tDCS does not enhance the effects of robot-assisted gait training in patients with subacute stroke

Article type: Research Article

Authors: Leon, Daniel^{a; b; c; *} | Cortes, Mar^{d; e; f} | Elder, Jessica^g | Kumru, Hatice^{a; b; c} | Laxe, Sara^{a; b; c} | Edwards, Dylan James^{h; i; k} | Tormos, Josep Maria^{a; b; c} | Bernabeu, Montserrat^{a; b; c} | Pascual-leone, Alvaro^{a; j}

Affiliations: [a] Fundación Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona –Barcelona, Spain | [b] Univ Autonoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain | [c] Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain | [d] Human Spinal Cord Injury Laboratory, Burke Medical Research Institute, White Plains, NY, USA | [e] Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, NY, USA | [f] Universitat de Barcelona, Gran Via de les Corts Catalanes, Barcelona, Spain | [g] Department of Biostatistics and Epidemiology, Weill Cornell Medicine, New York, NY, USA | [h] Brain Stimulation and Robotics Laboratory, Burke Medical Research Institute, White Plains, NY, USA | [i] Department of Neurology, Weill Cornell Medicine, New York, NY, USA | [j] Berenson-Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA | [k] School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia

Correspondence: [*] Corresponding author: Daniel Leon, Institut Guttmann, Institut Universitari de Neurorehabilitació adscript a la UAB, Barcelona, Spain, Camí de Can Rutí s/n, 08916 Badalona. Spain. Tel.: +34 93 497 77 00; Fax: +34 93 497 77 07; E-mail: [email protected].

Abstract: Background:Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique, which can modulate cortical excitability and combined with rehabilitation therapies may improve motor recovery after stroke. Objective:Our aim was to study the feasibility of a 4-week robotic gait training protocol combined with tDCS, and to study tDCS to the leg versus hand motor cortex or sham to improve walking ability in patients after a subacute stroke. Methods:Forty-nine subacute stroke patients underwent 20 daily sessions (5 days a week for 4 weeks) of robotic gait training combined with tDCS. Patients were assigned either to the tDCSleg group (n = 9), receiving 2 mA anodal tDCS over the motor cortex leg representation (vertex), or an active control group (n = 17) receiving anodal tDCS over the hand motor cortex area (tDCShand). In addition, we studied 23 matched patients in a control group receiving gait training without tDCS (notDCS). Study outcomes included gait speed (10-meter walking test), and quality of gait, using the Functional Ambulatory Category (FAC) before and after the 4-week training period. Results:Only one patient did not complete the treatment because he presented a minor side-effect. Patients in all three groups showed a significantly improvement in gait speed and FAC. The tDCSleg group did not perform better than the tDCShand or notDCS group. Conclusion:Combined tDCS and robotic training is a safe and feasible procedure in subacute stroke patients. However, adding tDCS to robot-assisted gait training shows no benefit over robotic gait training alone.

Keywords: Robot-assisted gait training, subacute stroke, transcranial direct current stimulation

DOI: 10.3233/RNN-170734

Journal: Restorative Neurology and Neuroscience, vol. 35, no. 4, pp. 377-384, 2017