Application of Transcranial Direct Current Stimulation (tDCS) for Gait Function Improvement of Parkinson's Disease Patient

Study Overview
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Brief Summary
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The purpose of this study was to investigate the effect of simultaneous application of transcranial direct current stimulation (tDCS) and treadmill gait training for gait function recovery in Parkinson's disease patients with gait impairment.

Official Title
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The Effect of Simultaneous Application of Transcranial Direct Current Stimulation (tDCS) and Gait Training for Parkinson's Disease Patients on Gait Function Improvement

Conditions
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Parkinson Disease

Intervention / Treatment
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* Device: Brain stimulation
* Device: Treadmill gait training


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age: 50 - 75 years Modified Hoehn and Yahr stages 1 to 4 Exclusion Criteria: Serious cardiac conditions (hospitalization for myocardial infarction or heart surgery within 3 months, history of congestive heart failure, documented serious and unstable cardiac arrhythmias, hypertrophic cardiomyopathy, severe aortic stenosis, angina or dyspnea at rest or during activities of daily living) Difficult to understand experimental tasks because of extremely severe cognitive impairment (Korean-Mini-Mental State Examination, K-MMSE≤10) History of psychiatric disease Implanted objects that would contraindicate tDCS

Ages Eligible for Study
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Minimum Age: 50 Years
Maximum Age: 74 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Gait training with brain stimulation<br>Treadmill gait training and transcranial direct current stimulation (tDCS) on the leg motor areas | Device: Brain stimulation<br>* tDCS brain stimulation on leg motor areas was applied to Parkinson patients.<br>Device: Treadmill gait training<br>* Treadmill gait training was applied to Parkinson patients.<br>|
| Active Comparator: Gait training with sham brain stimulation<br>Treadmill gait training and anodal sham transcranial direct current stimulation (tDCS) on the leg motor areas | Device: Treadmill gait training<br>* Treadmill gait training was applied to Parkinson patients.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in 10 meter walk test from baseline in gait speed | Measure of self selected speeds by measuring the time it takes an individual to walk 10 meters. To perform the test, patient walks 10 meters (33 ft) and the time is measured when the leading foot crosses the start line and the finish line. The instructions are: Please walk this distance at your normal pace when I say go. | session 0 (initial visit); session 10 (at approximately 4 weeks); after 4 weeks from intervention termination (follow-up)] | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Berg Balance Scale (BBS) from baseline in balance | Mesure of blance function. A five-point ordinal scale, ranging from 0-4. 0 indicates the lowest level of function and 4 the highest level of function. Score the LOWEST performance. Total Score = 56. | session 0 (initial visit); session 10 (at approximately 4 weeks); after 4 weeks from intervention termination (follow-up)] | 
| Change in Timed Up and Go test (TUG) from baseline in balance | Meserue of dynamic blance function. 11-20 seconds are within normal limits for frail elderly and disabled patients, and greater than 20 seconds means the person needs assistance outside and indicates further examination and intervention. A score of 30 seconds or more suggests that the person may be prone to falls. | session 0 (initial visit); session 10 (at approximately 4 weeks); after 4 weeks from intervention termination (follow-up)] | 
| Changes in Brain activation of resting-state functional MRI | Meserue of Neuroplasticity | session 0 (initial visit); session 10 (at approximately 4 weeks) | 
| Changes in motor evoked potentia | Measure the motor threshold and amplitude of motor evoked potential in first dorsal interosseous muscle and TA muscle. | session 0 (initial visit); session 10 (at approximately 4 weeks); after 4 weeks from intervention termination (follow-up)] | 
| Changes in Functional Reach Test (FRT) from baseline | FRT is a single item test developed as a quick screen for balance problems. Measurement Interpretation: 10/25 cm or greater Low risk of falls; 6/15cm to 10/25cm Risk of falling is 2x greater than normal; 6/15cm or less Risk of falling is 4x greater than normal; Unwilling to reach Risk of falling is 8x greater than normal | session 0 (initial visit); session 10 (at approximately 4 weeks); after 4 weeks from intervention termination (follow-up)] | 
| Change in muscle manual test (MMT) and range of motion (ROM) from baseline | Meserue of MMT and ROM of lower extremity. | session 0 (initial visit); session 10 (at approximately 4 weeks); after 4 weeks from intervention termination (follow-up)] | 
| Change in Unified Parkinson's Disease Rating Scale (UPDRS) from baseline | Meserue of Parkinson disease motor level. 1) nonmotor experiences of daily living (13 items), (2) motor experiences of daily living (13 items), (3) motor examination (18 items), and (4) motor complications (six items). Each subscale now has 0-4 ratings, where 0 = normal, 1 = slight, 2 = mild, 3 = moderate, and 4 = severe. | session 0 (initial visit); session 10 (at approximately 4 weeks); after 4 weeks from intervention termination (follow-up)] | 
| Change in Korean Mini-Mental State Examination (K-MMSE) from baseline | Meserue of cognition level. Any score of 24 or more (out of 30) indicates a normal cognition. Below this, scores can indicate severe (≤9 points), moderate (10-18 points) or mild (19-23 points) cognitive impairment. The raw score may also need to be corrected for educational attainment and age. | session 0 (initial visit); session 10 (at approximately 4 weeks); after 4 weeks from intervention termination (follow-up)] | 
| Change in Geriatric Depression Scale (GDS) from baseline | Meserue of depression. The grid sets a range of 0-9 as normal, 10-19 as mildly depressed, and 20-30 as severely depressed. | session 0 (initial visit); session 10 (at approximately 4 weeks); after 4 weeks from intervention termination (follow-up)] | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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transcranial direct current stimulation, gait training, Parkinson's disease