Concomitant transcranial direct current stimulation (tDCS) is suggested to enhance the functional effects of other physical rehabilitation methods in individuals with motor impairment stemming from a chronic cerebrovascular disease. Thus, the primary aim of the proposed study is to analyze the electrical activity of the tibialis anterior (TA) muscle of the paretic limb in stroke survivors following an intervention involving the combination of tDCS over the motor cortex and peripheral electrical stimulation (PES) administered over the paretic TA. The secondary objective is to analyze the effect on dynamic balance.
Methods: Thirty-six adult stroke survivors will be randomized into three groups: 1) Active tDCS + active PES; 2) Sham tDCS + active PES and 3) Active tDCS + sham PES. TDCS active will be positioned bilateral over the primary motor cortex of the damaged hemisphere (C1 or C2) and the cathode will be positioned over the primary motor cortex of the undamaged hemisphere (C1 or C2) with a current of 2 mA for 20 minutes. For sham tDCS, will follow the same standarts, however, the equipment will be switched on for only 20 seconds. PES will be administered to the paretic TA at 50 Hz for 30 minutes. Evaluations: the median frequency and root mean square (RMS) of the paretic TA will be analyzed using electromyography (EMG) and dynamic balance will be evaluated using the Mini-Balance Evaluation System (Mini-BESTest) at baseline (pre-intervention), after 10 treatment sessions at a frequency of five times a week for two weeks (post-intervention) and 30 days after the end of the interventions (follow up).
Discussion: PES has proven to facilitate the conduction of sensory-motor afferences to the cerebral cortex in stroke survivors. Combining PES with tDCS, which has a direct effect on increasing cortical excitability, could favor motor acquisition and neuronal plasticity in this population.
Objective: Lower limb motor dysfunction and lack of balance is one of the most common and disabling sequelae affecting stroke. Objectives: Analyze the effects of the combination of Transcranial Direct Stimulation (tDCS) with peripheral stimulation (PES) on the activity of the tibialis anterior (TA) paretic and balance of hemiparetic post stroke.Methods: Participated 36 hemiparetic chronic. The TA was evaluated with EMG by median frequency (MDF)/ root mean square (RMS) and balance by Mini-BES Test. Evaluations were performed three times: pre, post 10 treatment sessions and 30 followup days. To treatment, subjects were randomized in 3 groups: PESa (active) /tDCSp (placebo); PESa /tDCSa and PESp /tDCSa. tDCS anode electrode was applied over injured motor cortex (C1/C2) and cathode uninjured (C1/C2) for 20 min associated with active dorsiflexion and PES for 30 min (active PES was applied over paretic TA and placebo in TA bone portion). The treatment was performed five times a week/2 week.Results: There was no difference in RMS for either group. Intragroup MDF significantly decreased (p <0.05 Repeated measures ANOVA) after 10 days of treatment and follow-up in all groups; intergroup MDF was significantly lower after 10 days and follow-up in the PESa/tDCSa and PESp /tDCSa groups compared to PESa/tDCSp (p <0.05 Repeated measures ANOVA). Balance improved significantly (p= 0.00 Friedman) and clinically important (>3 points) in PESa /tDCSa after 10 days and follow-up there was no difference (p> 0.05 Kruskal-Wallis) between groups.
Conclusion:EMG, ETCC did not potentiate PES. In Balance, the combined techniques provided clinical improvement.
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