Ahmad Zafran, Ishtiaq Summaiya, Ilyas Saad, Shahid Irum, Tariq Iqbal, Malik Arshad Nawaz, Liu Tian, Wang Jue
The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Institute of Health and Rehabilitation Science, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China.
National Engineering Research Center for Healthcare Devices Guangzhou, Guangzhou, Guangdong, China.
Front Neurosci. 2022 Nov 24;16:1035558. doi: 10.3389/fnins.2022.1035558. eCollection 2022.
Balance and gait impairments are major motor deficits in stroke patients that require intensive neuro-rehabilitation. Anodal transcranial direct current stimulation is a neuro-modulatory technique recently used in stroke patients for balance and gait improvement. Majority of studies focusing on tDCS have assessed its effects on cerebral motor cortex and more recently cerebellum as well but to our best knowledge the comparison of stimulating these two regions in stroke patients is not investigated so far.
The current study aimed to compare the effect of anodal transcranial direct current stimulation on cerebellar and cerebral motor cortex M1 in stroke patients.
This double-blinded, parallel, randomized, sham controlled trial included 66 patients with a first-ever ischemic stroke were recruited into three groups; Cerebellar stimulation group (CbSG), M1 Stimulation Group (MSG), and Sham stimulation group (SSG). A total of three sessions of anodal transcranial direct current stimulation were given on consecutive days in addition to non-immersive virtual reality using Xbox 360 with kinect. Anodal tDCS with an intensity of 2 mA was applied for a duration of 20 min. Primary outcome measures berg balance scale (BBS), timed up and go test (TUG), BESTest Balance Evaluation-Systems Test (BESTest) and secondary outcomes measures montreal cognitive assessment (MoCA), mini mental state examination (MMSE), Johns Hopkins Fall Risk Assessment Tool (JHFRAT), twenty five feet walk test (25FWT), six minute walk test (6MWT), and tDCS Adverse Effects was assessed before initiation of treatment (T0) and at the end of third session of stimulation (T1).
The results of between group's analysis using mean difference showed a significant difference with -value <0.05 for balance (BBS, TUG, BESTest), walking ability (6MWT, 25FWT), risk of fall (JHFRAT). Cognitive function did not show any significant change among the groups for MoCA with -value >0.05 but MMSE was improved having significant -value ( = 0.013). However, 6MWT and 25FWT showed non-significant results for both between group and within group analysis. In pairwise comparison both the cerebellar and cerebral stimulation groups showed Significant difference with -value <0.05 in comparison to sham stimulation; BBS (cerebellar vs. sham ≤ 0.001, cerebral vs. sham = 0.011), TUG (cerebellar vs. sham = 0.001, cerebral vs. sham = 0.041), Bestest (cerebellar vs. sham = 0.007, cerebral vs. sham = 0.003). Whereas for JHFRAT only cerebellar stimulation in comparison to sham and motor cortex stimulation showed significant improvements (cerebellar vs. M1 = 0.037, cerebellar vs. sham = 0.037). MMSE showed significant improvement in M1 stimulation (M1 vs. cerebellar = 0.036, M1 vs. sham = 0.011).
Findings of the study suggest anodal tDCS stimulation of the cerebellum and cerebral motor cortex both improves gait, balance and risk of fall in stroke patients. However, both stimulation sites do not induce any notable improvement in cognitive function. Effects of both stimulation sites have similar effects on mobility in stroke patients.
平衡和步态障碍是中风患者主要的运动缺陷，需要强化神经康复治疗。阳极经颅直流电刺激是一种神经调节技术，最近被用于中风患者以改善平衡和步态。大多数关注经颅直流电刺激（tDCS）的研究评估了其对大脑运动皮层的影响，最近也有研究关注对小脑的影响，但据我们所知，目前尚未对中风患者刺激这两个区域的效果进行比较。
本研究旨在比较阳极经颅直流电刺激对中风患者小脑和大脑运动皮层M1的影响。
这项双盲、平行、随机、假刺激对照试验纳入了66例首次发生缺血性中风的患者，分为三组：小脑刺激组（CbSG）、M1刺激组（MSG）和假刺激组（SSG）。除了使用带Kinect的Xbox 360进行非沉浸式虚拟现实训练外，连续三天每天进行总共三次阳极经颅直流电刺激。施加强度为2 mA的阳极tDCS，持续20分钟。主要结局指标为伯格平衡量表（BBS）、计时起立行走测试（TUG）、BESTest平衡评估系统测试（BESTest）；次要结局指标为蒙特利尔认知评估量表（MoCA）、简易精神状态检查表（MMSE）、约翰霍普金斯跌倒风险评估工具（JHFRAT）、25英尺步行测试（25FWT）、6分钟步行测试（6MWT），并在治疗开始前（T0）和第三次刺激结束时（T1）评估tDCS的不良反应。
组间分析采用均值差，结果显示在平衡（BBS、TUG、BESTest）、步行能力（6MWT、25FWT）、跌倒风险（JHFRAT）方面差异有统计学意义，P值<0.05。认知功能方面，MoCA在各组间无显著变化，P值>0.05，但MMSE有改善，P值有统计学意义（P = 0.013）。然而，6MWT和25FWT在组间和组内分析中均无显著结果。在两两比较中，小脑刺激组和大脑刺激组与假刺激组相比差异均有统计学意义，P值<0.05；BBS（小脑与假刺激组P≤0.ooo1，大脑与假刺激组P = 0.011）、TUG（小脑与假刺激组P = 0.001，大脑与假刺激组P = 0.041）、Bestest（小脑与假刺激组P = 0.007，大脑与假刺激组P = 0.003）。而对于JHFRAT，仅小脑刺激与假刺激及运动皮层刺激相比有显著改善（小脑与M1组P = 0.037，小脑与假刺激组P = 0.037）。MMSE在M1刺激组有显著改善（M1与小脑组P = 0.036，M1与假刺激组P = 0.011）。
研究结果表明，阳极tDCS刺激小脑和大脑运动皮层均可改善中风患者的步态、平衡和跌倒风险。然而，两个刺激部位均未引起认知功能的显著改善。两个刺激部位对中风患者运动能力的影响相似。
