经颅直流电刺激联合平衡训练对慢性踝关节不稳患者预期姿势调整的影响。
Effects of Combining Transcranial Direct Current Stimulation With Balance Training on Anticipatory Postural Adjustments in Persons With Chronic Ankle Instability.
作者信息
Beyraghi Zivar, Khanmohammadi Roya, Hadian Mohammad Reza
机构信息
Physical Therapy Department, Tehran University of Medical Sciences, Tehran, Iran.
出版信息
Sports Health. 2025 Mar;17(2):383-393. doi: 10.1177/19417381241247746. Epub 2024 May 8.
BACKGROUND
The combination of transcranial direct current stimulation (tDCS) with balance training could integrate central and peripheral neural mechanisms. This study aimed to investigate the effects of concurrent balance training and tDCS over the supplementary motor area (SMA) on anticipatory postural adjustments during gait initiation (GI) in persons with chronic ankle instability (CAI).
HYPOTHESIS
Balance training will increase the center of pressure (COP) velocity and displacement during GI phases in all participants, and those receiving real tDCS will show greater increases.
STUDY DESIGN
Randomized controlled trial.
LEVEL OF EVIDENCE
Level 2.
METHODS
A total of 32 subjects were allocated to 2 groups: (1) intervention (balance training plus real tDCS) and (2) control (balance training plus sham tDCS). Outcome measures were COP-related parameters (displacement and velocity) during phases of GI (anticipatory, weight transition, and locomotor).
RESULTS
The results showed that, in the anticipatory phase, the anteroposterior displacement of the COP was increased significantly at posttest relative to pretest across both groups, (1,30) = 5.733, = 0.02. In addition, both groups revealed an increase in the mediolateral COP velocity at posttest, (1,30) = 10.523, < 0.01. In the weight transition phase, both groups had higher mediolateral COP velocity at posttest, (1,30) = 30.636, < 0.01. In the locomotor phase, in both groups, the anteroposterior COP velocity was increased significantly at posttest compared with pretest, (1,30) = 5.883, = 0.02.
CONCLUSION
Both groups demonstrated improvements in the anticipatory and execution phases of GI. Since no between-group difference was found, it can be interpreted that the anodal tDCS applied over the SMA has no added value over sham stimulation.
CLINICAL RELEVANCE
Balance training is beneficial for persons with CAI and can improve the anticipation and execution phases of GI without the aid of brain stimulation.
背景
经颅直流电刺激（tDCS）与平衡训练相结合可整合中枢和外周神经机制。本研究旨在探讨平衡训练与经颅直流电刺激辅助运动区（SMA）同时进行对慢性踝关节不稳（CAI）患者步态起始（GI）期间预期姿势调整的影响。
假设
平衡训练将增加所有参与者在GI阶段的压力中心（COP）速度和位移，接受真正tDCS的参与者将表现出更大的增加。
研究设计
随机对照试验。
证据水平
2级。
方法
总共32名受试者被分配到2组：（1）干预组（平衡训练加真正的tDCS）和（2）对照组（平衡训练加假tDCS）。结果测量指标为GI各阶段（预期、体重转移和运动）与COP相关的参数（位移和速度）。
结果
结果显示，在预期阶段，两组在测试后相对于测试前COP的前后位移均显著增加，（1,30）=5.733，P=0.02。此外，两组在测试后均显示COP的内外侧速度增加，（1,30）=10.523，P<0.01。在体重转移阶段，两组在测试后的内外侧COP速度均较高，（1,30）=30.636，P<0.01。在运动阶段，两组在测试后与测试前相比，COP的前后速度均显著增加，（1,30）=5.883，P=0.02。
结论
两组在GI的预期和执行阶段均表现出改善。由于未发现组间差异，可以解释为在SMA上施加的阳极tDCS相对于假刺激没有附加价值。
临床意义
平衡训练对CAI患者有益，无需脑刺激即可改善GI的预期和执行阶段。
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