The effect of single session bi-cephalic transcranial direct current stimulation on gait performance in sub-acute stroke: A pilot study

Abstract

Purpose: Non-invasive brain stimulation with transcranial direct current stimulation (tDCS) modulates cortical excitability and improves upper limb motor performance when applied to chronic stroke patients. The objective was to evaluate whether tDCS can influence gait function in sub-acute stroke patients. Methods:We assessed the effect of single session, bi-cephalic tDCS on gait performance in 14 subacute patients with stroke involving the cerebral hemisphere (2-8 weeks post-stroke) in a double-blinded, sham-controlled study. Patients were randomly allocated to receive either active (n = 7) or sham (n = 7) tDCS. The anodal electrode was placed on the scalp over the ipsilesional lower limb primary motor cortex and the cathode was placed over the contralesional leg motor cortex. Gait performance was measured using the Timed Up and Go test and the Performance Oriented Mobility Assessment before and after active or sham tDCS. Results: The tDCS group was significantly quicker in the Timed Up and Go test in the tDCS group, compared to the sham group (p = 0.018). The Performance Oriented Mobility Assessment was not different between groups (p = 0.897). Conclusions: This is the first study to examine the effects of tDCS on gait in stroke patients in the sub-acute stage. Active tDCS improved gait performance (Timed Up and Go) in stroke patients, despite no changes to limb biomechanics of the hemiparetic side (Performance Oriented Mobility Assessment), as compared to sham stimulation. These results suggest that tDCS could be used as a therapeutic adjunct for gait rehabilitation following stroke.

Effects of a single session of transcranial direct current stimulation on static balance in a patient with hemiparesis: a case study

“…According to Grecco et al 18 ) , the effects of tDCS depend on the location and polarity of the electrodes, and the intensity of the current used to enhance the excitability of the primary motor cortex. In a pilot study, Tahtis et al 19 ) found improvements in the dynamic balance of sub-acute stroke survivors following a single session of bi-cephalic tDCS with the anodal electrode placed on the scalp over the ispilateral lower limb motor cortex and the cathode placed over the contralateral lower limb motor cortex. Duarte et al 20 ) performed anodal tDCS on children with cerebral palsy (1 mA) in five weekly sessions and found that stimulation potentiated treadmill training, with improvements in both dynamic and static balance in comparison to a group submitted to placebo tDCS.…”

Cellular and Molecular Mechanisms of Action of Transcranial Direct Current Stimulation: Evidence from In Vitro and In Vivo Models

“…Cathodal tDCS significantly attenuates epileptic discharge frequency in patients ( Auvichayapat et al, 2013 ), with similar anticonvulsive properties also being observed in rats following cathodal tDCS ( Liebetanz et al, 2006b ). Finally, tDCS applied to stroke patients improves gait performance ( Tahtis et al, 2014 ), hand dexterity, and selective attention ( Au-Yeung et al, 2014 ), whereas motor and cognitive improvements were also seen in animal models of stroke ( Kim et al, 2010 ).…”

Stroke Treatment Associated with Rehabilitation Therapy and Transcranial DC Stimulation (START-tDCS): a study protocol for a randomized controlled trial

“…Although the required number and maximum sessions have not been established, we prefer to follow the model used in previous studies, which for most cases had consecutive sessions of tDCS applied for 10 days, and was able to improve motor function in different phases of stroke [ 24 , 85 , 86 ].…”

“…Studies show that CIMT is associated with functional improvement in acute and subacute stages of stroke [ 20 – 23 ]. Although most studies in neurostimulation therapy involve post-stroke patient monitoring for short periods [ 24 , 25 ], longitudinal studies would clarify the action mechanisms and the effective duration of this association (tDCS plus CIMT) from the early stages of stroke.…”