The Effects of Anodal Transcranial Direct Current Stimulation on the Walking Performance of Chronic Hemiplegic Patients

Ojardias, Étienne; Aze, O; Luneau, Davy; Mednieks, Jānis; Condemine, A.; Rimaud, Diana; Chassagne, Fanette; Giraux, Pascal

doi:10.1111/ner.12962

Cited by 24 publications

(26 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In contrast, other studies suggest that our interventions would not have affected other walking characteristics. A single session of tDCS does not alter spatiotemporal kinematics or kinetics during walking [ 54 – 56 ]. Moreover, other studies have found that combining tDCS with walking training does not alter walking spatiotemporal kinematics [ 42 , 48 ].…”

Section: Discussionmentioning

confidence: 99%

Cortical priming strategies for gait training after stroke: a controlled, stratified trial

Madhavan

Cleland

Sivaramakrishnan

et al. 2020

J NeuroEngineering Rehabil

View full text Add to dashboard Cite

Background: Stroke survivors experience chronic gait impairments, so rehabilitation has focused on restoring ambulatory capacity. High-intensity speed-based treadmill training (HISTT) is one form of walking rehabilitation that can improve walking, but its effectiveness has not been thoroughly investigated. Additionally, cortical priming with transcranial direct current stimulation (tDCS) and movement may enhance HISTT-induced improvements in walking, but there have been no systematic investigations. The objective of this study was to determine if motor priming can augment the effects of HISTT on walking in chronic stroke survivors. Methods: Eighty-one chronic stroke survivors participated in a controlled trial with stratification into four groups: 1) control-15 min of rest (n = 20), 2) tDCS-15 min of stimulation-based priming with transcranial direct current stimulation (n = 21), 3) ankle motor tracking (AMT)-15 min of movement-based priming with targeted movements of the ankle and sham tDCS (n = 20), and 4) tDCS+AMT-15 min of concurrent tDCS and AMT (n = 20). Participants performed 12 sessions of HISTT (40 min/day, 3 days/week, 4 weeks). Primary outcome measure was walking speed. Secondary outcome measures included corticomotor excitability (CME). Outcomes were measured at pre, post, and 3-month follow-up assessments. Results: HISTT improved walking speed for all groups, which was partially maintained 3 months after training. No significant difference in walking speed was seen between groups. The tDCS+AMT group demonstrated greater changes in CME than other groups. Individuals who demonstrated up-regulation of CME after tDCS increased walking speed more than down-regulators. Conclusions: Our results support the effectiveness of HISTT to improve walking; however, motor priming did not lead to additional improvements. Upregulation of CME in the tDCS+AMT group supports a potential role for priming in enhancing neural plasticity. Greater changes in walking were seen in tDCS up-regulators, suggesting that responsiveness to tDCS might play an important role in determining the capacity to respond to priming and HISTT. Trial registration: ClinicalTrials.gov, NCT03492229. Registered 10 April 2018retrospectively registered, https:// clinicaltrials.gov/ct2/show/NCT03492229.

show abstract

Section: Discussionmentioning

confidence: 99%

Cortical priming strategies for gait training after stroke: a controlled, stratified trial

Madhavan

Cleland

Sivaramakrishnan

et al. 2020

J NeuroEngineering Rehabil

View full text Add to dashboard Cite

show abstract

“…Similar to chronic stroke, intensive robotic therapy improved clinical and sometimes kinematic ( Triccas et al, 2015 ; Mazzoleni et al, 2017 ) outcomes in both active and sham groups comparably. Almost all non-robotic studies combined tDCS with other therapies, but active tDCS tended to enhance the effects of those therapies.…”

Section: Introductionmentioning

confidence: 88%

“…The few papers with 1 to 2 subacute stroke patients among many chronic patients were included in the chronic stroke table (Lindenberg et al, 2010, 2012; Tanaka et al, 2011 ). Meanwhile, papers with a larger mix of subacute and chronic patients were marked (b) and added to both tables ( Tables 4–5 ); one showed no significant effect of time since stroke ( Fleming et al, 2017 ), mean time since stroke was 4.9 ± 3 months in another ( Wu et al, 2013 ), and the third ( Triccas et al, 2015 ) had a near even mix of subacute and chronic patients.…”

Section: Introductionmentioning

confidence: 99%

Evidence-Based Guidelines and Secondary Meta-Analysis for the Use of Transcranial Direct Current Stimulation in Neurological and Psychiatric Disorders

