tDCS does not enhance the effects of robot-assisted gait training in patients with subacute stroke

León, Daniel; Cortes, Mar; Elder, Jessica; Kumru, Hatice; Laxe, Sara; Edwards, Dylan; Tormos, J.; Bernabeu, Montserrat; Pascual‐Leone, Álvaro

doi:10.3233/rnn-170734

Cited by 32 publications

(43 citation statements)

References 33 publications

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“…Weekly values for B) peak treadmill walking speed, C) distance walked, D) peak heart rate, and E) peak Borg 0-10 Rating of Perceived Exertion (RPE) are the average across the three training sessions within the respective week. Group mean ± SE is shown for stroke [42][43][44][45][46][47][48]. Some of these studies found that tDCS enhanced endurance when paired with robotic gait training [45] and enhanced walking speed when paired with body-weight-supported treadmill training [46].…”

Section: Discussionmentioning

confidence: 99%

“…Some of these studies found that tDCS enhanced endurance when paired with robotic gait training [45] and enhanced walking speed when paired with body-weight-supported treadmill training [46]. However, others found that tDCS paired with robotic gait training did not improve walking speed more than gait training alone [42][43][44][45]48]. Similarly, pairing tDCS with standard physical therapy did not enhance improvements in walking for acute or subacute stroke survivors [47,49,50].…”

Section: Discussionmentioning

confidence: 99%

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

Madhavan

Cleland

Sivaramakrishnan

et al. 2020

J NeuroEngineering Rehabil

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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.

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Section: Discussionmentioning

confidence: 99%

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

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“…For example, robotic assisted gait training combined with tDCS (1.5 mA, 7 min) delivered for 10 sessions over two weeks was found to have no additional effect compared to robotic gait training with sham tDCS [51]. Along similar lines, anodal tDCS (2 mA, 10 min) delivered for 20 sessions over four weeks combined with robotic training had no additional benefit over sham tDCS at improving gait speed or gait quality [52].…”

Section: Transcranial Direct Current Stimulation To Improve Lower Limmentioning

confidence: 91%

“…However, very few studies have investigated tDCS induced changes in impairment or activity-based measures directly related to gait or balance. Early evidence suggests that tDCS may have capacity to modify gait and balance outcomes in people with stroke [50,52], with these improvements likely to be more important for restoring mobility capacity and activities of daily living following stroke than highly sensitive assessments such as tracking error on an ankle tracing task.…”

Section: Quantifying Response To Tdcs Applicationmentioning

confidence: 99%

Transcranial Direct Current Stimulation to Facilitate Lower Limb Recovery Following Stroke: Current Evidence and Future Directions

Gowan

2020

Brain Sciences

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Stroke remains a global leading cause of disability. Novel treatment approaches are required to alleviate impairment and promote greater functional recovery. One potential candidate is transcranial direct current stimulation (tDCS), which is thought to non-invasively promote neuroplasticity within the human cortex by transiently altering the resting membrane potential of cortical neurons. To date, much work involving tDCS has focused on upper limb recovery following stroke. However, lower limb rehabilitation is important for regaining mobility, balance, and independence and could equally benefit from tDCS. The purpose of this review is to discuss tDCS as a technique to modulate brain activity and promote recovery of lower limb function following stroke. Preliminary evidence from both healthy adults and stroke survivors indicates that tDCS is a promising intervention to support recovery of lower limb function. Studies provide some indication of both behavioral and physiological changes in brain activity following tDCS. However, much work still remains to be performed to demonstrate the clinical potential of this neuromodulatory intervention. Future studies should consider treatment targets based on individual lesion characteristics, stage of recovery (acute vs. chronic), and residual white matter integrity while accounting for known determinants and biomarkers of tDCS response.

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“…Yet, other studies have not shown any additional improvement from tDCS (Hesse et al, 2011;Kim et al, 2014;Leon et al, 2017;Mazzoleni, Tran, Iardella, Dario, & Posteraro, 2017;Rossi, Sallustio, Di Legge, Stanzione, & Koch, 2013;Triccas et al, 2015). No group difference was revealed when bilateral movement therapy was combined with anodal, cathodal or sham tDCS in severe impaired subacute stroke patients (Hesse et al, 2011).…”

Section: Introductionmentioning

confidence: 96%

Effect of tDCS on Fine Motor Control of Patients in Subacute and Chronic Post-Stroke Stages

Pavlova

Semenov

Guekht

2019

Journal of Motor Behavior

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In this study we compared the effects of transcranial direct current stimulation (tDCS) in the subacute and chronic stages of post-stroke recovery. Anodal/sham tDCS was applied to the primary motor cortex of stroke patients in these stages of recovery in a cross-over design. The Jebsen-Taylor hand function test was employed. The repeated-measure ANOVA showed significant influence of the stimulation type and test performance time (during/after tDCS) with no overall influence of recovery stage. The interaction TYPE Ã TIME Ã STAGE was significant. The effect after anodal tDCS in the subacute stage was significantly higher compared to the effects in all relevant conditions including the chronic stage. Therefore, tDCS treatment in the subacute stage of recovery can be superior, at least for some patients, to treatment in the chronic stage.

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tDCS does not enhance the effects of robot-assisted gait training in patients with subacute stroke

Abstract: Combined tDCS and robotic training is a safe and feasible procedure in subacute stroke patients. However, adding tDCS to robot-assisted gait training shows no benefit over robotic gait training alone.

Cited by 32 publications

References 33 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

Transcranial Direct Current Stimulation to Facilitate Lower Limb Recovery Following Stroke: Current Evidence and Future Directions

Effect of tDCS on Fine Motor Control of Patients in Subacute and Chronic Post-Stroke Stages

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