Effects of Anodal Transcranial Direct Current Stimulation With Overground Gait Training on Lower Limb Performance in Individuals With Incomplete Spinal Cord Injury

Abstract

Objective: To determine the effects of anodal transcranial direct current stimulation (tDCS) combined with overground gait training on gait performance, dynamic balance, sit-to-stand performance, and quality of life in individuals with incomplete spinal cord injuries (iSCI). Design: Double-blind sham-controlled trial with a matched-pair design. Setting: Sirindhorn National Medical Rehabilitation Institute, Thailand. Participants: Individuals with iSCI (n=34) were allocated to the anodal or sham groups. Intervention: Anodal tDCS was administered over the M1 lower-limb motor area at an intensity of 2 mA for 20 min in the anodal group, while the sham group received a 30-s stimulation. Both groups received 40 min of overground gait training after tDCS for 5 consecutive daily sessions. Main Outcome Measures: The 10-meter walk test (10MWT) was the primary outcome, while spatiotemporal gait parameters, the timed Up and Go test, Five-Time Sit-to-Stand Test, and World Health Organization Quality of Life-BREF were secondary outcomes. Outcomes were assessed at baseline, post-intervention, and at 1-month (1M) and 2-month (2M) follow-ups. Result: Improvements in walking speed measured using the 10MWT were observed in both groups. However, the anodal group showed a greater improvement than the sham group. For fast speed, the mean between-group differences were 0.10 m/s, 95% CI (0.02 to 0.17) (post-intervention), 0.11 m/s, (0.03 to 0.19) (1M), and 0.11 m/s, (0.03 to 0.20) (2M), while for self-selected speed, the median differences were 0.10 m/s, 95% CI (0.06 to 0.14) (post-intervention) and 0.09 m/s, (0.01 to 0.19) (2M). The anodal group also had a greater stride length difference post-intervention (median difference: 0.07 m, 95% CI (0.01 to 0.14)). No significant between-group differences were found for other outcomes. Conclusion: Five-session of anodal tDCS with gait training slightly improved walking speed, sustained for 2 months post-intervention. However, effect on spatiotemporal gait parameters was limited and dynamic balance, functional tasks (ie, sit-to-stand), and quality of life were unaffected compared with overground gait training.