Neurological Rehabilitiation, Policlinico San Marco, Gruppo San Donato, Zingonia, Bergamo, Italy.
Department of Oncology and Hemato-Oncology, University of Milan, Via Santa Sofia 9/1, Milan, 20122, Italy.
J Neuroeng Rehabil. 2024 Sep 28;21(1):173. doi: 10.1186/s12984-024-01457-z.
Parkinson's disease (PD) is often accompanied by gait disorders and freezing of gait (FoG), disabling symptoms that are resistant to conventional dopamine treatments. Given the cerebellum's connectivity with the motor cortex and basal ganglia, and its implication in PD, combining transcranial direct current stimulation targeting the cerebellum (ctDCS) with physical exercise might improve gait and balance.
This study aimed to evaluate the effectiveness of a novel rehabilitation approach that combines noninvasive cerebellar stimulation with motor-cognitive training via an augmented reality treadmill (C-Mill VR) in individuals with PD and FoG.
Seventeen individuals with PD exhibiting FoG were enrolled in a randomized controlled trial. The participants were randomly assigned to a group receiving motor-cognitive training on the C-Mill VR with either ctDCS or sham ctDCS. Assessments were conducted pre-intervention (T0), post-intervention (T1) after 10 sessions, and at 4-week follow-up (T2), using various clinical scales. Additionally, C-Mill assessments of postural stability and gait were conducted at T0 and T1.
Although no significant time*group interactions were observed for any of the clinical variables measured, some were found in the C-Mill measures. Specifically, right lower limb sway in static conditions, both with eyes open (OAD) and eyes closed (OCD), significantly improved at T1 in the ctDCS group compared with the sham group.
C-Mill outcomes indicate that the combined treatment may enhance motor control. Participants who received ctDCS along with augmented reality motor-cognitive training showed better postural stability.
帕金森病（PD）常伴有步态障碍和冻结步态（FoG），这些症状会导致残疾，且对常规的多巴胺治疗有抗性。鉴于小脑与运动皮层和基底节的连接，以及其在 PD 中的作用，结合针对小脑的经颅直流电刺激（ctDCS）与体育锻炼可能会改善步态和平衡。
本研究旨在评估一种新的康复方法的有效性，该方法将小脑的非侵入性刺激与通过增强现实跑步机（C-Mill VR）进行的运动认知训练相结合，用于治疗 PD 伴 FoG 的患者。
17 名患有 PD 并伴有 FoG 的患者参加了一项随机对照试验。参与者被随机分配到接受 C-Mill VR 上的运动认知训练的组中，该训练接受 ctDCS 或假 ctDCS。在干预前（T0）、干预后 10 次（T1）和 4 周随访（T2）进行评估，使用各种临床量表。此外，在 T0 和 T1 进行 C-Mill 评估以测量姿势稳定性和步态。
虽然在测量的任何临床变量中都没有观察到时间*组间的显著相互作用，但在 C-Mill 测量中发现了一些。具体来说，在 ctDCS 组中，与假刺激组相比，在 T1 时，在静态条件下（睁眼（OAD）和闭眼（OCD）），右下肢摆动明显改善。
C-Mill 的结果表明，联合治疗可能增强运动控制。接受 ctDCS 联合增强现实运动认知训练的参与者表现出更好的姿势稳定性。
