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Combining physical training with transcranial direct current stimulation to improve gait in Parkinson's disease: a pilot randomized controlled study

Kaski, D; Dominguez, RO; Allum, JH; Islam, AF; Bronstein, AM; (2014) Combining physical training with transcranial direct current stimulation to improve gait in Parkinson's disease: a pilot randomized controlled study. Clinical Rehabilitation , 28 (11) pp. 1115-1124. 10.1177/0269215514534277. Green open access

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Abstract

OBJECTIVE: To improve gait and balance in patients with Parkinson's disease by combining anodal transcranial direct current stimulation with physical training. DESIGN: In a double-blind design, one group (physical training; n = 8) underwent gait and balance training during transcranial direct current stimulation (tDCS; real/sham). Real stimulation consisted of 15 minutes of 2 mA transcranial direct current stimulation over primary motor and premotor cortex. For sham, the current was switched off after 30 seconds. Patients received the opposite stimulation (sham/real) with physical training one week later; the second group (No physical training; n = 8) received stimulation (real/sham) but no training, and also repeated a sequential transcranial direct current stimulation session one week later (sham/real). SETTING: Hospital Srio Libanes, Buenos Aires, Argentina. SUBJECTS: Sixteen community-dwelling patients with Parkinson's disease. INTERVENTIONS: Transcranial direct current stimulation with and without concomitant physical training. MAIN MEASURES: Gait velocity (primary gait outcome), stride length, timed 6-minute walk test, Timed Up and Go Test (secondary outcomes), and performance on the pull test (primary balance outcome). RESULTS: Transcranial direct current stimulation with physical training increased gait velocity (mean = 29.5%, SD = 13; p < 0.01) and improved balance (pull test: mean = 50.9%, SD = 37; p = 0.01) compared with transcranial direct current stimulation alone. There was no isolated benefit of transcranial direct current stimulation alone. Although physical training improved gait velocity (mean = 15.5%, SD = 12.3; p = 0.03), these effects were comparatively less than with combined tDCS + physical therapy (p < 0.025). Greater stimulation-related improvements were seen in patients with more advanced disease. CONCLUSIONS: Anodal transcranial direct current stimulation during physical training improves gait and balance in patients with Parkinson's disease. Power calculations revealed that 14 patients per treatment arm (α = 0.05; power = 0.8) are required for a definitive trial.

Type: Article
Title: Combining physical training with transcranial direct current stimulation to improve gait in Parkinson's disease: a pilot randomized controlled study
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1177/0269215514534277
Publisher version: http://dx.doi.org/10.1177/0269215514534277
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Cerebral cortex, Parkinson’s disease, electrical stimulation therapy, exercise therapy, gait, Aged, Combined Modality Therapy, Double-Blind Method, Exercise Therapy, Female, Follow-Up Studies, Gait, Gait Disorders, Neurologic, Humans, Male, Middle Aged, Parkinson Disease, Pilot Projects, Postural Balance, Recovery of Function, Severity of Illness Index, Transcranial Direct Current Stimulation, Treatment Outcome
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology > IoN Central Administration
URI: https://discovery.ucl.ac.uk/id/eprint/1553267
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