title: Improving gait and balance in patients with leukoaraiosis using transcranial direct current stimulation and physical training: an exploratory study.
abstract: BACKGROUND
  Leukoaraiosis describes ischemic white matter lesions, a leading cause of gait disturbance in the elderly.
  
  
  OBJECTIVE
  Our aim was to improve gait and balance in patients with leukoaraiosis by combining a single session of transcranial direct current stimulation (tDCS) and physical training (PT).
  
  
  METHODS
  We delivered anodal tDCS over midline motor and premotor areas in 9 patients with leukoaraiosis. Patients underwent gait and balance training during tDCS stimulation (real/sham). This was repeated 1 week later with the stimulation crossed-over (sham/real) in a double-blind design. Assessments included gait velocity, stride length, stride length variability (primary gait outcomes), and a quantitative retropulsion test (primary balance outcome).
  
  
  RESULTS
  . Combining tDCS and PT improved gait velocity, stride length, stride length variability, and balance (all at P ≤ .05). Overall, training without tDCS showed no significant effects.
  
  
  CONCLUSIONS
  Combined anodal tDCS and PT improves gait and balance in this patient group, suggesting that tDCS could be an effective adjunct to PT in patients with leukoaraiosis, for whom no treatment is currently available.
authors.affiliation: 1Imperial College London, Charing Cross Hospital, London, UK.
authors.forename: Diego
authors.initials: D
authors.lastname: Kaski
authors.forename: Raul Omar
authors.initials: RO
authors.lastname: Dominguez
authors.forename: John H
authors.initials: JH
authors.lastname: Allum
authors.forename: Adolfo M
authors.initials: AM
authors.lastname: Bronstein
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D018592:Cross-Over Studies; D004311:Double-Blind Method; D004599:Electric Stimulation Therapy; D005081:Exercise Therapy; D005260:Female; D005684:Gait / Q000502:physiology*; D006801:Humans; D056784:Leukoencephalopathies / Q000534:rehabilitation*; D008297:Male; D009044:Motor Cortex / Q000502:physiology*; D004856:Postural Balance / Q000502:physiology*; D020127:Recovery of Function
keywords: gait; leukoaraiosis; rehabilitation; small vessel disease; training; transcranial direct current stimulation; white matter