Effects of Transcranial Direct Current Stimulation Plus Physical Therapy on Gait in Patients With Parkinson Disease

Yotnuengnit, Pattarapol; Bhidayasiri, Roongroj; Donkhan, Rattana; Chaluaysrimuang, Juthamas; Piravej, Krisna

doi:10.1097/phm.0000000000000783

Cited by 35 publications

(79 citation statements)

References 28 publications

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“…Our results show a reduction of step and stance duration and an increment of lower limb velocity during TUG, S&G and NW tests. These achievements confirm the findings reported in other works, which evidenced some improvement of hypokinetic gait in PD after tDCS treatment [29,30,51].…”

Section: Discussionsupporting

confidence: 92%

“…In fact, brain activation patterns in M1 and DLPFC are extremely involved in successful locomotion performance in patients with PD [21,[25][26][27]. Further, the effectiveness of tDCS for alleviating gait and postural instability seems promising [28][29][30][31], however, evidence of its benefit remains unclear and controversial [23,32] because different tDCS protocols and target areas of scalp have been considered, leading to conflicting evidence on MDS-UPDRS scores [23,28].…”

Section: Introductionmentioning

confidence: 99%

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Wearable Electronics Assess the Effectiveness of Transcranial Direct Current Stimulation on Balance and Gait in Parkinson’s Disease Patients

Ricci

Lazzaro

Pisani

et al. 2019

Sensors

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Currently, clinical evaluation represents the primary outcome measure in Parkinson’s disease (PD). However, clinical evaluation may underscore some subtle motor impairments, hidden from the visual inspection of examiners. Technology-based objective measures are more frequently utilized to assess motor performance and objectively measure motor dysfunction. Gait and balance impairments, frequent complications in later disease stages, are poorly responsive to classic dopamine-replacement therapy. Although recent findings suggest that transcranial direct current stimulation (tDCS) can have a role in improving motor skills, there is scarce evidence for this, especially considering the difficulty to objectively assess motor function. Therefore, we used wearable electronics to measure motor abilities, and further evaluated the gait and balance features of 10 PD patients, before and (three days and one month) after the tDCS. To assess patients’ abilities, we adopted six motor tasks, obtaining 72 meaningful motor features. According to the obtained results, wearable electronics demonstrated to be a valuable tool to measure the treatment response. Meanwhile the improvements from tDCS on gait and balance abilities of PD patients demonstrated to be generally partial and selective.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Wearable Electronics Assess the Effectiveness of Transcranial Direct Current Stimulation on Balance and Gait in Parkinson’s Disease Patients

Ricci

Lazzaro

Pisani

et al. 2019

Sensors

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“…To the present date, clinical studies on tDCS to treat PD symptoms have focused on two stimulation sites: primary motor cortex (M1) and dorsolateral prefrontal cortex (DLPFC). These studies have reported that anodal tDCS of M1 improves PD motor symptoms (Fregni et al, 2006 ; Benninger et al, 2010 ; Kaski et al, 2014a , b ; Valentino et al, 2014 ; Yotnuengnit et al, 2018 ), while anodal stimulation of DLPFC improves cognitive and executive functions (Boggio et al, 2006 ; Pereira et al, 2013 ; Doruk et al, 2014 ; Manenti et al, 2016 ). Since PD patients have concurrent motor and cognitive impairments, a tDCS protocol that can alleviate both types of symptoms would be an important alternative for PD therapy.…”

Section: Introductionmentioning

confidence: 99%

Effects of Transcranial Direct Current Stimulation (tDCS) Over the Frontal Polar Area on Motor and Executive Functions in Parkinson’s Disease; A Pilot Study

Ishikuro

Dougu

Nukui

et al. 2018

Front. Aging Neurosci.

