Effects of tDCS With Gait Training on Leg Performance in Incomplete Spinal Cord Injury
Condition: Incomplete Spinal Cord Injury
MeSH terms: Spinal Cord Injuries; Wounds and Injuries
Study type: Interventional

Summary: 
      This study aim to investigate the effects of anodal transcranial direct current stimulation
      combined with gait training for 5 consecutive session on gait performance, balance, sit to
      stand performance and quality of life in persons with incomplete SCI at post intervention,
      1-month follow-up and 2-month follow up
    

Detailed description: 
      The result from the previous studies of Water in 1994 regarding the ambulation status of
      patients with spinal cord injury (SCI) for a period of 1 year after injury. It was found that
      76% of incomplete paraplegia and 46 % of incomplete tetraplegia can recovery their walking
      ability to become community ambulators. However, the recovery rate gradually decreased and
      started to hit the plateau level around 9 months post injury or in chronic phase. Therefore,
      it is a challenge in rehabilitation to restore their functions such as walking which is a
      primary goal of functional independence.

      Activity-based rehabilitation therapy (ABRT) (such as locomotion training) is an intensive
      intervention that has the potential to promote neurological recovery and enhance walking
      ability in individual with incomplete SCI. Although, ABRT showed positive results in motor
      function recovery in incomplete SCI survivors, it may not be able to promote full recovery,
      especially in chronic patients. Recent studies showed that the combination of training with
      top-down approach may be an option that could promote motor recovery after SCI.

      transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique
      that is currently being used as an add-on treatment in neurorehabilitation. tDCS over the
      primary motor cortex has been shown to modulate neural activity at both cortical and spinal
      levels. It also produce an after-effect in modulating neuronal synaptic plasticity and
      increasing the expression of brain-derived neurotrophic factor (BDNF). Early tDCS studies
      have shown that increasing stimulation intensity or duration within certain limits enhances
      tDCS efficacy: while anodal stimulation increases cortical excitability, cathodal stimulation
      decreases it. The application of tDCS is to place the electrode in a specific montage on the
      decided target brain area and deliver the low-intensity current pass through that brain area
      for neural modulation during or after providing a rehabilitation program. Previous studies of
      the application of tDCS showed that applying of tDCS on primary motor cortex with intensity
      of 2 milliampere (mA) for 10-20 minutes combined with rehabilitation can enhance lower limb
      performance such as knee strength, ankle movement, and sit to stand performance in people
      with stroke as well as walking speed in people with Parkinson's disease. According to result
      from those previous studies can revealed that the combination of rehabilitation with
      modulation of corticospinal excitability can enhance lower limb performance in individual
      with neurological condition. In individuals with incomplete SCI, the excitability of the
      preserved corticospinal pathways is reduced which can affect the control of their motor
      skills and motor recovery. Several studies reported positive effect of anodal tDCS combined
      with training in individuals with incomplete SCI, however most of studies focused on upper
      limb function. Only few studies on the outcome of lower limb function and walking ability,
      which are required to return to their daily living and thus increase in quality of life
      (QOL). Moreover, most of studies in the lower limb were conducted in a small sample size and
      reported inconclusive results.

      Therefore, the purpose of this study is to determine whether the effects of combining anodal
      tDCS with gait training for 5 consecutive session in people with incomplete SCI can improve
      lower limb performance consist of gait performance(spatiotemporal), dynamic balance(time up
      and go test), sit to stand performance (5 times of sit to stand test) and QOL after a
      prolonged period of follow-up at 1-month and 2-month compare to control group of sham tDCS
      with gait training.
    

Intervention name(s): transcranial direct current stimulation
Intervention type(s): Device
Intervention description(s): Transcranial direct current stimulation will be use for the intervention. Anodal and sham tDCS will be applied in 2 mA through a pair of saline-soaked surface sponge electrode 35 cm square for 20 minute over the primary motor area for modulating the cortical excitability before apply the rehabilitation training
Allocation: Randomized
Intervention model: Factorial Assignment
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Transcranial direct current stimulation; Incomplete spinal cord injury; Lower limb performance