Abstract

Stroke remains a global leading cause of disability. Novel treatment approaches are required to alleviate impairment and promote greater functional recovery. One potential candidate is transcranial direct current stimulation (tDCS), which is thought to non-invasively promote neuroplasticity within the human cortex by transiently altering the resting membrane potential of cortical neurons. To date, much work involving tDCS has focused on upper limb recovery following stroke. However, lower limb rehabilitation is important for regaining mobility, balance, and independence and could equally benefit from tDCS. The purpose of this review is to discuss tDCS as a technique to modulate brain activity and promote recovery of lower limb function following stroke. Preliminary evidence from both healthy adults and stroke survivors indicates that tDCS is a promising intervention to support recovery of lower limb function. Studies provide some indication of both behavioral and physiological changes in brain activity following tDCS. However, much work still remains to be performed to demonstrate the clinical potential of this neuromodulatory intervention. Future studies should consider treatment targets based on individual lesion characteristics, stage of recovery (acute vs. chronic), and residual white matter integrity while accounting for known determinants and biomarkers of tDCS response.

Highlights

  • Stroke is the second leading cause of death and third leading cause of adult disability globally [1].With advancement in acute medical care, more people survive stroke, but frequently require extensive rehabilitative therapy to reduce impairment and improve quality of life

  • 10 sessions of anodal transcranial direct current stimulation (tDCS) (2 mA, 10 min) targeting the lower limb M1 was found to increase the amplitude of motor-evoked potentials (MEPs) recorded from the paretic tibialis anterior compared to sham stimulation [37]

  • It is worth noting that this study investigated upper limb outcomes and the role of the corticospinal tract may differ for the lower limb

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Summary

Introduction

Stroke is the second leading cause of death and third leading cause of adult disability globally [1]. In randomized sham-controlled trials, anodal stimulation of the motor cortex (M1) in the lesioned hemisphere was found to improve upper limb outcomes in chronic [21,22,23] and subacute stroke survivors [24,25,26], with behavior changes underpinned by increased cortical activity within the. 10 sessions of anodal tDCS (2 mA, 10 min) targeting the lower limb M1 was found to increase the amplitude of MEPs recorded from the paretic tibialis anterior compared to sham stimulation [37] This empirical evidence provides some support to the computational modelling to suggest that 10, thex FOR use of tDCS targeting the lower limb M1 can modify corticospinal excitability.

Transcranial
Principles of tDCS Application in Stroke
Quantifying
Biomarkers andDeterminants
Limitations
Findings
Conclusions
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