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Effect of single-session dual-tDCS before physical therapy on lower-limb performance in sub-acute stroke patients

Anodal stimulation increases cortical excitably, whereas cathodal stimulation
decreases cortical excitability. Dual transcranial direct current stimulation
(tDCS; anodal over the lesioned hemisphere, cathodal over the non-lesioned
hemisphere) was found to enhance motor learning. The corresponding tDCS-induced
changes were reported to reduce the inhibition exerted by the unaffected
hemisphere on the affected hemisphere and restore the normal balance of the
interhemispheric inhibition.
Most studies were devoted to the possible
modification of upper-limb motor function after tDCS; however, almost no study
has demonstrated its effects on lower-limb function and gait, which are also
commonly disordered in stroke patients with motor deficits. In this randomized
sham-controlled crossover study, we included 19 patients with sub-acute stroke.
Participants were randomly allocated to receive real or sham dual-tDCS followed
by conventional physical therapy with an intervention interval of at least 1
week. Dual-tDCS was applied over the lower-limb M1 at 2-mA intensity for 20min.
Lower-limb performance was assessed by the Timed Up and Go (TUG) and
Five-Times-Sit-To-Stand (FTSTS) tests and muscle strength was assessed by peak
knee torque of extension. We found a significant increase in time to perform the
FTSST for the real group, with improvements significantly greater than for the
sham group; the TUG score was significantly increased but not higher than for the
sham group. An after-effect on FTSTS was found at approximately 1 week after the
real intervention. Muscle strength was unchanged in both limbs for both real and
sham groups. Our results suggest that a single session of dual-tDCS before
conventional physical therapy could improve sit-to-stand performance, which
appeared to be improved over conventional physical therapy alone. However,
strength performance was not increased after the combination treatment.
CI - Copyright (c) 2018 Elsevier Masson SAS. All rights reserved.

Langue : ANGLAIS

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