Background: Over the last decade, transcranial direct current stimulation (tDCS) has set promise contributing to post-stroke gait rehabilitation. Even so, results are still inconsistent due to low sample size, heterogeneity of samples, and tDCS design differences preventing comparability. Nonetheless, updated knowledge in post-stroke neurophysiology and stimulation technologies opens up opportunities to massively improve treatments.
Objective: The current systematic review aims to summarize the current state-of-the-art on the effects of tDCS applied to stroke subjects for gait rehabilitation, discuss tDCS strategies factoring individual subject profiles, and highlight new promising strategies.
Methods: MEDLINE, SCOPUS, CENTRAL, and CINAHL were searched for stroke randomized clinical trials using tDCS for the recovery of gait before 7 February 2022. In order to provide statistical support to the current review, we analyzed the achieved effect sizes and performed statistical comparisons.
Results: A total of 24 records were finally included in our review, totaling = 651 subjects. Detailed analyses revealed = 4 (17%) studies with large effect sizes (≥0.8), = 6 (25%) studies with medium ones (≥0.5), and = 6 (25%) studies yielding low effects sizes (≤ 0.2). Statistically significant negative correlations (rho = -0.65, = 0.04) and differences ( = 0.03) argued in favor of tDCS interventions in the sub-acute phase. Finally, significant differences ( = 0.03) were argued in favor of a bifocal stimulation montage (anodal M1 ipsilesional and cathodal M1 contralesional) with respect to anodal ipsilesional M1.
Conclusion: Our systematic review highlights the potential of tDCS to contribute to gait recovery following stroke, although also the urgent need to improve current stimulation strategies and subject-customized interventions considering stroke severity, type or time-course, and the use of network-based multifocal stimulation approaches guided by computational biophysical modeling.
Systematic Review Registration: PROSPERO: CRD42021256347.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9490093 | PMC |
| http://dx.doi.org/10.3389/fneur.2022.953939 | DOI Listing |
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