The Effect of Motor Imaginary Combined with Transcranial Direct Current Stimulation (tDCS) on Balance in Middle-Aged Women with High Fall Risk: A Double-Blind Randomized Controlled Trial

Abstract

Introduction. The risk of falling and its subsequent injuries increases with aging. Impaired balance and gait are important contributing factors to the increased risk of falling. A wide range of methods was examined to improve balance, but these interventions might produce small effects or be inapplicable for this population. The current study aimed at investigating the effect of motor imaginary (MI) training combined with transcranial direct current stimulation (tDCS) over the cerebellum on balance in middle-aged women with high fall risk. Methods. Thirty subjects aged 40-65 years old were divided into two groups including intervention ( n = 15 ) and sham control ( n = 15 ). The participants completed a 4-week program 3 times per week. The intervention group performed MI training combined with tDCS over the cerebellum, and the control group performed MI training combined with sham tDCS over the cerebellum. Static and dynamic balance were measured at baseline and after completing the 4-week program using balance error scoring system (BESS) and Y balance testing, respectively. Result. A one-way analysis of covariance and paired t -tests were used to analyze the data. Significant improvement was observed in both balance tests in the intervention group after the implementation of the 4-week intervention program compared to the control group. The within-group analysis showed that both static and dynamic balance improved significantly from the baseline values only in the intervention group ( p < 0.05 ) and not in the control group ( p > 0.05 ). Conclusion. The results of the study indicate that MI training combined with tDCS over the cerebellum can lead to balance improvement in middle-aged women with high fall risk.

Non-invasive neuromodulation in reducing the risk of falls and fear of falling in community-dwelling older adults: systematic review

“…One study showed ( Ouzzani et al, 2016 ; Mozafaripour et al, 2023 ) that were significant improvement in both balance tests in the intervention group after intervention compared to the control group. Both static and dynamic balance improved significantly from the baseline values only in the intervention group and not in the control group.…”

“…The evidence from tDCS, the articles point out that from two to six sessions, positive effects are observed on postural balance and indirectly on the fall risk of the older adults ( Ehsani et al, 2017 ; Yosephi et al, 2018 ; Baharlouei et al, 2020 ; Schneider et al, 2021 ; Lo et al, 2023 ; Mozafaripour et al, 2023 ; Sayig-Keren et al, 2023 ). These are satisfactory evidence, as interventions directed at the musculoskeletal system indicate that 12 to 20 weeks of balance training are needed to reduce the fear of falling and improve dynamic balance indices in older adults at high risk of falling ( Judge et al, 1993 ; Lord and Castell, 1994 ; Gusi et al, 2012 ).…”

Age-Related Dysfunction in Balance: A Comprehensive Review of Causes, Consequences, and Interventions

“…The cerebellum receives input from various sensory systems and proprioceptive information from muscles and joints. It integrates this information to create a comprehensive representation of the position of body and movement in space [54]. Impotently, the cerebellum acts as a feedback control system.…”

Analysis of Cortico-Muscular Coupling and Functional Brain Network under Different Standing Balance Paradigms

“…Standing balance refers to the ability of the human body to automatically adjust and maintain a stable posture in a resting state. A degeneration of the musculoskeletal system, as well as neurological damage from stroke, can affect an individual's ability to balance [1,2]. Maintaining standing balance is a complex physiological process that involves the coordinated work of the nervous system, musculoskeletal system, and sensory system.…”