Mitsutake Tsubasa, Imura Takeshi, Hori Tomonari, Sakamoto Maiko, Tanaka Ryo
Department of Physical Therapy, Fukuoka International University of Health and Welfare, Fukuoka, Japan.
Department of Rehabilitation, Faculty of Health Sciences, Hiroshima Cosmopolitan University, Hiroshima, Japan.
Front Hum Neurosci. 2021 Dec 10;15:782305. doi: 10.3389/fnhum.2021.782305. eCollection 2021.
Combining transcranial direct current stimulation (tDCS) and repetitive gait training may be effective for gait performance recovery after stroke; however, the timing of stimulation to obtain the best outcomes remains unclear. We performed a systematic review and meta-analysis to establish evidence for changes in gait performance between online stimulation (tDCS and repetitive gait training simultaneously) and offline stimulation (gait training after tDCS). We comprehensively searched the electronic databases Medline, Cochrane Central Register of Controlled Trials, Physiotherapy Evidence Database, and Cumulative Index to Nursing and Allied Health Literature, and included studies that combined cases of anodal tDCS with motor-related areas of the lower limbs and gait training. Nine studies fulfilled the inclusion criteria and were included in the systematic review, of which six were included in the meta-analysis. The pooled effect estimate showed that anodal tDCS significantly improved the 10-m walking test ( = 0.04; = 0%) and 6-min walking test ( = 0.001; = 0%) in online stimulation compared to sham tDCS. Our findings suggested that simultaneous interventions may effectively improve walking ability. However, we cannot draw definitive conclusions because of the small sample size. More high-quality studies are needed on the effects of online stimulation, including various stimulation parameters.
将经颅直流电刺激（tDCS）与重复步态训练相结合可能对中风后步态功能恢复有效；然而，获得最佳效果的刺激时机仍不明确。我们进行了一项系统评价和荟萃分析，以确定在线刺激（tDCS与重复步态训练同时进行）和离线刺激（tDCS后进行步态训练）之间步态功能变化的证据。我们全面检索了电子数据库Medline、Cochrane对照试验中央注册库、物理治疗证据数据库以及护理与健康相关文献累积索引，并纳入了将阳极tDCS与下肢运动相关区域及步态训练相结合的病例研究。九项研究符合纳入标准并被纳入系统评价，其中六项被纳入荟萃分析。汇总效应估计显示，与假tDCS相比，在线刺激中阳极tDCS显著改善了10米步行试验（P = 0.04；I² = 0%）和6分钟步行试验（P = 0.001；I² = 0%）。我们的研究结果表明，同时进行干预可能有效提高步行能力。然而，由于样本量小，我们无法得出明确结论。需要更多关于在线刺激效果的高质量研究，包括各种刺激参数。
