Effects of different montages of transcranial direct current stimulation on the risk of falls and lower limb function after stroke

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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The effect of Transcranial direct current stimulation (tDCS) on the lower limb function with & without Step exercise in chronic stroke patients: a randomized control clinical trial

Koomesh journal ◽

10.52547/koomesh.23.3.320 ◽

2021 ◽

Vol 23 (3) ◽

pp. 320-326

Author(s):

Roghayeh Mohammadi ◽

Sajjad Ramezani ◽

Mohammadreza Mohammadi ◽

Elham Fatemi ◽

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...

Keyword(s):

Clinical Trial ◽

Direct Current ◽

Transcranial Direct Current Stimulation ◽

Lower Limb ◽

Control Clinical Trial ◽

Chronic Stroke ◽

Stroke Patients ◽

Direct Current Stimulation ◽

Randomized Control ◽

Lower Limb Function

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Transcranial direct current stimulation combined with robotic therapy for upper and lower limb function after stroke: a systematic review and meta-analysis of randomized control trials

Journal of NeuroEngineering and Rehabilitation ◽

10.1186/s12984-021-00941-0 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Natalia Comino-Suárez ◽

Juan C. Moreno ◽

Julio Gómez-Soriano ◽

Álvaro Megía-García ◽

Diego Serrano-Muñoz ◽

...

Keyword(s):

Systematic Review ◽

Upper Limb ◽

Direct Current ◽

Transcranial Direct Current Stimulation ◽

Lower Limb ◽

Functional Independence ◽

Limb Function ◽

Robotic Therapy ◽

Upper Limb Function ◽

Lower Limb Function

Abstract Background Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation method able to modulate neuronal activity after stroke. The aim of this systematic review was to determine if tDCS combined with robotic therapy (RT) improves limb function after stroke when compared to RT alone. Methods A search for randomized controlled trials (RCTs) published prior to July 15, 2021 was performed. The main outcome was function assessed with the Fugl-Meyer motor assessment for upper extremities (FM/ue) and 10-m walking test (10MWT) for the lower limbs. As secondary outcomes, strength was assessed with the Motricity Index (MI) or Medical Research Council scale (MRC), spasticity with the modified Ashworth scale (MAS), functional independence with the Barthel Index (BI), and kinematic parameters. Results Ten studies were included for analysis (n = 368 enrolled participants). The results showed a non-significant effect for tDCS combined with RT to improve upper limb function [standardized mean difference (SMD) = − 0.12; 95% confidence interval (CI): − 0.35–0.11)]. However, a positive effect of the combined therapy was observed in the lower limb function (SMD = 0.48; 95% CI: − 0.15–1.12). Significant results favouring tDCS combined with RT were not found in strength (SMD = − 0.15; 95% CI: − 0.4–0.1), spasticity [mean difference (MD) = − 0.15; 95% CI: − 0.8–0.5)], functional independence (MD = 2.5; 95% CI: − 1.9–6.9) or velocity of movement (SMD = 0.06; 95% CI: − 0.3–0.5) with a “moderate” or “low” recommendation level according to the GRADE guidelines. Conclusions Current findings suggest that tDCS combined with RT does not improve upper limb function, strength, spasticity, functional independence or velocity of movement after stroke. However, tDCS may enhance the effects of RT alone for lower limb function. tDCS parameters and the stage or type of stroke injury could be crucial factors that determine the effectiveness of this therapy.

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Inhibitory Transcranial Direct Current Stimulation Enhances Weak Beta Event-Related Synchronization After Foot Motor Imagery in Patients With Lower Limb Amputation

Journal of Clinical Neurophysiology ◽

10.1097/wnp.0000000000000123 ◽

2015 ◽

Vol 32 (1) ◽

pp. 44-50 ◽

Cited By ~ 5

Author(s):

Naoyuki Takeuchi ◽

Takayuki Mori ◽

Kazunori Nishijima ◽

Takeo Kondo ◽

Shin-Ichi Izumi

Keyword(s):

Motor Imagery ◽

Direct Current ◽

Transcranial Direct Current Stimulation ◽

Lower Limb ◽

Lower Limb Amputation ◽

Limb Amputation ◽

Direct Current Stimulation

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Transcranial direct current stimulation for motor recovery of upper limb function after stroke

Neuroscience & Biobehavioral Reviews ◽

10.1016/j.neubiorev.2014.07.022 ◽

2014 ◽

Vol 47 ◽

pp. 245-259 ◽

Cited By ~ 34

Author(s):

