Effect of transcranial direct current stimulation (tDCS) on gait performance in patient with Parkinson's disease

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Effect of transcranial direct current stimulation (tDCS) on gait performance in patient with Parkinson's disease


Author: Chan, Mei-yee Raphael
Title: Effect of transcranial direct current stimulation (tDCS) on gait performance in patient with Parkinson's disease
Degree: M.Sc.
Year: 2012
Subject: Parkinson's disease -- Treatment.
Electric Stimulation.
Brain stimulation -- Therapeutic use.
Hong Kong Polytechnic University -- Dissertations
Department: Dept. of Rehabilitation Sciences
Pages: x, 102 leaves : ill. ; 30 cm.
Language: English
InnoPac Record: http://library.polyu.edu.hk/record=b2507561
URI: http://theses.lib.polyu.edu.hk/handle/200/6530
Abstract: Introduction: Parkinson's disease (PD) is a progressive neurodegenerative disease. It is characterized by motor deficits with shuffling gait, and all aspects of movement are affected by bradykinesia. Treatment includes medication like L-dopa; neurosurgery intervention like stereotactic thalamotomy and deep brain stimulation; therapeutic exercise like physiotherapy. With time, PD eventually responds less to dopaminergic therapy; invasive brain surgery poses surgical risk; therapeutic exercise cannot improve the mobility reserve. Non-invasive brain stimulation such as transcranial direct current stimulation(tDCS) has shown promising results. tDCS is easy to apply and it may be used as a possible therapeutic tool. Objectives: To investigate the effect of transcranial direct current stimulation on gait performance in patients with PD. Design: Double-blinded, randomized, sham controlled study. Subjects: 32 adult patients with PD were recruited and randomized into real group and sham group. Methods: Anodal tDCS was applied to the lower limb primary motor cortex (M1) to the side with more profound PD symptom in PD patients for 5 consecutive days. The walking performance at natural speed and fastest speed and Unified Parkinson's Disease Rating Scale-motor examination (UPDRS III) were assessed in 3 intervals, baseline, day 1 immediately after the first intervention and day 6 after 5 consecutive days of tDCS stimulation. The outcomes were analyzed by two-way repeated measure ANOVA. The level of significance was set at 0.05. Results: During walking at natural speed, there was significant interaction for cadence (p=0.027). Post-hoc one-way repeated measure ANOVA showed that the cadence significantly increased in day 6 when compared with that in day 1 (p<0.05) in the sham group only. There was no significant change for stride length, cadence and gait speed for the real tDCS group. There was also no significant change for stride length and gait speed for the sham group. During walking at the fastest speed there was no significant change for stride length, cadence, and gait speed in both subject groups. For UPDRS, there was no interaction and both real and sham group showed significant reduction in the motor score (p<0.05), indicating that subjects in both groups showed improvement in the PD-specific impairment. Conclusion: Application of anodal tDCS to lower limb motor M1 of PD patients demonstrated no significant difference between the real and sham group in walking performance and UPDRS III scores in this study profile. Further study is needed to examine the therapeutic benefit of tDCS in gait performance in patients with PD.

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