Transcranial direct current stimulation for improving ambulation after stroke: a systematic review and meta-analysis

Area of Science:

• Neuroscience
• Rehabilitation Medicine
• Clinical Trials

Background:

• Functional ambulation remains a challenge for stroke survivors.
• Transcranial direct current stimulation (tDCS) is explored for improving post-stroke walking.
• Previous reviews offered limited insights into tDCS effects on specific walking outcomes.

Purpose of the Study:

• To update evidence on tDCS for improving post-stroke walking and mobility.
• To emphasize individual outcome measures.
• To analyze tDCS effects based on different stimulation modes via subgroup analysis.

Main Methods:

• Systematic search of PubMed, Medline, PEDro, Scopus, and Cochrane databases up to January 2019.
• Inclusion of 14 eligible reports with good methodological quality (PEDro scale score 6.8).
• Meta-analysis of primary and secondary outcomes, including subgroup analyses for tDCS modes.

Main Results:

• Active tDCS showed no significant improvement over sham for walking speed (SMD=0.189, P=0.252) and 6-minute walking distance (SMD=0.209, P=0.453).
• Significant positive effects were observed for Functional Ambulation Category (FAC) (SMD=0.542, P=0.008), Rivermead Mobility Index (SMD=0.699, P=0.008), and Timed Up and Go test (TUG) (SMD=0.676, P=0.001).
• Anodal tDCS positively impacted FAC (SMD=0.611, P=0.005), and dual-hemispheric tDCS improved TUG (SMD=1.090, P=0.000).

Conclusions:

• tDCS demonstrates variable effects on post-stroke walking and functional mobility.
• Specific tDCS protocols, like anodal and dual-hemispheric, show promise for certain functional outcomes.
• Further research may refine tDCS application for optimal stroke rehabilitation outcomes.