Abstract
To maintain the balance, the postural system needs to integrate the three main sensorial systems: visual, vestibular, and somatosensory to keep postural control within the limits of stabilization. Damage of one of these systems, in this case, the vision, will have a great disturbance on the postural control influencing the behavior of the balance, resulting in falls. The aim of this study protocol for a randomized, controlled clinical trial is to analyze the effects of transcranial direct current stimulation (tDCS) combined with proprioceptive exercises on postural control in individuals with congenital and acquired blindness. In this randomized, controlled, double-blind, clinical trial, male, and female individuals with blindness between 18 and 55 years of age will participate in this study divided into three phases: 1—Determine differences in postural control and gait between individuals with congenital and acquired blindness with and without the use of a guide stick when wearing shoes and when barefoot; 2—A pilot study to analyze the effects a bilateral cerebellar anodal tDCS on postural on postural control and gait; and 3—A treatment protocol will be conducted in which the participants will be allocated to four groups: G1—active tDCS + dynamic proprioceptive exercises; G2—sham tDCS + dynamic proprioceptive exercises; G3—active tDCS + static proprioceptive exercises; and G4—sham tDCS + static proprioceptive exercises. Evaluations will involve a camera system for three-dimensional gait analysis, a force plate, and electromyography. Dynamic stability will be determined using the Timed Up and Go test and static stability will be analyzed with the aid of the force plate. The viability of this study will allow the determination of differences in postural control between individuals with congenital and acquired blindness, the analysis of the effect of tDCS on postural control, and the establishment of a rehabilitation protocol.
Highlights
Postural control (PC) can be negatively affected in individuals with blindness due to the lack of availability of visual input [1, 2]
To determine possible differences in PC betweenindividuals with congenital and acquired blindness; [2] to evaluate the motor pattern of gait with and without the use of a guide stick when wearing shoes or while barefoot; and [3] to analyze whether proprioceptive exercises with or without transcranial direct current stimulation (tDCS) can lead to different results with regard to PC
This study protocol is divided into three phases where phase 1 is a cross-sectional study to determine differences in postural control and gait between groups; phase 2 is a pilot study of phase three, a randomized, controlled, double-blind, clinical trial with blind individuals
Summary
Postural control (PC) can be negatively affected in individuals with blindness due to the lack of availability of visual input [1, 2]. Balance training or postural perturbation training, enhance proxies of static and dynamic steady-state, reactive balance, and dynamic reflex responses that induce disturbances in the sensory feedback system [5] to generate an automatic response in the neuromuscular control of a given joint These interventions attempts to enhance PC and balance to improve the stability of the body, thereby reducing the risk of falls. As stated earlier for the visually impaired people, motor control is quite challenged even in simple tasks that require PC due to their blindness, and that tDCS induces cerebellar excitability changes [11], in which can modulate cerebellarmotor cortex excitability and affect positively PC processing [12]. To determine possible differences in PC betweenindividuals with congenital and acquired blindness; [2] to evaluate the motor pattern of gait with and without the use of a guide stick when wearing shoes or while barefoot; and [3] to analyze whether proprioceptive exercises with or without tDCS can lead to different results with regard to PC
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