Abstract #21: Combining Multisession Transcranial Direct Current Stimulation with Physical Activity to improve Gait and Balance in people with Multiple Sclerosis

Asymmetrical lower limb strength is a significant contributor to impaired walking abilities in people with multiple sclerosis (PwMS). Transcranial direct current stimulation (tDCS) may be an effective technique to enhance cortical excitability and increase neural drive to more-affected lower limbs. A sham-controlled, randomized, cross-over design was employed. Two women with MS underwent two 20 min sessions of either 3 mA tDCS or Sham before 20 min of treadmill walking at a self-selected speed. During walking, the participants were injected with the glucose analogue, [18F] fluorodeoxyglucose (FDG). Participants were then imaged to examine glucose metabolism and uptake asymmetries in the legs. Standardized uptake values (SUVs) were compared between the legs and asymmetry indices were calculated. Subject 2 was considered physically active (self-reported participating in at least 30 min of moderate-intensity physical activity on at least three days of the week for the last three months), while Subject 1 was physically inactive. In Subject 1, there was a decrease in SUVs at the left knee flexors, left upper leg, left and right plantar flexors, and left and right lower legs and SUVs in the knee extensors and dorsiflexors were considered symmetric after tDCS compared to Sham. Subject 2 showed an increase in SUVs at the left and right upper legs, right plantar flexors, and right lower leg with no muscle group changing asymmetry status. This study demonstrates that tDCS may increase neural drive to leg muscles and decrease glucose uptake during walking in PwMS with low physical activity levels.

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The Effect of Transcranial Direct Current Stimulation and Core Stability Training on the Balance and Disability of Patients With Multiple Sclerosis

Physical Treatments - Specific Physical Therapy ◽

10.32598/ptj.11.3.477.1 ◽

2021 ◽

Vol 11 (3) ◽

pp. 189-198

Author(s):

Soudabeh Raeisi ◽

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Seyed Kazem Mousavi Sadati ◽

Mojtaba Azimian ◽

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...

Keyword(s):

Multiple Sclerosis ◽

Postural Control ◽

Direct Current ◽

Vestibular System ◽

Transcranial Direct Current Stimulation ◽

Core Stability ◽

Direct Current Stimulation ◽

Cerebellar Tdcs ◽

Stability Training ◽

Sensory Condition

Purpose: Physicians report balance disorders and fatigue as the symptoms of Multiple Sclerosis (MS) disease. The present study compares the effect of transcranial Direct Current Stimulation (tDCS) and core stability training on the balance and disability of patients with MS. Methods: This is a pre-test, post-test experiment study. The statistical population included all patients with MS who reffered to Rofaydeh Rehabilitation Hospital in Tehran City, Iran, in the winter of 2019. A total of 30 male and female patients aged 27-70 years were selected through available and purposive sampling methods and then randomly divided into experimental and control groups (each group 15 persons). The initial measurements of the participants’ kinetic variables of postural control were carried out by the posturography device, and afterward, Kurtzke Expanded Disability Status Scale (EDSS) was employed to measure disability. The participants’ training included core stability training for 8 weeks (30-40 min, 3 sessions per week) with 20 min online cerebellar transcranial direct current stimulation, 2 sessions per week (The first and third sessions). Then, the research variables were measured again. Results: The results demonstrated the significant influence of cerebellar tDCS on the variables of postural control equilibrium in the second sensory condition (P<0.001), third sensory condition (P<0.001), fourth sensory condition (P<0.001), fifth sensory condition (P=0.034), and combine equilibrium (P<0.001). Besides, the cerebellar current stimulation enhanced the sensory performance of the experimental group in using the vestibular system input data (P<0.001) and vision (P<0.001), but it had no significant effect on the ability to use somatosensory input (P=0.203) and vision preference (P=0.343). This research also revealed that the cerebellar current stimulation decreased EDSS in MS patients (P=0.026). Conclusion: The cerebellar tDCS has a beneficial effect on balance, EDSS, and modified fatigue impact scale in MS patients. The study findings also indicate that the cerebellum, vestibular system, and visual system are related, and they have an impact on balance, and cerebellar stimulation can facilitate learning motor skills.

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