Browse > Article
http://dx.doi.org/10.14474/ptrs.2022.11.1.8

Targetting Balance and Gait Rehabilitation with Multichannel Transcranial Direct Current Stimulation in a Sub-Acute Stroke Survivor-A Case Report  

Gakhar, Kazal (Department of Physiotherapy, Punjabi University)
Arumugam, Narkeesh (Department of Physiotherapy, Punjabi University)
Midha, Divya (Department of Physiotherapy, Punjabi University)
Publication Information
Physical Therapy Rehabilitation Science / v.11, no.1, 2022 , pp. 8-15 More about this Journal
Abstract
Objective: Post stroke motor recovery is facilitated by the brain reorganization or the neuroplastic changes. The therapeutic approach mentioned in the current case is one of the approaches for enhancing motor recovery by stimulating the damaged neural networks directing the motor behaviour of a person. The aim of the present study was to establish the changes in the balance and gait pattern of an individual through multi target stimulation of areas of cerebral cortex by utilising multichannel trans cranial direct current stimulation (M-tDCS) in a sub-acute stroke survivor. Design: A Case Report Methods: The present patient was the participant of the trial (CTRI/2021/02/031044).The patient was intervened with M-tDCS (anodes over left primary motor cortex that is C3 point and left dorsolateral prefrontal cortex i.e., F3 point and cathodes over supraorbital areas, Intensity - 1.2mA) for the duration of 20 minutes along with turbo med extern - an AFO to facilitate ankle dorsi flexion and conventional physiotherapy rehabilitation. The Fugl-Meyer assessment lower extremity (FMA-LE), Berg Balance Scale (BBS), Wisconsin Gait Scale (WGS) and the Stroke Specific Quality of Life (SSQOL) measures were used for outcome assessment. Baseline assessment was done on day 0 followed by assessment on 10 and 20 post intervention. Results: Improvement was seen in all the tools i.e. (FMA -LE), BBS, SSQOL and WGS over the time period of 20 days. Conclusions: M-tDCS resulted in improvement in gait parameters, balance and motor functions of lower extremity of the patient.
Keywords
Stroke; balance; Brain stimulation; Multichannel transcranial direct current stimulation;
Citations & Related Records
Times Cited By KSCI : 2  (Citation Analysis)
연도 인용수 순위
1 Young W. Electrical stimulation and motor recovery. Cell Transplant 2015;24:429-446.   DOI
2 Kang N, Summers JJ, Cauraugh JH. Transcranial direct current stimulation facilitates motor learning post-stroke: a systematic review and meta-analysis. J Neurol NeurosurgPsychiatry 2016;87:345-355.   DOI
3 O'Brien AT, Bertolucci F, Torrealba-Acosta G, Huerta R, Fregni F, Thibaut A. Non-invasive brain stimulation for fine motor improvement after stroke: meta-analysis. Eur J Neurol 2018;25:1017-1026.   DOI
4 Lefebvre S, and Liew SL. Anatomical Parameters of tDCS to Modulate the Motor System after Stroke: A Review. Frontiers in neurology 2017;8:29.   DOI
5 Allman C, Amadi U, Winkler AM, Wilkins L, Filippini N, Kischka U, et al. Ipsilesional anodal tDCS enhances the functional benefits of rehabilitation in patients after stroke. Sci Transl Med 2016;8: 330.
6 Bindman LJ, Lippold OC, Redfearn JW. Long-lasting changes in the level of the electrical activity of the cerebral cortex produced by the currents. Nature 1962;196:584-585.   DOI
7 Sullivan EV, Adalsteinsson E, Hedehus M, Ju C, Moseley M, Lim KO, et al. Equivalent disruption of regional white matter microstructure in ageing healthy men and women. Neuroreport. 2001;12:99-104.   DOI
8 Dagan M, Herman T, Harrison R, Zhou J, Giladi N, Ruffini G. et al. Multitarget transcranial direct current stimulation for freezing of gait in Parkinson's disease. Mov Disord, 2018;33, pp.642-6.   DOI
9 Phipps MS, Cronin CA. Management of acute ischemic stroke. BMJ 2020; 368: l6983.   DOI
10 Pandian JD, Gall SL, Kate MP, Silva GS, Akinyemi RO, Ovbiagele BI, et al. Prevention of stroke: a global perspective. Lancet 2018;392:1269-1278.   DOI
11 Bregman DJ, Harlaar J, Meskers CG, de Groot V. Spring-like Ankle Foot Orthoses reduce the energy cost of walking by taking over ankle work. Gait Posture 2012;35:148-53.   DOI
12 Otal B, Dutta A, Foerster A, Ripolles O, Kuceyeski A, Miranda PC, Edwards DJ, Ilic TV, Nitsche MA and Ruffini G.Opportunities for Guided Multichannel Non-invasive Transcranial Current Stimulation in Post stroke Rehabilitation. Front. Neurol 2019;7:21.
