Abstract
Objective: Combining transcranial direct current stimulation (tDCS) and repetitive gait training may be effective for gait performance recovery after stroke; however, the timing of stimulation to obtain the best outcomes remains unclear. We performed a systematic review and meta-analysis to establish evidence for changes in gait performance between online stimulation (tDCS and repetitive gait training simultaneously) and offline stimulation (gait training after tDCS).Methods: We comprehensively searched the electronic databases Medline, Cochrane Central Register of Controlled Trials, Physiotherapy Evidence Database, and Cumulative Index to Nursing and Allied Health Literature, and included studies that combined cases of anodal tDCS with motor-related areas of the lower limbs and gait training. Nine studies fulfilled the inclusion criteria and were included in the systematic review, of which six were included in the meta-analysis.Result: The pooled effect estimate showed that anodal tDCS significantly improved the 10-m walking test (p = 0.04; I2 = 0%) and 6-min walking test (p = 0.001; I2 = 0%) in online stimulation compared to sham tDCS.Conclusion: Our findings suggested that simultaneous interventions may effectively improve walking ability. However, we cannot draw definitive conclusions because of the small sample size. More high-quality studies are needed on the effects of online stimulation, including various stimulation parameters.
Highlights
Stroke often causes walking problems due to sensorimotor dysfunction, such as motor paresis, decreased muscle strength, and impaired proprioceptive capabilities
Studies were included in this systematic review if they met the following criteria: (1) the patients were diagnosed with hemorrhagic or ischemic stroke with unilateral hemiplegia; (2) the patients could walk without support and maintain their own body weight or balance; (3) a combination of anodal Transcranial direct current stimulation (tDCS) on the motor-related areas and repetitive gait training was performed; (4) gait performance outcomes were assessed; (5) the study was a randomized controlled trial (RCT), crossover RCT, or highquality comparative studies; (6) the study was a clinical trial with at least seven sessions per week; and (7) the article was written in English
Six studies were divided broadly into two research categories: (1) online stimulation, in which anodal tDCS and repetitive gait training were performed simultaneously; and (2) offline stimulation, in which anodal tDCS was followed by gait training
Summary
Stroke often causes walking problems due to sensorimotor dysfunction, such as motor paresis, decreased muscle strength, and impaired proprioceptive capabilities. Patients with stroke may experience a decreased quality of life (QOL) and limited activities of daily living because of disease-related walking dysfunction. Improving mobility, including the walking speed, is an important goal for patients with stroke. A systematic review of the current guidelines showed that RAGT is generally recommended to improve lower limb motor function, including gait and strength (Calabró et al, 2021). These repetitive walking exercises are expected to induce cortical motor plasticity and improve mobility
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