Effects of Anodal Transcranial Direct Current Stimulation With Overground Gait Training on Lower Limb Performance in Individuals With Incomplete Spinal Cord Injury
Pipat Klamruen, Jatuporn Suttiwong, Benchaporn Aneksan, มณฑิชา ม่วงเงิน, Chanapass Denduang, Wanalee Klomjai*
Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, Thailand; Neuro Electrical Stimulation Laboratory (NeuE), Mahidol University, Nakhon Pathom, Thailand; Physical Therapy Unit, Sirindhorn National Medical Rehabilitation Institute, Nonthaburi, Thailand
Objective: To determine the effects of anodal transcranial direct current stimulation (tDCS) combined with overground gait training on gait performance, dynamic balance, sit-to-stand performance, and quality of life in individuals with incomplete spinal cord injuries (iSCI).
Design: Double-blind sham-controlled trial with a matched-pair design.
Setting: Sirindhorn National Medical Rehabilitation Institute, Thailand.
Participants: Individuals with iSCI (n=34) were allocated to the anodal or sham groups.
Intervention: Anodal tDCS was administered over the M1 lower-limb motor area at an intensity of 2 mA for 20 min in the anodal group, while the sham group received a 30-s stimulation. Both groups received 40 min of overground gait training after tDCS for 5 consecutive daily sessions.
Main outcome measures: The 10-meter walk test (10MWT) was the primary outcome, while spatiotemporal gait parameters, the timed Up and Go test, Five-Time Sit-to-Stand Test, and World Health Organization Quality of Life-BREF were secondary outcomes. Outcomes were assessed at baseline, post-intervention, and at 1-month (1M) and 2-month (2M) follow-ups.
Result: Improvements in walking speed measured using the 10MWT were observed in both groups. However, the anodal group showed a greater improvement than the sham group. For fast speed, the mean between-group differences were 0.10 m/s, 95% CI (0.02 to 0.17) (post-intervention), 0.11 m/s, (0.03 to 0.19) (1M), and 0.11 m/s, (0.03 to 0.20) (2M), while for self-selected speed, the median differences were 0.10 m/s, 95% CI (0.06 to 0.14) (post-intervention) and 0.09 m/s, (0.01 to 0.19) (2M). The anodal group also had a greater stride length difference post-intervention (median difference: 0.07 m, 95% CI (0.01 to 0.14)). No significant between-group differences were found for other outcomes.
Conclusion: Five-session of anodal tDCS with gait training slightly improved walking speed, sustained for 2 months post-intervention. However, effect on spatiotemporal gait parameters was limited and dynamic balance, functional tasks (ie, sit-to-stand), and quality of life were unaffected compared with overground gait training.
Archives of Physical Medicine Rehabilitation ปี 2566, November ปีที่: ฉบับที่ หน้า
Physical Therapy, Rehabilitation, Spinal cord injuries, Transcranial direct current stimulation, lower extremity