Brain Stimulation – Gait Rehab

Transcranial Direct Current stimulation for post-stroke gait rehab, a pilot study


Background

Gait deficits following stroke are frequent and commonly persistent. Current rehabilitation methods fail to restore normal gait for many stroke survivors.  Individuals with persistent gait deficits following stroke are more dependent on caregivers for assistance with activities of daily living and exhibit limitations in community ambulation. Therefore, it is important to develop treatment methods that improve gait for those with persistent deficits following stroke. Transcranial Direct Current Stimulation (tDCS), a form of non-invasive brain stimulation (NIBS), is a promising treatment method that warrants further investigation in gait therapies.

In upper limb randomized control trials, tDCS+rehabilitation produced clinically significant gains. However, for chronic gait, tDCS+gait training studies are limited. In a pilot crossover single session study, we demonstrated feasibility and potential benefit of combined tDCS+gait training versus gait training alone. While this single session study design was essential to demonstrate feasibility, the only way to determine whether brain stimulation is beneficial for gait training is by utilizing a randomized multi-session study design. The reason that a multi-session rehabilitation protocol is required is because clinically significant and lasting improvements can be achieved only with repeated, intensive practice for patients with chronic stroke.


About This Study

Objective/Specific Aims: The specific aims of this research study are to demonstrate the feasibility of a 10-session protocol combining simultaneous tDCS and gait training to produce a clinically significant lasting improvement in gait performance, and to evaluate neuroplastic brain changes in response to tDCS to both sides of the brain combined with gait training.

Study Information:  Study participants will be treated with 10 sessions that consists of both brain stimulation (tDCS) and gait therapy. Gait therapy will include training in the virtual reality environment. The study will demonstrate feasibility of this protocol to achieve clinically significant and lasting improvement in gait performance. Brain stimulation is intended to target two main adaptive neuroplastic mechanisms involved in post-stroke motor recovery: 1) facilitation of the residual ipsilesional motor output pathways for the lower extremity and 2) suppression of transcallosal inhibition from the contralesional motor regions.

 

Principal Investigator: Svetlana Pundik, MD, MSc
Program Contact: Jessica McCabe, PT
Contact Number: (216) 791-3800 x3830
Contact Email: jmccabe@fescenter.org