Combined effects of cerebellar transcranial direct current stimulation and transcutaneous spinal direct current stimulation on robot-assisted gait training in patients with chronic brain stroke: A pilot, single blind, randomized controlled trial

Article type: Research Article

Authors: Picelli, Alessandro^{a; b; *} | Chemello, Elena^a | Castellazzi, Paola^a | Filippetti, Mirko^a | Brugnera, Annalisa^a | Gandolfi, Marialuisa^{a; b} | Waldner, Andreas^{c; d} | Saltuari, Leopold^{d; e} | Smania, Nicola^{a; b}

Affiliations: [a] Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy | [b] Neurorehabilitation Unit, Hospital Trust of Verona, Verona, Italy | [c] Villa Melitta Rehabilitation Clinic, Bolzano, Italy | [d] Research Unit for Neurorehabilitation South Tyrol, Bolzano, Italy | [e] Department of Neurology, Hochzirl Hospital, Zirl, Austria

Correspondence: [*] Corresponding author: Alessandro Picelli, Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, P.le L.A. Scuro, 10. 37134 Verona, Italy. Tel.: +39 0458124573; Fax: +39 0458124495; E-mail: alessandro.picelli@univr.it.

Abstract: Background:Preliminary evidence showed additional effects of anodal transcranial direct current stimulation over the damaged cerebral hemisphere combined with cathodal transcutaneous spinal direct current stimulation during robot-assisted gait training in chronic stroke patients. This is consistent with the neural organization of locomotion involving cortical and spinal control. The cerebellum is crucial for locomotor control, in particular for avoidance of obstacles, and adaptation to novel conditions during walking. Despite its key role in gait control, to date the effects of transcranial direct current stimulation of the cerebellum have not been investigated on brain stroke patients treated with robot-assisted gait training. Objective:To evaluate the effects of cerebellar transcranial direct current stimulation combined with transcutaneous spinal direct current stimulation on robot-assisted gait training in patients with chronic brain stroke. Methods:After balanced randomization, 20 chronic stroke patients received ten, 20-minute robot-assisted gait training sessions (five days a week, for two consecutive weeks) combined with central nervous system stimulation. Group 1 underwent on-line cathodal transcranial direct current stimulation over the contralesional cerebellar hemisphere + cathodal transcutaneous spinal direct current stimulation. Group 2 received on-line anodal transcranial direct current stimulation over the damaged cerebral hemisphere + cathodal transcutaneous spinal direct current stimulation. The primary outcome was the 6-minute walk test performed before, after, and at follow-up at 2 and 4 weeks post-treatment. Results:The significant differences in the 6-minute walk test noted between groups at the first post-treatment evaluation (p = 0.041) were not maintained at either the 2-week (P = 0.650) or the 4-week (P = 0.545) follow-up evaluations. Conclusion:Our preliminary findings support the hypothesis that cathodal transcranial direct current stimulation over the contralesional cerebellar hemisphere in combination with cathodal transcutaneous spinal direct current stimulation might be useful to boost the effects of robot-assisted gait training in chronic brain stroke patients with walking impairment.

Keywords: Central nervous system, cerebellum, spinal cord, rehabilitation

DOI: 10.3233/RNN-170784

Journal: Restorative Neurology and Neuroscience, vol. 36, no. 2, pp. 161-171, 2018