Jitka Lüdemann-Podubecká ◽

Kathrin Bösl ◽

Sandra Rothhardt ◽

Geert Verheyden ◽

Dennis Alexander Nowak

Keyword(s):

Upper Limb ◽

Direct Current ◽

Transcranial Direct Current Stimulation ◽

Motor Recovery ◽

Limb Function ◽

Direct Current Stimulation ◽

Upper Limb Function

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Comparison of Transcranial Direct Current Stimulation Electrode Montages for the Lower Limb Motor Cortex

Brain Sciences ◽

10.3390/brainsci9080189 ◽

2019 ◽

Vol 9 (8) ◽

pp. 189 ◽

Cited By ~ 3

Author(s):

Radhika Patel ◽

Sangeetha Madhavan

Keyword(s):

Motor Control ◽

Direct Current ◽

Transcranial Direct Current Stimulation ◽

Lower Limb ◽

Target Location ◽

Motor Behavior ◽

Tibialis Anterior Muscle ◽

Target Area ◽

Corticomotor Excitability ◽

Direct Current Stimulation

Transcranial direct current stimulation (tDCS) has been widely explored as a neuromodulatory adjunct to modulate corticomotor excitability and improve motor behavior. However, issues with the effectiveness of tDCS have led to the exploration of empirical and experimental alternate electrode placements to enhance neuromodulatory effects. Here, we conducted a preliminary study to compare a novel electrode montage (which involved placing 13 cm2 electrodes anterior and posterior to the target location) to the traditionally used electrode montage (13 cm2 stimulating electrode over the target area and the 35 cm2 reference electrode over the contralateral orbit). We examined the effects of tDCS of the lower limb motor area (M1) by measuring the corticomotor excitability (CME) of the tibialis anterior muscle using transcranial magnetic stimulation in twenty healthy participants. We examined behavioral effects using a skilled motor control task performed with the ankle. We did not find one electrode montage to be superior to the other for changes in the CME or motor control. When the group was dichotomized into responders and non-responders (based on upregulation in CME), we found that the responders showed significant upregulation from baseline after tDCS for both montages. However, only the responders in the traditional montage group showed significant changes in motor control after tDCS. These results do not support the superiority of the new anterior–posterior montage over the traditional montage. Further work with a larger cohort and multiple cumulative sessions may be necessary to confirm our results.

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Combining transcranial direct current stimulation with aerobic exercise to optimize cortical priming in stroke

Applied Physiology Nutrition and Metabolism ◽

10.1139/apnm-2020-0677 ◽

2020 ◽

Author(s):

Anjali Sivaramakrishnan ◽

Sangeetha Madhavan

Keyword(s):

Reaction Time ◽

Aerobic Exercise ◽

Direct Current ◽

Transcranial Direct Current Stimulation ◽

Lower Limb ◽

Synergistic Effects ◽

Short Interval ◽

Moderate Intensity ◽

Direct Current Stimulation ◽

Transcallosal Inhibition

Aerobic exercise (AE) and transcranial direct current stimulation (tDCS) are priming techniques that have been studied for their potential neuromodulatory effects on corticomotor excitability (CME), however the synergistic effects of AE and tDCS are not explored in stroke. Here we investigated the synergistic effects of AE and tDCS on CME, intracortical and transcallosal inhibition, and motor control for the lower limb in stroke. 26 stroke survivors participated in three sessions - tDCS, AE and AE + tDCS. AE included moderate intensity exercise and tDCS included 1 mA of anodal tDCS to the lower limb motor cortex with or without AE. Outcomes included measures of CME, short interval intracortical inhibition (SICI), ipsilateral silent period (iSP) (an index of transcallosal inhibition) for the tibialis anterior and ankle reaction time. Ipsilesional CME significantly decreased for AE compared to AE + tDCS and tDCS. No differences were noted in SICI, iSP measures or reaction time between all three sessions. Our findings suggest that a combination of exercise and tDCS, and tDCS demonstrate greater excitability of the ipsilesional hemisphere compared to exercise only, however these effects were specific to the descending corticomotor pathways. No additive priming effects of exercise and tDCS over tDCS was observed. Novelty: • An exercise and tDCS paradigm upregulated the descending motor pathways from the ipsilesional lower limb M1 compared to exercise. • Exercise or tDCS administered alone or in combination did not affect intracortical or transcallosal inhibition or reaction time.

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