections to interact with neocortical areas and may provide some peculiar plasticity mechanisms. So, it has been proposed as “non-lesioned entry” to the motor or cognitive system for the application of noninvasive stimulation techniques in patients with supratentorial stroke. Objective: To compare the effects of two different protocols of cerebellar transcranial direct current stimulation combined with transcutaneous spinal direct current stimulation on robotic gait training in patients with chronic supratentorial stroke. Methods: Forty patients with chronic supratentorial stroke were randomly assigned into two groups. All patients received ten, 20-minute robotic gait training sessions, five days a week, for two consecutive weeks. Group 1 underwent cathodal transcranial direct current stimulation over the contralesional cerebellar hemisphere + cathodal transcutaneous spinal direct current stimulation in combination with robotic training. Group 2 underwent cathodal transcranial direct current stimulation over the ipsilesional cerebellar hemisphere + cathodal transcutaneous spinal direct current stimulation in combination with robotic training. The primary outcome was the 6-minute walk test performed before, after, and at follow-up at 2 and 4 weeks post-treatment. Results: No significant difference in the 6-minute walk test between groups was found at the first post-treatment evaluation ( P = 0.976), as well as at the 2-week ( P = 0.178) and the 4-week ( P = 0.069) follow-up evaluations. Both groups showed significant within-group improvements in the 6-minute walk test at all time points.∥Conclusions: Our findings support the hypothesis that cathodal transcranial direct current stimulation over the contralesional or ipsilesional cerebellar hemisphere in combination with cathodal transcutaneous spinal direct current stimulation may lead to similar effects on robotic gait training in chronic supratentorial stroke patients.

Nervous system modulation through electrical stimulation in companion animals

“…In human patients, there is recent evidence suggesting that TDCS combined with TESCS may enhance the effects of robotic-assisted gait training [ 129 ]. The use of TDCS with FES should also be considered [ 130 ], and the combination of TDCS with conventional locomotor training appears to promote balance recovery.…”

Effect of Transcutaneous Spinal Direct Current Stimulation (TsDCS) Combined with Other Therapies on Walking Capacity in Patients with Neurological Disorders: A Systematic Review

“…The sample that is part of this review was comprised of a total of 141 patients with different types of pathologies: 93 subjects with chronic stroke in three studies (Picelli et al, 2015(Picelli et al, , 2018(Picelli et al, , 2019, 28 subjects with cerebral palsy (Solopova et al, 2017), and 20 subjects with neurodegenerative ataxia (Benussi et al, 2018).…”

“…In terms of electrode size for TsDCS, it was 23.75 cm 2 (Picelli et al, 2018(Picelli et al, , 2019, 35 cm 2 (Picelli et al, 2015), 8 × 6 cm 2 (Benussi et al, 2018), and 5 × 8 cm 2 (Solopova et al, 2017), respectively. In three of the studies, the cathode was placed over the spinous processes of the thoracic vertebra (from 9th to 11th) and the anode was placed above the shoulder of the unaffected hemibody (Picelli et al, 2015(Picelli et al, , 2018(Picelli et al, , 2019; in the other two studies, the cathode was placed midline at T11 and at L1 spinous processes (Solopova et al, 2017) and was placed over the spinal lumbar enlargement (2 cm under T11; Benussi et al, 2018).…”

Rewiring the Lesioned Brain: Electrical Stimulation for Post-Stroke Motor Restoration

“…Spinal cord stimulation can modulate both the local and distal neural circuits, and induce neurophysiological and behavioral changes. 95,96 To investigate the combined effects of transcutaneous spinal direct current stimulation (tsDCS) on cortical tDCS or cerebellar tDCS, Picelli et al [97][98][99] conducted several double-blinded, randomized controlled gait training clinical trials.…”

“…97 Similarly, cathode cerebellar tDCS+tsDCS+RAGT resulted in higher improvements in walking capacity and gait cadence in chronic ischemic stroke and supratentorial stroke patients. 98,99 Though several clinical trials have been conducted, the rationale of tsDCS in stroke patients and the mechanism of spinal locomotion control remain unclear. Future studies should elucidate the mechanism of tsDCS modulation effects on the local spinal, supra-spinal, and intracortical motor control process.…”