Daniel Leon1,2,3, Mar Cortes4,5,6, Jessica Elder7, Hatice Kumru1,2,3, Sara Laxe1,2,3, Dylan James Edwards8,9,10, Josep Maria Tormos1,2,3, Montserrat Bernabeu1,2,3, Alvaro Pascual-Leone1,11. 1. Fundación Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona -Barcelona, Spain. 2. Univ Autonoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain. 3. Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain. 4. Human Spinal Cord Injury Laboratory, Burke Medical Research Institute, White Plains, NY, USA. 5. Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, NY, USA. 6. Universitat de Barcelona, Gran Via de les Corts Catalanes, Barcelona, Spain. 7. Department of Biostatistics and Epidemiology, Weill Cornell Medicine, New York, NY, USA. 8. Brain Stimulation and Robotics Laboratory, Burke Medical Research Institute, White Plains, NY, USA. 9. Department of Neurology, Weill Cornell Medicine, New York, NY, USA. 10. School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia. 11. Berenson-Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Abstract
BACKGROUND:Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique, which can modulate cortical excitability and combined with rehabilitation therapies may improve motor recovery after stroke. OBJECTIVE: Our aim was to study the feasibility of a 4-week robotic gait training protocol combined with tDCS, and to study tDCS to the leg versus hand motor cortex or sham to improve walking ability in patients after a subacute stroke. METHODS:Forty-nine subacute stroke patients underwent 20 daily sessions (5 days a week for 4 weeks) of robotic gait training combined with tDCS. Patients were assigned either to the tDCSleg group (n = 9), receiving 2 mA anodal tDCS over the motor cortex leg representation (vertex), or an active control group (n = 17) receiving anodal tDCS over the hand motor cortex area (tDCShand). In addition, we studied 23 matched patients in acontrol group receiving gait training without tDCS (notDCS). Study outcomes included gait speed (10-meter walking test), and quality of gait, using the Functional Ambulatory Category (FAC) before and after the 4-week training period. RESULTS: Only one patient did not complete the treatment because he presented a minor side-effect. Patients in all three groups showed a significantly improvement in gait speed and FAC. The tDCSleg group did not perform better than the tDCShand or notDCS group. CONCLUSION: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.
RCT Entities:
BACKGROUND: Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique, which can modulate cortical excitability and combined with rehabilitation therapies may improve motor recovery after stroke. OBJECTIVE: Our aim was to study the feasibility of a 4-week robotic gait training protocol combined with tDCS, and to study tDCS to the leg versus hand motor cortex or sham to improve walking ability in patients after a subacute stroke. METHODS: Forty-nine subacute strokepatients underwent 20 daily sessions (5 days a week for 4 weeks) of robotic gait training combined with tDCS. Patients were assigned either to the tDCSleg group (n = 9), receiving 2 mA anodal tDCS over the motor cortex leg representation (vertex), or an active control group (n = 17) receiving anodal tDCS over the hand motor cortex area (tDCShand). In addition, we studied 23 matched patients in a control group receiving gait training without tDCS (notDCS). Study outcomes included gait speed (10-meter walking test), and quality of gait, using the Functional Ambulatory Category (FAC) before and after the 4-week training period. RESULTS: Only one patient did not complete the treatment because he presented a minor side-effect. Patients in all three groups showed a significantly improvement in gait speed and FAC. The tDCSleg group did not perform better than the tDCShand or notDCS group. CONCLUSION: Combined tDCS and robotic training is a safe and feasible procedure in subacute strokepatients. However, adding tDCS to robot-assisted gait training shows no benefit over robotic gait training alone.
Entities:
Keywords:
Robot-assisted gait training; subacute stroke; transcranial direct current stimulation
Authors: Orna Rosenthal; Alan M Wing; Jeremy L Wyatt; David Punt; Briony Brownless; Chit Ko-Ko; R Christopher Miall Journal: J Neuroeng Rehabil Date: 2019-03-20 Impact factor: 4.262
Authors: Rubén Hernández de Paz; Diego Serrano-Muñoz; Soraya Pérez-Nombela; Elisabeth Bravo-Esteban; Juan Avendaño-Coy; Julio Gómez-Soriano Journal: J Neuroeng Rehabil Date: 2019-09-14 Impact factor: 4.262