Abstract
Patients with Parkinson's disease (PD) have difficulties while performing dual-task activities, a condition present in everyday life. It is possible that strategies such as transcranial Direct Current Stimulation (tDCS) can be associated with motor training enriched with dual-task training to improve the performance of two concurrent tasks. Currently, it is unclear whether specific tasks and clinical conditions of PD patients have different results after the intervention. Therefore, the proposed randomized controlled trial will examine task-dependency in enhancing the effects of tDCS-linked rehabilitation training on PD and the relationships between baseline outcomes in responders and non-responders to therapy. Fifty-six patients with Parkinson's disease will be recruited to participate in this controlled, double-blind randomized multicentric clinical trial. Patients in modified Hoehn & Yahr stage 1.5–3, age between 40 and 70 years will be included. Subjects will be randomly assigned to an experimental group (EG) and a control group (CG). The EG will perform treadmill gait training associated with dual task exercises+tDCS, while the CG will only engage in treadmill gait training+tDCS. Blinded testers will assess patients before and after 12 intervention sessions and after a 4-week follow-up period. All patients will undergo a screening and an initial visit before being assessed for primary and secondary outcomes. The primary outcome measure is functional mobility measured by Timed Up and Go Test. Secondary outcomes include cognitive function, participation, motor function and body function and structure. This study will evaluate the effectiveness of an intervention protocol with tDCS, dual-task training and gait training in patients with PD. The study will also highlight the clinical factors and variability between individuals that could interfere in the training of a specific task and influence the therapeutic effect.Clinical Trial registration: www.ClinicalTrials.gov, identifier NCT04581590.
Highlights
Parkinson’s disease (PD) is a neurodegenerative disorder that affects motor and cognitive function, especially when individuals are submitted to dual tasks (Cameron et al, 2010; Kelly et al, 2012)
Evidence shows the benefit of combined therapies to treat the disease (Zhou et al, 2014; Manenti et al, 2016; Vervoort et al, 2016), demonstrating improvement when patients with PD are submitted to cognitive training during gait while performing a dual task (YogevSeligmann et al, 2012)
It is suggested that synergic effects occur when both therapies are applied simultaneously, due to a likely modulation of the circuits that control planning and execute motor tasks (Fregni et al, 2006; Benninger et al, 2010; Kaski et al, 2014), with possible neuroplastic changes in the feedback loops that regulate the cognitive components affected by PD (Manor et al, 2018)
Summary
Parkinson’s disease (PD) is a neurodegenerative disorder that affects motor and cognitive function, especially when individuals are submitted to dual tasks (Cameron et al, 2010; Kelly et al, 2012). Evidence shows the benefit of combined therapies to treat the disease (Zhou et al, 2014; Manenti et al, 2016; Vervoort et al, 2016), demonstrating improvement when patients with PD are submitted to cognitive training during gait while performing a dual task (YogevSeligmann et al, 2012). It is suggested that synergic effects occur when both therapies are applied simultaneously, due to a likely modulation of the circuits that control planning and execute motor tasks (Fregni et al, 2006; Benninger et al, 2010; Kaski et al, 2014), with possible neuroplastic changes in the feedback loops that regulate the cognitive components affected by PD (Manor et al, 2018)
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