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

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.

Download Full-text

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

Neurological Research ◽

10.1080/01616412.2017.1371473 ◽

2017 ◽

Vol 39 (12) ◽

pp. 1037-1043 ◽

Cited By ~ 13

Author(s):

Suellen Marinho Andrade ◽

José Jamacy de Almeida Ferreira ◽

Thatiana Silva Rufino ◽

Germana Medeiros ◽

Jader Duarte Brito ◽

...

Keyword(s):

Direct Current ◽

Transcranial Direct Current Stimulation ◽

Lower Limb ◽

Limb Function ◽

Direct Current Stimulation ◽

Risk Of Falls ◽

Lower Limb Function

Download Full-text

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 ◽

◽

...

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

Download Full-text

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.

Download Full-text

Transcranial Direct Current Stimulation for the Treatment of Refractory Symptoms of Schizophrenia. Current Evidence and Future Directions

Current Pharmaceutical Design ◽

10.2174/1381612821666150619093648 ◽

2015 ◽

Vol 21 (23) ◽

pp. 3373-3383 ◽

Cited By ~ 39

Author(s):

Marine Mondino ◽

Jerome Brunelin ◽

Ulrich Palm ◽

Andre Brunoni ◽

Emmanuel Poulet ◽

...

Keyword(s):

Direct Current ◽

Transcranial Direct Current Stimulation ◽

Current Evidence ◽

Future Directions ◽

Direct Current Stimulation ◽

Refractory Symptoms

Download Full-text

Exploring the neural, behavioural, and clinical effects of transcranial direct current stimulation in patients with a Prolonged Disorder of Consciousness; protocol for a double-blind randomised crossover feasibility study

10.21203/rs.3.rs-15515/v1 ◽

2020 ◽

Author(s):

Davinia Fernández-Espejo ◽

Davide Aloi ◽

Antonio Incisa della Rocchetta ◽

Damon Hoad ◽

Richard Greenwood ◽

...

Keyword(s):

Individual Differences ◽

Feasibility Study ◽

Direct Current ◽

Transcranial Direct Current Stimulation ◽

Brain Activity ◽

Brain Structures ◽

Clinical Effects ◽

Disorder Of Consciousness ◽

Double Blind ◽

Direct Current Stimulation

Abstract Background: Therapeutic options for patients with prolonged disorders of consciousness (PDOC) are very limited, and patients often show little to no progress over time. It is widely recognized that some PDOC patients retain a higher level of cognition that may be apparent on the basis of their external responses, and simply are unable to produce purposeful motor behaviours. This dissociation has been linked to specific impairments in the motor network that lead to a reduction in thalamo-cortical coupling. Here, we will assess whether transcranial direct current stimulation (tDCS) can modulate thalamo-cortical coupling and improve patients’ responsiveness. We will focus on characterising the mechanisms of action of tDCS and the bases for potential individual differences in responsiveness to the stimulation across participants.Methods: This is a multi-centre double-blind randomised crossover feasibility study. It is divided into two streams: (a) MRI stream: 5 PDOC patients will complete 5 anodal, cathodal, and sham stimulation sessions (paired with passive mobilisation of the thumb) in separate weeks. We will measure brain activity and connectivity with functional magnetic resonance imaging and electroencephalography (EEG). We will look at brain structures to assess differences associated with responsiveness. (b) Bedside stream: 10 patients will complete one session of anodal or cathodal stimulation and one session of sham. We will measure brain activity and connectivity with EEG and we will conduct follow up assessments at 3 and 6 months. In both streams we will also look at changes in the clinical profile of patients with the Coma Recovery Scale Revised and in command following behaviour with electromyography and motion tracking. We will assess feasibility on measures of eligibility, recruitment, retention, and completion of tests.Discussion: This feasibility study is the first step towards developing personalised tDCS interventions to restore external responsiveness in PDOC patients. Our results will inform the design of a future trial fully powered for characterising neural, behavioural, and clinical effects of tDCS in PDOC as well as the mechanisms underlying individual differences in responsiveness.

Download Full-text

The effects of transcranial direct current stimulation on objective and subjective indexes of exercise performance: a systematic review and meta-analysis.

10.31236/osf.io/e2buc ◽

2018 ◽

Author(s):

Darias Holgado ◽

Miguel A. Vadillo ◽

Daniel Sanabria

Keyword(s):

Systematic Review ◽

Direct Current ◽

Exercise Performance ◽

Transcranial Direct Current Stimulation ◽

Perceived Exertion ◽

Effect Sizes ◽

Electrode Placement ◽

Current Evidence ◽

Time To Exhaustion ◽

Direct Current Stimulation

Objective: To examine the effectss of transcranial direct current stimulation (tDCS) on objective and subjective indexes of exercise performance.Design: Systematic review and meta-analysis.Data Sources: A systematic literature search of electronic databases (PubMed, Web of Science, Scopus, Google Scholar) and reference lists of included articles up to June 2018.Eligibility Criteria: Published articles in journals or in repositories with raw data available, randomized sham-controlled trial comparing anodal stimulation with a sham condition providing data on objective (e.g. time to exhaustion or time-trial performance) or subjective (e.g. rate of perceived exertion) indexes of exercise performance.Results: The initial search provided 420 articles of which 31 were assessed for eligibility. Finally, the analysis of effect sizes comprised 24 studies with 386 participants. The analysis indicated that anodal tDCS had a small but positive effect on performance g = 0.34, 95% CI [0.12, 0.52], z = 3.24, p = 0.0012. Effects were not significantly moderated by type of outcome, electrode placement, muscles involved, number of sessions, or intensity and duration of the stimulation. Importantly, the funnel plot showed that, overall, effect sizes tended to be larger in studies with lower sample size and high standard error. Summary: The results suggest that tDCS may have a positive impact on exercise performance. However, the effect is probably small and most likely biased by low quality studies and the selective publication of significant results. Therefore, the current evidence does not provide strong support to the conclusion that tDCS is an effective means to improve exercise performance.

Download Full-text