da Cunha Maira Jaqueline, Pires Dorneles Gilson, Peres Alessandra, Maurer Simone, Horn Keli, Souza Pagnussat Aline
Rehabilitation Sciences Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil.
Movement Analysis and Rehabilitation Laboratory, UFCSPA, Porto Alegre, Brazil.
Int J Neurosci. 2024 Dec;134(12):1518-1527. doi: 10.1080/00207454.2023.2272041. Epub 2023 Oct 26.
Transcranial direct current stimulation (tDCS) and foot drop stimulators (FDS) are widely used for stroke rehabilitation. However, no study has investigated if tDCS could boost the effects of FDS and gait training in improving clinical parameters and neuroplasticity biomarkers of chronic post-stroke subjects.
To investigate the effects of combining tDCS and FDS on motor impairment, functional mobility, and brain-derived neurotrophic factor (BDNF) serum levels. Also, to evaluate the effects of this protocol on the insulin-like growth factor-1 (IGF-1), insulin growth factor-binding proteins-3 (IGFBP-3), interleukin (IL) 6 and 10, and tumor necrosis factor-α (TNF-α) levels.
Thirty-two chronic post-stroke individuals were randomized to tDCS plus FDS or sham tDCS plus FDS groups. Both groups underwent ten gait training sessions for two weeks using a FDS device and real or sham tDCS. Blood samples and clinical data were acquired before and after the intervention. Motor impairment was assessed by the Fugl-Meyer Assessment and functional mobility using the Timed up and Go test.
Both groups improved the motor impairment and functional mobility and increased the BDNF levels. Both groups also increased the IL-10 and decreased the cortisol, IL-6, and TNF-α levels. No difference was observed between groups.
tDCS did not add effect to FDS and gait training in improving clinical parameters and neuroplasticity biomarkers in chronic post-stroke individuals. Only FDS and gait training might be enough for people with chronic stroke to modify some clinical parameters and neuroplasticity biomarkers.
经颅直流电刺激（tDCS）和足下垂刺激器（FDS）广泛应用于中风康复。然而，尚无研究调查tDCS是否能增强FDS和步态训练对改善慢性中风患者临床参数和神经可塑性生物标志物的效果。
研究tDCS与FDS联合应用对运动功能障碍、功能活动能力以及脑源性神经营养因子（BDNF）血清水平的影响。同时，评估该方案对胰岛素样生长因子-1（IGF-1）、胰岛素生长因子结合蛋白-3（IGFBP-3）、白细胞介素（IL）6和10以及肿瘤坏死因子-α（TNF-α）水平的影响。
将32例慢性中风患者随机分为tDCS联合FDS组或假tDCS联合FDS组。两组均使用FDS设备及真正的或假的tDCS进行为期两周的十次步态训练。在干预前后采集血样和临床数据。采用Fugl-Meyer评估法评估运动功能障碍，采用计时起立行走测试评估功能活动能力。
两组的运动功能障碍和功能活动能力均得到改善，BDNF水平均升高。两组的IL-10水平也均升高，皮质醇、IL-6和TNF-α水平均降低。两组之间未观察到差异。
在改善慢性中风患者的临床参数和神经可塑性生物标志物方面，tDCS并未增强FDS和步态训练的效果。对于慢性中风患者，仅FDS和步态训练可能就足以改善一些临床参数和神经可塑性生物标志物。
