Abstract
BackgroundTranscranial direct-current stimulation (tDCS) is an easy-to-apply, cheap, and safe technique capable of affecting cortical brain activity. However, its effectiveness has not been proven for many clinical applications.ObjectiveThe aim of this systematic review was to determine whether the effect of different strategies for gait training in patients with neurological disorders can be enhanced by the combined application of tDCS compared to sham stimulation. Additionally, we attempted to record and analyze tDCS parameters to optimize its efficacy.MethodsA search in Pubmed, PEDro, and Cochrane databases was performed to find randomized clinical trials that combined tDCS with gait training. A chronological filter from 2010 to 2018 was applied and only studies with variables that quantified the gait function were included.ResultsA total of 274 studies were found, of which 25 met the inclusion criteria. Of them, 17 were rejected based on exclusion criteria. Finally, 8 trials were evaluated that included 91 subjects with stroke, 57 suffering from Parkinson’s disease, and 39 with spinal cord injury. Four of the eight assessed studies did not report improved outcomes for any of its variables compared to the placebo treatment.ConclusionsThere are no conclusive results that confirm that tDCS can enhance the effect of the different strategies for gait training. Further research for specific pathologies, with larger sample sizes and adequate follow-up periods, are required to optimize the existing protocols for applying tDCS.
Highlights
Difficulty to walk is a key feature of neurological disorders [1], so much so that recovering and/or maintaining the patient’s walking ability has become one of the main aims of all neurorehabilitation programs [2]
There are no conclusive results that confirm that Transcranial direct-current stimulation (tDCS) can enhance the effect of the different strategies for gait training
Improvements in the functionality of upper limbs and fine motor skills of the hand with paresis have been observed in patients with stroke using tDCS, the results were somewhat controversial [12, 13]
Summary
Difficulty to walk is a key feature of neurological disorders [1], so much so that recovering and/or maintaining the patient’s walking ability has become one of the main aims of all neurorehabilitation programs [2]. The loss of this ability is one of the most significant factors negatively impacting on the social and professional reintegration of neurological patients [3]. Strategies for gait rehabilitation traditionally focus on improving the residual ability to walk and compensation strategies. Improvements in the functionality of upper limbs and fine motor skills of the hand with paresis have been observed in patients with stroke using tDCS, the results were somewhat controversial [12, 13]. A Cochrane review on the effectiveness of tDCS in treating Parkinson’s disease highlights the great potential of the technique to improve motor skills, but the significance level of the evidence was not enough to clearly recommend it [14]. Transcranial direct-current stimulation (tDCS) is an easy-to-apply, cheap, and safe technique capable of affecting cortical brain activity. Its effectiveness has not been proven for many clinical applications
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