13 Aqueveque P, Ortega P, Pino E., Saavedra F, Germany E and Gomez B. After stroke movement impairments: a review of current technologies for rehabilitation. Physical Disabilities-Therapeutic Implications 2017:95-116.
14 Chen CC, Hong WH, Wang CM, Chen CK, Wu KP, Kang CF et al. Kinematic features of rear-foot motion using anterior and posterior ankle-foot orthoses in stroke patients with hemiplegic gait. Arch Phys Med Rehabil. 2010;91:1862-8.   DOI
15 BiksonM, Rahman A and Datta A. Computational models of transcranial direct current stimulation. Clin. EEG Neurosci. 2012;43:176-183.   DOI
16 https://turbomedorthotics.com.
17 Gladstone DJ, Danells CJ, Black SE. The fugl-meyer assessment of motor recovery after stroke: a critical review of its measurement properties. Neurorehabil Neural Repair 2002;16:232-40.   DOI
18 Yaliman A, Kesiktas N, Ozkaya M, Eskiyurt N, Erkan O, Yilmaz E. Evaluation of Intrarater and Interrater Reliability of the Wisconsin Gait Scale with Using the Video Taped Stroke Patients in a Turkish Sample 2019;253-258.
19 Pedersen SG, Heiberg G A, Nielsen J F, Friborg O, Stabel HH, Anke A, Arntzen C. Validity, reliability and Norwegian adaptation of the Stroke-Specific Quality of Life (SS-QOL) scale. SAGE Open Medicine 2019.
20 Muniyar K, Darade SB. Effect of swiss ball training and conventional physiotherapy to improve balance and mobility in post-stroke patients. Int J PhysiotherRes 2018; 6(3):2813-2822.   DOI
21 Medeiros LF, Souza IC, Vidor LP, Souza, A et al. Neurobiological effects of Transcranial Direct Current Stimulation: A review. Front Psychiatry 2012;3:110.   DOI
22 Kollen B, Kwakkel G, Lindeman E. Longitudinal robustness of variables predicting independent gait following severe middle cerebral artery stroke: a prospective cohort study. Clin Rehabil 2006;20:262-8.   DOI
23 Megan K, Joseph S, Katelynn K, Cecelia K, Robert SP. Reliability and Validity of the Berg Balance Scale in the Stroke Population: A Systematic Review, Physical & Occupational Therapy In Geriatrics 2019;37:3:196-221.   DOI
24 Dhawale T, Ujwal Y and Anuja P. Effect of trunk control exercises on balance and gait in stroke patients- randomized control trial. Int J Phys Educ Sports Health.2018;5:6:15-18.
25 DePaz RH, Serrano-Munoz D, Perez-Nombela S, Bravo-Esteban E, Avendano-Coy J, & Gomez-Soriano J. Combining transcranial direct-current stimulation with gait training in patients with neurological disorders: a systematic review. Journal of neuroengineering and rehabilitation, 2019;16:1:114.   DOI
26 de Moura M, Hazime F.A, Marotti Aparici LV, Grecco L, Brunoni AR and Hasue RH. Effects of transcranial direct current stimulation (tDCS) on balance improvement: a systematic review and meta-analysis. Somatosensory&motor research 2019;36:2:122-135.   DOI
27 Agboada D, Mosayebi-Samani M, Kuo MF and Nitsche MA. Induction of long-term potentiation-like plasticity in the primary motor cortex with repeated anodal transcranial direct current stimulation-Better effects with intensified protocols?. Brain stimulation 2020;13:4:987-997.   DOI
28 Li J, Zhong D, Ye J, He M, Liu X, Zheng H, Jin R, Zhang SL. Rehabilitation for balance impairment in patients after stroke: a protocol of a systematic review and network meta-analysis. BMJ open 2019;9:7.
29 Schmid AA, Van PM, Altenburger PA, Miller KK, Combs SA, Page SJ. Balance is associated with quality of life in chronic stroke. Top Stroke Rehabil 2013;20:340-6.   DOI
30 Duncan PW, Zorowitz R, Bates B, Choi JY, Glasberg JJ, Graham GD et al. Management of adult stroke rehabilitation care-a clinical practice guideline. Stroke 2015;36:e100-e143.
31 Lopez EF, Portilla CuencaJC, Leno DiazC, Parraga Sanchez JM, Gamez-Leyva G, Casado Naranjo I. Sex differences in long-term quality of life after stroke: influence of mood and functional status. Neurologia 2019.
32 MidhaD and Arumugam N.Targeting motor and cognitive networks with multichanneltranscranial direct current stimulation along with peripheral stimulation in a subacute stroke survivor: single case study. PhysTher Rehabil Sci 2020;9:4:318-323.
33 Kwakkel G, Kollen BJ, van der Grond J, Prevo AJ. Probability of regaining dexterity in the flaccid upper limb: impact of severity of paresis and time since onset in acute stroke. Stroke 2003;34:9:2181-6.