Brain stimulation paired with novel locomotor training with robotic gait orthosis in chronic stroke: a feasibility study

Abstract

Objectives: 1) To investigate the feasibility of combining transcranial direct current stimulation (tDCS) to the lower extremity (LE) motor cortex with novel locomotor training to facilitate gait in subjects with chronic stroke and low ambulatory status, and 2) to obtain insight from study subjects and their caregivers to inform future trial design.

Methods: Double-blind, randomized controlled study with additional qualitative exploratory descriptive design. One-month follow-up.10 subjects with stroke were recruited and randomized to active tDCS or sham tDCS for 12 sessions. Both groups participated in identical locomotor training with a robotic gait orthosis (RGO) following each tDCS session. RGO training protocol was designed to harness cortical neuroplasticity. Data analysis included assessment of functional and participation outcome measures and qualitative thematic analysis.

Results: Eight subjects completed the study. Both groups demonstrated trends toward improvement, but the active tDCS group showed greater improvement than the sham group. Qualitative analyses indicated beneficial effects of this combined intervention.

Conclusions: It is feasible to combine tDCS targeting the LE motor cortex with our novel locomotor training. It appears that tDCS has the potential to enhance the effectiveness of gait training in chronic stroke. Insights from participants provide additional guidance in designing future trials.

Conflict of interest statement

Declaration of Interest: The authors declare no potential conflicts of interest with respect to the authorship and/or publication of this article.

Figures

Fig. 1

This is a mock depiction of the tDCS delivery. The salmon-colored electrode is the anode, or excitatory electrode; it was placed over the cortical motor area controlling the lower extremity. The blue electrode is the cathode, or inhibitory electrode; it was placed supraorbitally.

Fig. 2

LT-RGO (Lokomat, Hocoma Inc, Switzerland). The harness system provides body weight support. The robotic exoskeleton facilitates a bilaterally symmetrical gait pattern as the user attempts to walk on the treadmill.

Fig. 3

Results comparing group data (active versus sham tDCS) for the 10 Meter Walk Test, Timed Up and Go, Functional Ambulation Category, and Berg Balance Score including change from baseline to post-intervention (4 weeks) and change from baseline to 1-month follow-up.