Effects of Anodal Transcranial Direct Current Stimulation With Overground Gait Training on Lower Limb Performance in Individuals With Incomplete Spinal Cord Injury

Objective: To determine the effects of anodal transcranial direct current stimulation (tDCS) combined with overground gait training on gait performance, dynamic balance, sit -to -stand performance, and quality of life in individuals with incomplete spinal cord injuries (iSCI). Design: Double-blind sham -controlled trial with a matched -pair design. Setting: Sirindhorn National Medical Rehabilitation Institute, Thailand. Participants: Individuals with iSCI (n=34) were allocated to the anodal or sham groups. Intervention: Anodal tDCS was administered over the M1 lower -limb motor area at an intensity of 2 mA for 20 min in the anodal group, while the sham group received a 30-s stimulation. Both groups received 40 min of overground gait training after tDCS for 5 consecutive daily sessions. Main Outcome Measures: The 10 -meter walk test (10MWT) was the primary outcome, while spatiotemporal gait parameters, the timed Up and Go test, Five -Time Sit -to -Stand Test, and World Health Organization Quality of Life-BREF were secondary outcomes. Outcomes were assessed at baseline, post -intervention, and at 1 -month (1M) and 2 -month (2M) follow-ups. Result: Improvements in walking speed measured using the 10MWT were observed in both groups. However, the anodal group showed a greater improvement than the sham group. For fast speed, the mean between -group differences were 0.10 m/s, 95% CI (0.02 to 0.17) (post -intervention), 0.11 m/s, (0.03 to 0.19) (1M), and 0.11 m/s, (0.03 to 0.20) (2M), while for self-selected speed, the median differences were 0.10 m/s, 95% CI (0.06 to 0.14) (post -intervention) and 0.09 m/s, (0.01 to 0.19) (2M). The anodal group also had a greater stride length difference post -intervention (median difference: 0.07 m, 95% CI (0.01 to 0.14)). No significant between -group differences were found for other outcomes. Conclusion: Five -session of anodal tDCS with gait training slightly improved walking speed, sustained for 2 months post -intervention. However, effect on spatiotemporal gait parameters was limited and dynamic balance, functional tasks (ie, sit -to -stand), and quality of life were unaffected compared with overground gait training. Archives of Physical Medicine and Rehabilitation 2024;105:857 -67 (c) 2023 by the American Congress of Rehabilitation Medicine.