Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC.
Division of Nerve Repair, Department of Neurosurgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
Neurorehabil Neural Repair. 2024 Sep;38(9):680-692. doi: 10.1177/15459683241268583. Epub 2024 Aug 5.
Gait disturbances are exacerbated in people with Parkinson's disease (PD) during dual-task walking (DTW). Transcranial direct current stimulation (tDCS) has been shown to exert beneficial effects on gait performance and cortical excitability in PD; however, its combined effects with treadmill training (TT) remain undetermined.
To investigate the effects of tDCS followed by TT on DTW performance and cortical excitability in individuals with PD.
Thirty-four PD participants were randomized to dorsal lateral prefrontal cortex (DLPFC) tDCS and TT group (DLPFC tDCS + TT group) or sham tDCS and TT group (sham tDCS + TT group) for 50 minutes per session (20 minutes tDCS followed by 30 minutes TT), 12 sessions within 5 weeks (2-3 sessions each week). Outcome measures included cognitive dual-task walking (CDTW), motor dual-task walking (MDTW), usual walking performance, cortical excitability, functional mobility, cognitive function, and quality of life.
The DLPFC tDCS + TT group exerted significantly greater improvement in CDTW velocity ( = .046), cadence ( = .043), and stride time ( = .041) compared to sham tDCS + TT group. In addition, DLPFC tDCS + TT group demonstrated a significant increase in resting motor threshold of stimulated hemisphere compared with sham tDCS + TT group ( = .026). However, no significant differences between groups were found in MDTW performance and other outcomes.
Twelve-session DLPFC tDCS followed by TT significantly improved CDTW performance and decreased cortical excitability more than TT alone in individuals with PD. Applying DLPFC tDCS prior to TT could be suggested for gait rehabilitation in individuals with PD.
Australian New Zealand Clinical Trials Registry ACTRN12622000101785.
在进行双重任务行走（DTW）时，帕金森病（PD）患者的步态障碍会加剧。经颅直流电刺激（tDCS）已被证明对 PD 患者的步态表现和皮质兴奋性有有益影响；然而，其与跑步机训练（TT）联合使用的效果仍不确定。
研究背外侧前额叶皮质（DLPFC）tDCS 联合 TT 对 PD 患者 DTW 表现和皮质兴奋性的影响。
34 名 PD 参与者被随机分为背外侧前额叶皮质（DLPFC）tDCS 和 TT 组（DLPFC tDCS+TT 组）或假刺激和 TT 组（假刺激+TT 组），每组接受 50 分钟的治疗（20 分钟 tDCS 后进行 30 分钟 TT），每周 2-3 次，共 12 次，为期 5 周。结果测量包括认知双重任务行走（CDTW）、运动双重任务行走（MDTW）、常规行走表现、皮质兴奋性、功能移动性、认知功能和生活质量。
与假刺激+TT 组相比，DLPFC tDCS+TT 组在 CDTW 速度（ = .046）、步频（ = .043）和步长时间（ = .041）方面的改善更为显著。此外，DLPFC tDCS+TT 组与假刺激+TT 组相比，刺激半球的静息运动阈值显著增加（ = .026）。然而，两组在 MDTW 表现和其他结果方面无显著差异。
12 次 DLPFC tDCS 联合 TT 显著改善 PD 患者的 CDTW 表现，且比 TT 单独治疗更能降低皮质兴奋性。在 PD 患者的步态康复中，可考虑在 TT 前应用 DLPFC tDCS。
澳大利亚新西兰临床试验注册中心 ACTRN12622000101785。
