Anodal tDCS and virtual reality gait rehabilitation in individuals with chronic stroke: a case series report

 Of course, your competent? doctor has had protocols for using anodal tDCS for years already. NO?  So, you DON'T have a functioning stroke doctor, do you?

anodal tDCS (29 posts to July 2013)

Anodal tDCS and virtual reality gait rehabilitation in individuals with chronic stroke: a case series report

Aracely MarksShelley Oliveira BarbosaDaniella NapoliSusan E. D'Andrea^*

• Motion VR Biomechanics Laboratory, Department of Kinesiology, University of Rhode Island, Kingston, RI, United States

Background: Stroke is a principal cause of long-term disability worldwide, significantly impairing motor function, including gait and mobility. Conventional physical therapy, primarily focusing on repetitive, task-specific exercises, often falls short in addressing the complex rehabilitative needs of stroke survivors. Emerging technologies such as virtual reality (VR) and transcranial direct current stimulation (tDCS) have shown potential to enhance neuroplasticity and functional recovery, suggesting that their combined use could offer a novel pathway for stroke rehabilitation.

Objective: This study evaluated the efficacy of an integrated VR and tDCS treadmill training protocol in improving gait and mobility outcomes among individuals with chronic stroke.

Methods: Five chronic stroke patients were recruited for this study. Participants were randomly assigned to receive either anodal tDCS or sham stimulation in conjunction with VR treadmill training. The anodal stimulation was targeted at the ipsilesional motor cortex, specifically over the primary motor cortex (M1) area corresponding to the C3/C4 locations in the 10–20 EEG system. The intervention consisted of 10 30-min sessions over 2 weeks. Clinical assessments, including the Dynamic Gait Index (DGI), Berg Balance Scale (BBS), 10-meter Walk Test (10MWT), and the Timed Up and Go Test (TUG) were conducted pre-intervention, immediately post-intervention, and at a 2-week follow-up.

Results: All participants demonstrated improvements in the clinical measures post-intervention, irrespective of whether they received anodal tDCS or sham stimulation. Notably, clinically significant improvements, defined by an improvement greater or equal to the established minimal clinically important differences (MCIDs), were observed in DGI scores for four participants, suggesting enhanced gait functionality.

Conclusion: The combined VR and tDCS interventions promise to improve gait and mobility in chronic stroke survivors. While the observed improvements were not distinctly attributed to tDCS, the role of VR training was notably beneficial. These preliminary findings underscore the potential of integrating emerging technologies in stroke rehabilitation and highlight the need for future research with larger cohorts to explore the distinct contributions of each modality and validate this integrative approach.

Introduction

Stroke is a leading cause of long-term disability, often resulting in motor deficits like weakness, spasticity, poor coordination, and balance issues, which impair gait (Langhorne et al., 2011). Post-stroke rehabilitation is essential for mobility and independence but relies heavily on structured, repetitive exercises (Pollock et al., 2014) which may lack the engagement needed for sustained practice and motor learning (Winstein et al., 2016). Challenges such as therapist availability and the cost of long-term care highlight the need for cost-effective, innovative solutions to support home-based exercise (Cramer et al., 2011).

Virtual reality (VR) rehabilitation addresses these limitations, offering engaging, variable, and intensive rehabilitation options. VR therapy integrates visual and sensory feedback to create an immersive and motivating environment that can drive neuroplastic changes through an enriched experience (Laver et al., 2011). Virtual environments simulate real-world tasks and challenges that can be adapted to individual patient needs and progress (Crosbie et al., 2007). Anodal transcranial direct current stimulation (tDCS), a form of non-invasive brain stimulation, has been shown to enhance cortical excitability, potentially facilitating the relearning of motor skills and expediting recovery, which may be pivotal in restoring motor function post-stroke (Stagg and Johansen-Berg, 2013). Using the engaging and adaptable nature of VR and the neuroplasticity promoting effects of tDCS, this integrative approaches could represent a new path for post-stroke motor recovery (Fregni and Pascual-Leone, 2007).

A considerable amount of research has explored the efficacy of VR rehabilitation in stroke. Recent literature shows the VR training can improve balance and fall risk (Kannan et al., 2019; Lee et al., 2024; Zhang et al., 2021) and mobility and gait (Anwar et al., 2021; De Keersmaecker et al., 2023; Gibbons et al., 2016; Lin et al., 2023). Additionally, by delivering real-life environments, VR training can accelerate the transfer of skills to activities of daily living (Aderinto et al., 2023).

This paper presents a series of five patients who receive VR training to improve gait and mobility after a stroke.

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