Fregni

El-Hagrassy

Pacheco‐Barrios

et al. 2020

International Journal of Neuropsychopharmacology

387

242

View full text Add to dashboard Cite

Background Transcranial direct current stimulation (tDCS) has shown promising clinical results, leading to increased demand for an evidence-based review on its clinical effects. Objective We convened a team of tDCS experts to conduct a systematic review of clinical trials with more than one session of stimulation testing: Pain, Parkinson’s Disease Motor Function and Cognition, Stroke Motor Function and Language, Epilepsy, Major Depressive Disorder, Obsessive-Compulsive Disorder, Tourette Syndrome, Schizophrenia and Drug Addiction. Methods Experts were asked to conduct this systematic review according to the search methodology from PRISMA guidelines. Recommendations on efficacy were categorized into: Levels A (definitely effective), B (probably effective), C (possibly effective) or no recommendation. We assessed risk of bias for all included studies to confirm whether results were driven by potentially biased studies. Results Although most of the clinical trials have been designed as proof-of-concept trials, some of the indications analyzed in this review can be considered as definitely effective (Level A) such as depression, probably effective (Level B) such as neuropathic pain, fibromyalgia, migraine, post-operative patient-controlled analgesia and pain, Parkinson´s disease (motor and cognition), stroke (motor), epilepsy, schizophrenia and alcohol addiction. Assessment of bias showed that most of the studies had low risk of biases and sensitivity analysis for bias did not change these results. Effect sizes vary from 0.01 to 0.70 and were significant in about 8 conditions, with largest effect size being in postoperative acute pain, and smaller in stroke motor recovery (nonsignificant when combined with robotic therapy). Conclusion All recommendations listed here are based on current published Pubmed-indexed data. Despite high level of evidence in some conditions, it needs to be underscored that effect sizes and duration of effects are often limited; thus, real clinical impact needs to be further determined with different study designs.

show abstract

“…Restorative therapies that aim to restore the normal functioning of the neural circuits affected by stroke may have strong potential to improve post-stroke propulsion. For example, neuromodulatory treatments such as repetitive TMS and transcranial direct current stimulation can be paired with gait training interventions to augment the excitability of the lesioned corticospinal pathways [80][81][82][83][84]. Paired associative stimulation has also been used to promote targeted plasticity in corticospinal circuits in individuals with stroke and spinal cord injury [85][86][87].…”

Section: Neurophysiological Basis For Propulsion Impairmentsmentioning

confidence: 99%

These legs were made for propulsion: advancing the diagnosis and treatment of post-stroke propulsion deficits

Awad

Lewek

Kesar

et al. 2020

J NeuroEngineering Rehabil

View full text Add to dashboard Cite

Advances in medical diagnosis and treatment have facilitated the emergence of precision medicine. In contrast, locomotor rehabilitation for individuals with acquired neuromotor injuries remains limited by the dearth of (i) diagnostic approaches that can identify the specific neuromuscular, biomechanical, and clinical deficits underlying impaired locomotion and (ii) evidence-based, targeted treatments. In particular, impaired propulsion by the paretic limb is a major contributor to walking-related disability after stroke; however, few interventions have been able to target deficits in propulsion effectively and in a manner that reduces walking disability. Indeed, the weakness and impaired control that is characteristic of post-stroke hemiparesis leads to heterogeneous deficits that impair paretic propulsion and contribute to a slow, metabolically-expensive, and unstable gait. Current rehabilitation paradigms emphasize the rapid attainment of walking independence, not the restoration of normal propulsion function. Although walking independence is an important goal for stroke survivors, independence achieved via compensatory strategies may prevent the recovery of propulsion needed for the fast, economical, and stable gait that is characteristic of healthy bipedal locomotion. We posit that post-stroke rehabilitation should aim to promote independent walking, in part, through the acquisition of enhanced propulsion. In this expert review, we present the biomechanical and functional consequences of post-stroke propulsion deficits, review advances in our understanding of the nature of post-stroke propulsion impairment, and discuss emerging diagnostic and treatment approaches that have the potential to facilitate new rehabilitation paradigms targeting propulsion restoration.

show abstract

The Effects of Anodal Transcranial Direct Current Stimulation on the Walking Performance of Chronic Hemiplegic Patients

Cited by 24 publications

References 35 publications

Cortical priming strategies for gait training after stroke: a controlled, stratified trial

Cortical priming strategies for gait training after stroke: a controlled, stratified trial

Evidence-Based Guidelines and Secondary Meta-Analysis for the Use of Transcranial Direct Current Stimulation in Neurological and Psychiatric Disorders

These legs were made for propulsion: advancing the diagnosis and treatment of post-stroke propulsion deficits

Contact Info

Product

Resources

About