Corominas-Teruel Xavier, Mozo Rosa María San Segundo, Simó Montserrat Fibla, Colomina Fosch Maria Teresa, Valero-Cabré Antoni
Department of Psychology, Neurobehavior and Health Research Group (NEUROLAB), Universitat Rovira i Virgili, Tarragona, Spain.
Cerebral Dynamics, Plasticity and Rehabilitation Group, Institut du Cerveau et de la Moelle Epinière, CNRS UMR 7225, Paris, France.
Front Neurol. 2022 Sep 7;13:953939. doi: 10.3389/fneur.2022.953939. eCollection 2022.
Over the last decade, transcranial direct current stimulation (tDCS) has set promise contributing to post-stroke gait rehabilitation. Even so, results are still inconsistent due to low sample size, heterogeneity of samples, and tDCS design differences preventing comparability. Nonetheless, updated knowledge in post-stroke neurophysiology and stimulation technologies opens up opportunities to massively improve treatments.
The current systematic review aims to summarize the current state-of-the-art on the effects of tDCS applied to stroke subjects for gait rehabilitation, discuss tDCS strategies factoring individual subject profiles, and highlight new promising strategies.
MEDLINE, SCOPUS, CENTRAL, and CINAHL were searched for stroke randomized clinical trials using tDCS for the recovery of gait before 7 February 2022. In order to provide statistical support to the current review, we analyzed the achieved effect sizes and performed statistical comparisons.
A total of 24 records were finally included in our review, totaling = 651 subjects. Detailed analyses revealed = 4 (17%) studies with large effect sizes (≥0.8), = 6 (25%) studies with medium ones (≥0.5), and = 6 (25%) studies yielding low effects sizes (≤ 0.2). Statistically significant negative correlations (rho = -0.65, = 0.04) and differences ( = 0.03) argued in favor of tDCS interventions in the sub-acute phase. Finally, significant differences ( = 0.03) were argued in favor of a bifocal stimulation montage (anodal M1 ipsilesional and cathodal M1 contralesional) with respect to anodal ipsilesional M1.
Our systematic review highlights the potential of tDCS to contribute to gait recovery following stroke, although also the urgent need to improve current stimulation strategies and subject-customized interventions considering stroke severity, type or time-course, and the use of network-based multifocal stimulation approaches guided by computational biophysical modeling.
PROSPERO: CRD42021256347.
在过去十年中，经颅直流电刺激（tDCS）有望促进中风后的步态康复。即便如此，由于样本量小、样本异质性以及tDCS设计差异导致缺乏可比性，其结果仍不一致。尽管如此，中风后神经生理学和刺激技术方面的最新知识为大幅改善治疗提供了机会。
本系统评价旨在总结tDCS应用于中风患者进行步态康复的当前最新研究现状，讨论考虑个体受试者特征的tDCS策略，并突出新的有前景的策略。
检索MEDLINE、SCOPUS、CENTRAL和CINAHL数据库，查找2022年2月7日前使用tDCS促进中风后步态恢复的随机临床试验。为了为当前评价提供统计支持，我们分析了所取得的效应量并进行了统计比较。
我们的评价最终纳入了24项记录，共计n = 651名受试者。详细分析显示，有4项（17%）研究效应量较大（≥0.8），6项（25%）研究效应量中等（≥0.5），6项（25%）研究效应量较小（≤0.2）。具有统计学意义的负相关性（rho = -0.65，p = 0.04）和差异（p = 0.03）支持在亚急性期进行tDCS干预。最后，具有统计学意义的差异（p = 0.03）支持双焦点刺激模式（阳极刺激患侧M1区，阴极刺激健侧M1区）优于阳极刺激患侧M1区。
我们的系统评价强调了tDCS对中风后步态恢复的潜在作用，尽管也迫切需要改进当前的刺激策略以及考虑中风严重程度、类型或病程的个体化干预措施，并使用基于计算生物物理模型指导的基于网络的多焦点刺激方法。
PROSPERO：CRD42021256347。
