Immediate Effects of Anodal Transcranial Direct Current Stimulation on Postural Stability Using Computerized Dynamic Posturography in People With Chronic Post-stroke Hemiparesis

Jing Nong Liang; Leonard Ubalde; Jordon Jacklin; Peyton Hobson; Sara Wright-Avila; Yun-Ju Lee

doi:10.3389/fnhum.2020.00341

Immediate Effects of Anodal Transcranial Direct Current Stimulation on Postural Stability Using Computerized Dynamic Posturography in People With Chronic Post-stroke Hemiparesis

Front Hum Neurosci. 2020 Aug 27:14:341. doi: 10.3389/fnhum.2020.00341. eCollection 2020.

Authors

Jing Nong Liang^{1

2}, Leonard Ubalde^{1

2}, Jordon Jacklin¹, Peyton Hobson¹, Sara Wright-Avila¹, Yun-Ju Lee³

Affiliations

¹ Department of Physical Therapy, University of Nevada, Las Vegas, Las Vegas, NV, United States.
² Interdisciplinary Doctoral Program in Neuroscience, University of Nevada, Las Vegas, Las Vegas, NV, United States.
³ Department of Industrial Engineering and Engineering Management, National Tsing Hua University, Hsinchu, Taiwan.

Abstract

Postural stability is commonly decreased in individuals with chronic post-stroke hemiparesis due to multisystemic deficits. Transcranial direct current stimulation (tDCS) is a non-invasive method to modulate cortical excitability, inducing neuroplastic changes to the targeted cortical areas and has been suggested to potentially improve motor functions in individuals with neurological impairments. The purpose of this double-blinded, sham-controlled study was to examine the acute effects of anodal tDCS over the lesioned motor cortex leg area with concurrent limits of stability training on postural control in individuals with chronic post-stroke hemiparesis. Ten individuals with chronic post-stroke hemiparesis received either anodal or sham tDCS stimulation over the lesioned leg region of the motor cortex while undergoing 20 min of postural training. The type of stimulation to receive during the first session was pseudorandomized, and the two sessions were separated by 14 days. Before and immediately after 20 min of tDCS, the 10 m walk test, the Berg Balance Scale, and dynamic posturography assessments were performed. After a single session of anodal tDCS with concurrent postural training, we observed no changes in clinical measures of balance and walking, assessed using the Berg Balance Scale and 10 m walk test. For dynamic posturography assessments, participants demonstrated improvements in adaptation responses to toes-up and toes-down perturbations, regardless of the type of tDCS received. Additionally, improved performance in the shifting center of gravity was observed during anodal tDCS. Taken together, these preliminary findings suggest that tDCS can potentially be used as a feasible approach be incorporated into the rehabilitation of chronic post-stroke individuals with issues related to postural control and fear of falling, and that multiple sessions of tDCS stimulation may be needed to improve functional measures of postural control and walking.

Keywords: center of gravity; dynamic posturography; fear of falling; post-stroke hemiparesis; postural control; transcranial direct current stimulation.