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Parkinson’s disease (PD) is a neurodegenerative disorder with motor and non-motor symptoms due to degeneration of dopaminergic neurons. The current pharmacological treatments induce complications associated with long-term use. However, current stimulation techniques for PD treatment, such as deep brain stimulation (DBS), are too invasive. In this context, non-invasive brain stimulation including transcranial direct current stimulation (tDCS) may be a safe and effective alternative treatment for PD. We previously reported that anodal tDCS over the frontal polar area (FPA) improved motor functions in heathy subjects. Therefore, in the present study, effects of tDCS over the FPA on motor and cognitive functions of PD patients were analyzed. Nine PD patients (3 men and 6 women) participated in this cross over study with three tDCS protocols; anodal, cathodal or sham tDCS over the FPA. Each tDCS protocol was applied for 1 week (5 times/week). Before and after each protocol, motor and cognitive functions of the patients were assessed using Unified PD Rating Scale [UPDRS (part III: motor examination)], Fugl Meyer Assessment set (FMA), Simple Test for Evaluating hand Function (STEF) and Trail Making Test A (TMT-A). The results indicated that anodal stimulation significantly decreased scores of motor disability in UPDRS-III compared with sham and cathodal stimulation, and significantly increased scores of motor functions in FMA compared with sham stimulation. Furthermore, anodal stimulation significantly decreased time to complete a motor task requiring high dexterity in STEF compared with those requiring low and medium levels of dexterity. In addition, anodal stimulation significantly decreased time to complete the TMT-A task, which requires executive functions, compared with sham stimulation. To the best of our knowledge, this is the first clinical research reporting that tDCS over the FPA successfully improved the motor and non-motor functions in PD patients. These findings suggest that tDCS over the FPA might be a useful alternative for the treatment of PD patients.

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“…Anodal tDCS may also induce dopamine release in the basal ganglia by the activation of glutamatergic corticostriatal fibers (Siebner et al, 1999;Fregni et al, 2006;Valentino et al, 2014). Studies have been done by targeting either the motor cortex (M1, 1-2 mA, 13-30 min) (Verheyden et al, 2013;Kaski et al, 2014b;Mak and Yu, 2014;Valentino et al, 2014;Costa-Ribeiro et al, 2016Schabrun et al, 2016;Fernandez-Lago et al, 2017;da Silva et al, 2018;Yotnuengnit et al, 2018) or the dorsolateral prefrontal cortex (DLPFC, 2 mA, 7-20 min) (Manenti et al, 2014;Lattari et al, 2017). At post-stimulation, a short-term benefit in gait was noted in most of these studies.…”

Section: Transcranial Direct Current Stimulation Idiopathic Parkinsonmentioning

confidence: 99%

Non-invasive Transcranial Electrical Stimulation in Movement Disorders

et al. 2020

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Dysfunction within large-scale brain networks as the basis for movement disorders is an accepted hypothesis. The treatment options for restoring network function are limited. Non-invasive brain stimulation techniques such as repetitive transcranial magnetic stimulation are now being studied to modify the network. Transcranial electrical stimulation (tES) is also a portable, cost-effective, and non-invasive way of network modulation. Transcranial direct current stimulation and transcranial alternating current stimulation have been studied in Parkinson's disease, dystonia, tremor, and ataxia. Transcranial pulsed current stimulation and transcranial random noise stimulation are not yet studied enough. The literature in the use of these techniques is intriguing, yet many unanswered questions remain. In this review, we highlight the studies using these four potential tES techniques and their electrophysiological basis and consider the therapeutic implication in the field of movement disorders. The objectives are to consolidate the current literature, demonstrate that these methods are feasible, and encourage the application of such techniques in the near future. Keywords: non-invasive brain stimulation (NIBS), transcranial electrical stimulation (tES), transcranial direct current stimulation (tDCS), transcranial alternating current stimulation (tACS), transcranial pulsed current stimulation (tPCS), transcranial random noise stimulation (tRNS)

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Effects of Transcranial Direct Current Stimulation Plus Physical Therapy on Gait in Patients With Parkinson Disease

Abstract: Anodal tDCS or physical therapy could be used alone or together as a combination treatment to improve the walking speed of patients with Parkinson disease. The effects lasted for approximately 8 wks. The combination treatment was not superior to the use of tDCS or physical therapy alone.

Cited by 35 publications

References 28 publications

Wearable Electronics Assess the Effectiveness of Transcranial Direct Current Stimulation on Balance and Gait in Parkinson’s Disease Patients

Wearable Electronics Assess the Effectiveness of Transcranial Direct Current Stimulation on Balance and Gait in Parkinson’s Disease Patients

Effects of Transcranial Direct Current Stimulation (tDCS) Over the Frontal Polar Area on Motor and Executive Functions in Parkinson’s Disease; A Pilot Study

Non-invasive Transcranial Electrical Stimulation in Movement Disorders

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