Improving Gait and Balance in Patients With Leukoaraiosis Using Transcranial Direct Current Stimulation and Physical Training

Kaski, Diego; Domínguez, Raúl; Allum, J.H.J.; Bronstein, Adolfo M.

doi:10.1177/1545968313496328

Cited by 60 publications

(63 citation statements)

References 26 publications

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“…The application of tDCS may, therefore, be useful to increase the activation of reticulospinal motoneurons or result in a stronger reticulospinal output, both of which could be beneficial for motor recovery and rehabilitation [6]. Interestingly, a recent study in patients with leukoaraoisis (hyperintensities in the subcortical white matter) showed that balance performance improved in response to a combined session of physical training and tDCS over the midline motor and premotor areas, but not following physical training alone [61]. In light of the present results, these improvements may have resulted from tDCS-induced reticulospinal facilitation.…”

Section: Discussionmentioning

confidence: 99%

Subcortical Structures in Humans Can Be Facilitated by Transcranial Direct Current Stimulation

Nonnekes¹,

Arrogi²,

Munneke³

et al. 2014

PLoS ONE

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Transcranial direct current stimulation (tDCS) is a noninvasive brain stimulation technique that alters cortical excitability. Interestingly, in recent animal studies facilitatory effects of tDCS have also been observed on subcortical structures. Here, we sought to provide evidence for the potential of tDCS to facilitate subcortical structures in humans as well. Subjects received anodal-tDCS and sham-tDCS on two separate testing days in a counterbalanced order. After stimulation, we assessed the effect of tDCS on two responses that arise from subcortical structures; (1) wrist and ankle responses to an imperative stimulus combined with a startling acoustic stimulus (SAS), and (2) automatic postural responses to external balance perturbations with and without a concurrent SAS. During all tasks, response onsets were significantly faster following anodal-tDCS compared to sham-tDCS, both in trials with and without a SAS. The effect of tDCS was similar for the dominant and non-dominant leg. The SAS accelerated the onsets of ankle and wrist movements and the responses to backward, but not forward perturbations. The faster onsets of SAS-induced wrist and ankle movements and automatic postural responses following stimulation provide strong evidence that, in humans, subcortical structures - in particular the reticular formation - can be facilitated by tDCS. This effect may be explained by two mechanisms that are not mutually exclusive. First, subcortical facilitation may have resulted from enhanced cortico-reticular drive. Second, the applied current may have directly stimulated the reticular formation. Strengthening reticulospinal output by tDCS may be of interest to neurorehabilitation, as there is evidence for reticulospinal compensation after corticospinal lesions.

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Section: Discussionmentioning

confidence: 99%

Subcortical Structures in Humans Can Be Facilitated by Transcranial Direct Current Stimulation

Nonnekes¹,

Arrogi²,

Munneke³

et al. 2014

PLoS ONE

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“…This result suggests that targeting neocortical regions involved with gait using noninvasive stimulation may be one therapeutic strategy to overcome the corticosubcortical disconnection caused by white matter lesions in leukoaraiosis [77].…”

Section: The Use Of Tdcs In Patients With Small Vessel Disease With Gmentioning

confidence: 94%

“…The principal result was that the combination of tDCS and locomotor training improves clinically relevant locomotor performance as measured by stride length ( = 0.047), stride length variability ( = 0.001), and gait velocity ( = 0.008; Figure 4(b)) in patients with leukoaraiosis [77]. We also observed improvements in the time taken to regain posture following a retropulsive stimulus in the tDCS and physical therapy group, but not with tDCS or physical therapy alone ( = 0.045; Figure 4(c)).…”

Section: The Use Of Tdcs In Patients With Small Vessel Disease With Gmentioning

confidence: 97%

Treatments for Neurological Gait and Balance Disturbance: The Use of Noninvasive Electrical Brain Stimulation

Kaski

Bronstein

2014

Advances in Neuroscience

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Neurological gait disorders are a common cause of falls, morbidity, and mortality, particularly amongst the elderly. Neurological gait and balance impairment has, however, proved notoriously difficult to treat. The following review discusses some of the first experiments to modulate gait and balance in healthy adults using anodal transcranial direct current stimulation (tDCS) by stimulating both cerebral hemispheres simultaneously. We review and discuss published data using this novel tDCS approach, in combination with physical therapy, to treat locomotor and balance disorders in patients with small vessel disease (leukoaraiosis) and Parkinson’s disease. Finally, we review the use of bihemispheric anodal tDCS to treat gait impairment in patients with stroke in the subacute phase. The findings of these studies suggest that noninvasive electrical stimulation techniques may be a useful adjunct to physical therapy in patients with neurological gait disorders, but further mutlicentre randomized sham-controlled studies are needed to evaluate whether experimental tDCS use can translate into mainstream clinical practice for the treatment of neurological gait disorders.

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“…LA patients may suffer from cognitive dysfunctions and depression as well as a variety of behavioral deficits, such as disturbed micturition and gait, balance disorders and even disability in daily life [3,4]. Sensorimotor disturbance is an early and the most pervasive symptom [5,6,7] and has become a research focus and a key issue for the clinical treatment of LA [8,9,10,11,12]. However, the relationship between the behavioral disturbances and certain cerebral changes in LA are unclear.…”

Section: Introductionmentioning

confidence: 99%

Breakdown of Sensorimotor Network Communication in Leukoaraiosis

Lai²,

Zhang³

et al. 2015

Neurodegener Dis

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Background: Leukoaraiosis (LA) patients may suffer from sensorimotor dysfunctions. The relationship between behavioral disturbances and changes in the sensorimotor network (SMN) has not been thoroughly elucidated. Objective: This study investigated the hypothesized breakdown of communication of SMN and its behavioral consequences in LA. Methods: Fluid-attenuated inversion recovery (FLAIR) images, resting-state functional magnetic resonance images (fMRI) and behavioral data were collected from 30 LA patients and 26 healthy individuals (normal controls, NC). The subjects were grouped according to LA severity, as indicated by their FLAIR images. Group independent component analysis was applied to the fMRI data to map the functional connectivity of SMN for NC and LA patients. A whole-brain, voxel-wise analysis was employed to investigate the functional connectivity alteration of SMN in LA. The relationships between LA severity, functional connectivity alteration of the SMN and behavioral clinical symptoms were examined by correlation analysis. Results: The right cingulate motor area (rCMA), left posterior insula and left ventral premotor area showed attenuated functional connectivity in the LA patients. The extent of the attenuation was related to the severity of the disease. Furthermore, the attenuation in the rCMA was associated with worse sensorimotor integration performance. Conclusions: These results suggest that LA impairs sensorimotor integration by interfering with the communication or coordination of these aforementioned regions related to the SMN.

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Improving Gait and Balance in Patients With Leukoaraiosis Using Transcranial Direct Current Stimulation and Physical Training

Abstract: Combined anodal tDCS and PT improves gait and balance in this patient group, suggesting that tDCS could be an effective adjunct to PT in patients with leukoaraiosis, for whom no treatment is currently available.

Cited by 60 publications

References 26 publications

Subcortical Structures in Humans Can Be Facilitated by Transcranial Direct Current Stimulation

Subcortical Structures in Humans Can Be Facilitated by Transcranial Direct Current Stimulation

Treatments for Neurological Gait and Balance Disturbance: The Use of Noninvasive Electrical Brain Stimulation

Breakdown of Sensorimotor Network Communication in Leukoaraiosis

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