Effects of Transcranial Direct Current Stimulation (tDCS) Plus Physical Therapy on Gait in Parkinson

Abstract

To study the effect of transcranial direct current stimulation (tDCS) combined with physical therapy on walking ability in patients with Parkinson’s disease (PD), a preliminary study Experimental double-blinded randomized controlled trial. Outpatient Rehabilitation Clinic, King Chulalongkorn Memorial Hospital, Thailand PD patients (N=32, age 40-80 y) with Modified Hoehn & Yahr stages 2 & 3 The 1st group (G1) was treated with anodal tDCS 2 mA stimulated on lower extremity motor cortex, the 2nd group (G2) with same anodal tDCS and physical therapy and the 3rd group (G3) was given sham tDCS and underwent physical therapy. All protocols were scheduled over 6 sessions in 2 weeks. Gait speed (m/s), step length (cm) and cadence (step/min) were assessed by gait & motion analysis at baseline, 2nd, 4th and 8th week post-treatment. At all follow-up visits (2nd, 4th and 8th week), all groups showed significant improvements (P<0.05) in gait speed and step length but not cadence. For gait speed, G1 showed 18.7%, 18.0%, 19.1%, (P= 0.008, 0.009 & 0.017) G2 showed 20.6%, 26.2%, 23.7% and G3 showed 11.0%, 20.9%, 23.5% improvement, respectively. For step length, G1 showed 16.4%, 16.8%, 13.8% G2 showed 21.3%, 18.3%, 12.8% and G3 showed 6.9%, 8.9% & 14.1% improvement, respectively. When compared among groups, G2 showed the highest percent of improvement in gait speed and step length at 2nd and 4th week, but not significant. Anodal tDCS or physical therapy showed significant improvement in gait ability in PD patients. Combined treatment may have an additive effect.