School of Physical Therapy, Texas Woman's University, Dallas Texas 75235 United States.
School of Physical Therapy, Texas Woman's University, Dallas Texas 75235 United States.
Gait Posture. 2020 May;78:1-5. doi: 10.1016/j.gaitpost.2020.02.020. Epub 2020 Feb 29.
Individuals with stroke often experience difficulty in dual-task walking and are prone to falling when walking and talking. Previous studies in other populations have suggested that non-invasive brain stimulation could enhance dual-task gait performance by stimulating dorsolateral prefrontal cortex (DLPFC) or supplementary motor area (SMA). It was unclear if the benefits of brain stimulation would be observed in individuals with stroke.
Would single-session 5 Hz rTMS applied to DLPFC or SMA improve dual-task gait performance in individuals with stroke?
This single group repeated measure study included fifteen individuals with left chronic stroke (mean age = 58 years). Participants received 5 Hz rTMS to either DLPFC, SMA, or M1 of the left lesioned hemisphere across three different sessions. Single- and dual-task gait speed was assessed before and after rTMS with the dualtask gait being walking and counting backward by 3 s.
We observed that rTMS to left DLPFC resulted in a greater increase in dual-task gait speed, but not single-task gait speed, compared to the other two stimulation sites (M1 and SMA) but the difference was not statistically significant (p = 0.06). Five out of fifteen participants demonstrated a clinically significant improvement in dual-task gait speed (> 0.1 m/s) after rTMS to DLPFC.
The results suggest that DLPFC could be a potential treatment target to improve dual-task gait performance in persons with chronic stroke.
中风患者在进行双任务行走时通常会遇到困难，并且在行走和说话时容易摔倒。先前在其他人群中的研究表明，非侵入性脑刺激可以通过刺激背外侧前额叶皮层（DLPFC）或辅助运动区（SMA）来提高双任务步态表现。目前尚不清楚中风患者是否会观察到脑刺激的益处。
单次 5Hz rTMS 应用于 DLPFC 或 SMA 是否会改善中风患者的双任务步态表现？
这项单组重复测量研究纳入了 15 名左侧慢性中风患者（平均年龄=58 岁）。参与者在三个不同的疗程中接受了左侧病变半球的 DLPFC、SMA 或 M1 的 5Hz rTMS。在 rTMS 前后，通过双任务步态（步行和倒计数 3 秒）评估单任务和双任务的步行速度。
我们观察到，与其他两个刺激部位（M1 和 SMA）相比，rTMS 左侧 DLPFC 导致双任务步态速度的增加更大，而单任务步态速度没有增加，但差异无统计学意义（p=0.06）。在接受 DLPFC rTMS 后，15 名参与者中有 5 名的双任务步态速度（>0.1m/s）出现了临床意义上的显著改善。
结果表明，DLPFC 可能是改善慢性中风患者双任务步态表现的潜在治疗靶点。
