Abstract
BackgroundGait difficulties are common and frequently devastating to people with Parkinson’s disease (PD). These difficulties are often followed by an increased risk of falls, leading to injury, hospitalization and mortality. The dysfunction in the basal ganglia-thalamocortical motor circuits and reduced activity in the premotor and primary motor cortices has raised interest in transcranial direct current stimulation (tDCS) as an adjunct intervention in PD. tDCS might provide a potentially safe and non-invasive treatment by modulating cortical excitability and behavioural outcomes. The aim of this study is to compare the effects of different monopolar and bipolar montages of tDCS administered to the motor cortex and cerebellum on gait speed in PD.MethodsThis study will be conducted in a randomized, double-blind cross-over design. Eighteen participants diagnosed with Parkinson’s disease will receive anodal and sham tDCS (1 mA, 20 min, 10 × 4 cm2) over the premotor and primary motor cortices with the cathode over the cerebellum during treadmill walking. Three montages will be applied over three sessions and compared: anodal tDCS with a small active cathode (4 × 4 cm2); anodal tDCS with a large, functionally inert cathode (10 × 10 cm2); and sham tDCS. The primary outcome measure is gait speed, and secondary outcome measures include gait parameters (temporospatial, segmental, kinematic), the Timed Up and Go test and lower limb muscle activity patterns as measured by electromyography.DiscussionThis study will investigate the short-term effects of anodal tDCS over the premotor and primary motor cortices on gait abilities using monopolar and bipolar montages in people with PD. The outcomes will inform future studies aimed at inducing longer-lasting changes in neural excitability and performance using multisession tDCS designs in PD.Trial registrationAustralian New Zealand Clinical Trials Registry (ANZCTR), ACTRN12618000063213. Registered on 17 January 2018. Retrospectively registered.
Highlights
Gait difficulties are common and frequently devastating to people with Parkinson’s disease (PD)
Motor complications in PD have been linked to degeneration of dopaminergic neurons in the substantia nigra compacta of the basal ganglia, which results in a deficit of dopamine and disruption of dopaminergic neurotransmission [7]
Modelling electric field intensity (EFI) We modelled the EFI using a computational model generated by a MATLAB toolbox, COMETS2, to simulate the two montages
Summary
Gait difficulties are common and frequently devastating to people with Parkinson’s disease (PD). The dysfunction in the basal ganglia-thalamocortical motor circuits and reduced activity in the premotor and primary motor cortices has raised interest in transcranial direct current stimulation (tDCS) as an adjunct intervention in PD. Gait difficulties are common and often incapacitating for individuals with Parkinson’s disease (PD) They manifest as reduced gait speed, stride length, coordination and arm swing [1] as well as increased cadence, upper body movement and double support duration [2, 3]. Underpinning this altered gait are changes in muscle activation. The cerebellum has been shown to be hyperactive in PD, presumably to compensate for the deficiency in function of the basal ganglia and the cortico-cerebellar circuit [10]
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