Transcranial direct current stimulation associated with gait training in Parkinson's disease: A pilot randomized clinical trial.

OBJECTIVE: The aim of this study is to investigate the effects of transcranial direct current stimulation (tDCS) combined with cueing gait training (CGT) on functional mobility in patients with Parkinson´s disease (PD). METHODS: A pilot double-blind controlled, randomized clinical trial was conducted with 22 patients with PD assigned to the experimental (anodal tDCS plus CGT) and control group (sham tDCS plus CGT). The primary outcome (functional mobility) was assessed by 10-m walk test, cadence, stride length, and Timed Up and Go test. Motor impairment, bradykinesia, balance, and quality of life were analyzed as secondary outcomes. Minimal clinically important differences (MCIDs) were observed when assessing outcome data. RESULTS: Both groups demonstrated similar gains in all outcome measures, except for the stride length. The number of participants who showed MCID was similar between groups. CONCLUSION: The CGT provided many benefits to functional mobility, motor impairment, bradykinesia, balance, and quality of life. However, these effect magnitudes were not influenced by stimulation, but tDCS seems to prolong the effects of cueing therapy on functional mobility.

Dopamine-independent effects of combining transcranial direct current stimulation with cued gait training on cortical excitability and functional mobility in Parkinson's disease.

OBJECTIVE: To investigate the dopamine-dependent effect of combining transcranial direct current stimulation (tDCS) with visually cued gait training on cortical excitability and functional mobility in individuals with Parkinson's disease. DESIGN: A pilot, randomized, double-blind, controlled trial. METHODS: Twenty-two patients with Parkinson's disease were randomly assigned to 2 groups: (i) active anodal tDCS over the supplementary motor area (experimental group), or (ii) sham tDCS (control group). After tDCS, both groups participated in a visually cued gait training. Functional mobility was evaluated with the Timed Up and Go test (TUG). Cortical excitability was assessed by active motor threshold and motor-evoked potential amplitudes elicited by transcranial magnetic stimulation in patients in on and off medication states. RESULTS: In the TUG test both groups achieved improvements either in on or off medication condition compared with baseline. However, for both medication conditions, these gains were maintained only in the experimental group during 1-month follow-up, compared with baseline. In the experimental group, enhancement of cortical excitability was observed at post-intervention and 1-month follow-up (both only for the "on" phase) compared with baseline. CONCLUSION: These findings suggest that tDCS, independent of dopaminergic medication state, might prolong the positive effect induced by cued gait training on functional mobility.