Bueno Maria Eduarda Brandão, Silva Taís Caroline Oliveira da, de Souza Rogério José, Volpe Renata Pasquarelli, Moura Felipe Arruda, Smaili Suhaila Mahmoud
Neurofunctional Physical Therapy Research Group (GPFIN), Graduate Program in Rehabilitation Sciences - State University of Londrina, Paraná, Brazil.
Laboratory of Applied Biomechanics, Sport Sciences Department - State University of Londrina, Paraná, Brazil.
Clin Neurol Neurosurg. 2023 Mar;226:107604. doi: 10.1016/j.clineuro.2023.107604. Epub 2023 Jan 24.
Application methods of transcranial direct current stimulation (tDCS) in Parkinson's disease (PD) are quite divergent making it difficult to define the clinical effectiveness of the tDCS on PD. Thus, the aim of this study was to verify the acute effects of tDCS when applied to different targets (Cz or C3-Cz-C4) combined to physical therapy to improve balance and gait in individuals with PD. A randomized controlled trial was conducted, with 50 individuals who were separated into four groups: 1) Real tDCS (Cz) + physical therapy, 2) Real tDCS (C3-Cz-C4) + physical therapy, 3) Sham tDCS + physical therapy and 4) Educational lecture + physical therapy. The current intensity was 2 mA, applied for 20 min. For the instrumental assessment of balance and gait, the 3D motion analysis system was used. For the biomechanical analysis of gait, three different conditions were performed: normal gait, dual task gait and obstacle gait. For balance analysis, the following positions were utilized: Romberg with eyes opened, Romberg with eyes closed, Tandem with eyes opened and Tandem with eyes closed. All evaluations were performed pre-intervention, post-intervention (immediately at the end of the intervention) and were followed-up on (24 h after the end of the intervention). No statistically significant differences were found for all gait and balance outcomes when considering the interaction between time (pre, post and follow-up assessments) versus group (Education, Sham, Cz and C3-Cz-C4). In conclusion, it was found that one session of tDCS, stimulating Cz or C3-Cz-C4 combined with physical therapy, was not effective in improving the balance and gait in people with PD as compared to sham tDCS or educational lecture plus physiotherapy.
经颅直流电刺激（tDCS）在帕金森病（PD）中的应用方法差异很大，这使得难以确定tDCS对PD的临床疗效。因此，本研究的目的是验证tDCS应用于不同靶点（Cz或C3 - Cz - C4）并结合物理治疗时对改善PD患者平衡和步态的急性影响。进行了一项随机对照试验，50名个体被分为四组：1）真正的tDCS（Cz）+物理治疗，2）真正的tDCS（C3 - Cz - C4）+物理治疗，3）假tDCS +物理治疗，4）教育讲座+物理治疗。电流强度为2 mA，施加20分钟。使用3D运动分析系统对平衡和步态进行仪器评估。对于步态的生物力学分析，进行了三种不同的情况：正常步态、双重任务步态和障碍步态。对于平衡分析，采用了以下姿势：睁眼Romberg姿势、闭眼Romberg姿势、睁眼串联姿势和闭眼串联姿势。所有评估均在干预前、干预后（干预结束时立即进行）以及随访时（干预结束后24小时）进行。考虑时间（干预前、干预后和随访评估）与组（教育组、假刺激组、Cz组和C3 - Cz - C4组）之间的相互作用时，所有步态和平衡结果均未发现统计学上的显著差异。总之，研究发现，与假tDCS或教育讲座加物理治疗相比，单次tDCS刺激Cz或C3 - Cz - C4并结合物理治疗对改善PD患者的平衡和步态无效。
