title: Combined transcranial direct current stimulation and robot-assisted gait training in patients with chronic stroke: a preliminary comparison.
abstract: OBJECTIVE
  To evaluate whether robot-assisted gait training combined with transcranial direct current stimulation is more effective than robot-assisted gait training alone or conventional walking rehabilitation for improving walking ability in stroke patients.
  
  
  METHODS
  Pilot randomized clinical trial.
  
  
  METHODS
  Rehabilitation unit of a university hospital.
  
  
  METHODS
  Thirty patients with chronic stroke.
  
  
  METHODS
  All patients received ten 50-minute treatment sessions, five days a week, for two consecutive weeks. Group 1 (n = 10) underwent a robot-assisted gait training combined with transcranial direct current stimulation; group 2 (n = 10) underwent a robot-assisted gait training combined with sham transcranial direct current stimulation; group 3 (n = 10) performed overground walking exercises.
  
  
  METHODS
  Patients were evaluated before, immediately after and two weeks post treatment.
  
  
  METHODS
  six-minute walking test, 10-m walking test.
  
  
  RESULTS
  No differences were found between groups 1 and 2 for all primary outcome measures at the after treatment and follow-up evaluations. A statistically significant improvement was found after treatment in performance on the six-minute walking test and the 10-m walking test in favour of group 1 (six-minute walking test: 205.20 ± 61.16 m; 10-m walking test: 16.20 ± 7.65 s) and group 2 (six-minute walking test: 182.5 ± 69.30 m; 10-m walking test: 17.71 ± 8.20 s) compared with group 3 (six-minute walking test: 116.30 ± 75.40 m; 10-m walking test: 26.30 ± 14.10 s). All improvements were maintained at the follow-up evaluation.
  
  
  CONCLUSIONS
  In the present pilot study transcranial direct current stimulation had no additional effect on robot-assisted gait training in patients with chronic stroke. Larger studies are required to confirm these preliminary findings.
authors.affiliation: Neuromotor and Cognitive Rehabilitation Research Centre, Department of Neurological, Neuropsychological, Morphological and Movement Sciences, University of Verona, Italy.
authors.forename: Christian
authors.initials: C
authors.lastname: Geroin
authors.forename: Alessandro
authors.initials: A
authors.lastname: Picelli
authors.forename: Daniele
authors.initials: D
authors.lastname: Munari
authors.forename: Andreas
authors.initials: A
authors.lastname: Waldner
authors.forename: Christopher
authors.initials: C
authors.lastname: Tomelleri
authors.forename: Nicola
authors.initials: N
authors.lastname: Smania
mesh_terms: D000368:Aged; D004599:Electric Stimulation Therapy / Q000379:methods*; D005260:Female; D020233:Gait Disorders, Neurologic / Q000209:etiology / Q000534:rehabilitation*; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital; D010865:Pilot Projects; D012371:Robotics / Q000379:methods*; D020521:Stroke / Q000150:complications; D000071939:Stroke Rehabilitation; D050781:Transcranial Magnetic Stimulation / Q000379:methods; D016138:Walking / Q000502:physiology