title: Combined effects of transcranial direct current stimulation (tDCS) and transcutaneous spinal direct current stimulation (tsDCS) on robot-assisted gait training in patients with chronic stroke: A pilot, double blind, randomized controlled trial.
abstract: OBJECTIVE
  Preliminary evidence has shown no additional effects of transcranial direct current stimulation (tDCS) on robotic gait training in chronic stroke, probably due to the neural organization of locomotion involving cortical and spinal control. Our aim was to compare the combined effects of tDCS and transcutaneous spinal direct current stimulation (tsDCS) on robotic gait training in chronic stroke.
  
  
  METHODS
  Thirty chronic stroke patients received ten 20-minute robot-assisted gait training sessions, five days a week, for 2 consecutive weeks combined with anodal tDCS + sham tsDCS (group 1; n = 10) or sham tDCS + cathodal tsDCS (group 2; n = 10) or tDCS + cathodal tsDCS (group 3; n = 10). The primary outcome was the 6-minute walk test (6MWT) performed before, after, 2 weeks and 4 weeks post-treatment.
  
  
  RESULTS
  Significant differences in the 6MWT distance were noted between group 3 and group 1 at the post-treatment and 2-week follow-up evaluations (post-treatment P = 0.015; 2-week follow-up P = 0.001) and between group 3 and group 2 (post-treatment P = 0.010; 2-week follow-up P =  .015). No difference was found between group 2 and group 1.
  
  
  CONCLUSIONS
  Our preliminary findings support the hypothesis that anodal tDCS combined with cathodal tsDCS may be useful to improve the effects of robotic gait training in chronic stroke.
authors.affiliation: Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurological and Movement Sciences, University of Verona, Verona, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Picelli
authors.affiliation: Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurological and Movement Sciences, University of Verona, Verona, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Chemello
authors.affiliation: Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurological and Movement Sciences, University of Verona, Verona, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Castellazzi
authors.affiliation: Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurological and Movement Sciences, University of Verona, Verona, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Roncari
authors.affiliation: Villa Melitta Rehabilitation Clinic, Bolzano, Italy.
authors.forename: Andreas
authors.initials: A
authors.lastname: Waldner
authors.affiliation: Department of Neurology, Hochzirl Hospital, Zirl, Austria.|Research Unit for Neurorehabilitation South Tyrol, Bolzano, Italy.
authors.forename: Leopold
authors.initials: L
authors.lastname: Saltuari
authors.affiliation: Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurological and Movement Sciences, University of Verona, Verona, Italy.|Neurorehabilitation Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Smania
mesh_terms: D000368:Aged; D001921:Brain / Q000503:physiopathology*; D004311:Double-Blind Method; D005260:Female; D005684:Gait / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D020127:Recovery of Function / Q000502:physiology; D012371:Robotics; D013116:Spinal Cord / Q000503:physiopathology*; D000071939:Stroke Rehabilitation; D065908:Transcranial Direct Current Stimulation; D004561:Transcutaneous Electric Nerve Stimulation; D016896:Treatment Outcome; D016138:Walking / Q000502:physiology*
keywords: Central nervous system; brain; rehabilitation; spinal cord