Combining physical training with transcranial direct current stimulation to improve gait in Parkinson's disease: a pilot randomized controlled study.
OBJECTIVE
To improve gait and balance in patients with Parkinson's disease by combining anodal transcranial direct current stimulation with physical training.


METHODS
In a double-blind design, one group (physical training; n = 8) underwent gait and balance training during transcranial direct current stimulation (tDCS; real/sham). Real stimulation consisted of 15 minutes of 2 mA transcranial direct current stimulation over primary motor and premotor cortex. For sham, the current was switched off after 30 seconds. Patients received the opposite stimulation (sham/real) with physical training one week later; the second group (No physical training; n = 8) received stimulation (real/sham) but no training, and also repeated a sequential transcranial direct current stimulation session one week later (sham/real).


METHODS
Hospital Srio Libanes, Buenos Aires, Argentina.


METHODS
Sixteen community-dwelling patients with Parkinson's disease.


METHODS
Transcranial direct current stimulation with and without concomitant physical training.


METHODS
Gait velocity (primary gait outcome), stride length, timed 6-minute walk test, Timed Up and Go Test (secondary outcomes), and performance on the pull test (primary balance outcome).


RESULTS
Transcranial direct current stimulation with physical training increased gait velocity (mean = 29.5%, SD = 13; p < 0.01) and improved balance (pull test: mean = 50.9%, SD = 37; p = 0.01) compared with transcranial direct current stimulation alone. There was no isolated benefit of transcranial direct current stimulation alone. Although physical training improved gait velocity (mean = 15.5%, SD = 12.3; p = 0.03), these effects were comparatively less than with combined tDCS + physical therapy (p < 0.025). Greater stimulation-related improvements were seen in patients with more advanced disease.


CONCLUSIONS
Anodal transcranial direct current stimulation during physical training improves gait and balance in patients with Parkinson's disease. Power calculations revealed that 14 patients per treatment arm (α = 0.05; power = 0.8) are required for a definitive trial.
Division of Brain Sciences, Imperial College London, London, UK Universidad de Buenos Aires, Hospital Sirio Libanés Buenos Aires, Buenos Aires, Argentina d.kaski@imperial.ac.uk.
D
D
Kaski
Universidad de Buenos Aires, Hospital Sirio Libanés Buenos Aires, Buenos Aires, Argentina.
R O
RO
Dominguez
University ORL Clinic, Basel, Switzerland.
J H
JH
Allum
Department of Primary Care and Public Health, Imperial College London, London, UK.
A F
AF
Islam
Division of Brain Sciences, Imperial College London, London, UK.
A M
AM
Bronstein
D000368:Aged; D003131:Combined Modality Therapy; D004311:Double-Blind Method; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005684:Gait / Q000502:physiology; D020233:Gait Disorders, Neurologic / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000150:complications / Q000175:diagnosis / Q000534:rehabilitation*; D010865:Pilot Projects; D004856:Postural Balance / Q000502:physiology*; D020127:Recovery of Function; D012720:Severity of Illness Index; D065908:Transcranial Direct Current Stimulation / Q000379:methods*; D016896:Treatment Outcome
Cerebral cortex; Parkinson’s disease; electrical stimulation therapy; exercise therapy; gait