Abstract
Unilateral weakness of the lower limb is a hallmark of multiple sclerosis (MS) and a significant contributor to the progressive worsening of walking ability. There are currently no effective rehabilitation strategies targeting strength asymmetries and/or gait impairments in people with MS (PwMS). Transcranial direct current stimulation (tDCS) has improved motor outcomes in various populations, but the effect of tDCS on gait in PwMS and the ideal timing window of tDCS application are still unknown. This study investigated the effects of tDCS, either before or during a 6 min walk test (6MWT), on the distance walked and gait characteristics in PwMS. Twelve participants were recruited and randomly assigned into BEFORE or DURING groups (both n = 6). The BEFORE group received stimulation before performing a 6MWT (sham/2 mA, 13 min). The DURING group received stimulation only during a 6MWT (sham/2 mA, 6 min). Stimulation was over the more MS-affected primary motor cortex (M1). Distance walked and gait characteristics of the walk were the primary and secondary outcomes. The results indicated a significant decrease in distance walked in the DURING group (p = 0.026) and a significant increase in gait velocity in the BEFORE group (p = 0.04). These changes were accompanied by trends (p < 0.1) in distance walked, gait velocity, and stride length. Overall, the results of this study suggest that tDCS performed before a 6MWT might be more effective than tDCS during a 6MWT and that a single session of tDCS may not be sufficient to influence gait.Clinical Trial Registration: www.ClinicalTrials.gov, identifier #NCT03757819.
Highlights
Weakness on one side of the body is a hallmark of multiple sclerosis (MS) and has been determined to be a significant contributor to the progressive worsening of walking abilities (Kent-Braun et al, 1997; Thoumie and Mevellec, 2002; Mevellec et al, 2003; Ng et al, 2004; Kalron et al, 2011; Broekmans et al, 2013)
The BEFORE group performed the 6MWT at a higher gait velocity after transcranial direct current stimulation (tDCS) and the DURING group walked a significantly shorter distance in the 6MWT with tDCS
These changes were accompanied by trends (p < 0.1) in distance walked, gait velocity, and stride length in the same direction as the significant results for each group
Summary
Weakness on one side of the body is a hallmark of multiple sclerosis (MS) and has been determined to be a significant contributor to the progressive worsening of walking abilities (Kent-Braun et al, 1997; Thoumie and Mevellec, 2002; Mevellec et al, 2003; Ng et al, 2004; Kalron et al, 2011; Broekmans et al, 2013). One possible modality that fulfills these tDCS and Gait in MS requirements is transcranial direct current stimulation (tDCS; Jeffery et al, 2007). One study of tDCS in PwMS found that a single session of anodal tDCS (1 mA for 20 min) over the primary motor cortex (M1) contralateral to the more-impaired hand resulted in increased corticospinal output and projection strength compared to sham stimulation (Cuypers et al, 2013). One study has investigated a single application of anodal tDCS to improve knee extensor fatigability in PwMS and found no effect on an isometric task (Proessl et al, 2018).
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