Transcranial direct current stimulation combined with robotic training in incomplete spinal cord injury: a randomized, sham-controlled clinical trial

Spinal Cord Series and Cases, 2021 · DOI: https://doi.org/10.1038/s41394-021-00448-9 · Published: September 14, 2021

Spinal Cord Injury Neurology Rehabilitation

Simple Explanation

This study investigates whether transcranial direct current stimulation (tDCS) combined with robotic training can improve walking ability in people with incomplete spinal cord injury (SCI). The researchers compared a group receiving active tDCS to a sham tDCS group. Participants received 30 sessions of either active or sham tDCS before robotic training sessions. The primary goal was to see if active tDCS led to greater improvements in walking, as measured by the WISCI-II scale. The study found that participants who received active tDCS showed a significant improvement in walking ability compared to those who received sham tDCS after 30 sessions and at a three-month follow-up.

Study Duration

12 weeks or 6 weeks

Participants

43 participants with incomplete SCI

Evidence Level

Level 1, Randomized, sham-controlled clinical trial

Key Findings

1
Active tDCS combined with robotic training resulted in a significant improvement in walking ability compared to sham tDCS after 30 sessions.
2
The improvement in walking ability with active tDCS was sustained at a three-month follow-up.
3
15 sessions of tDCS did not yield significant improvements in walking ability, suggesting a dose-dependent effect.

Research Summary

This randomized, sham-controlled clinical trial investigated the effects of tDCS combined with robotic training on gait disability in incomplete SCI. Participants received either active or sham tDCS before Lokomat sessions. The study found a significant difference in the percentage of participants who improved in WISCI-II at the 30-session mark and at the follow-up in the active tDCS group compared to the sham group. The authors concluded that 30 sessions of active tDCS are associated with a significant improvement in walking compared to sham, and this improvement can be related to different aspects of motor learning, including motor recovery and compensation.

Practical Implications

Clinical Practice

Integrating tDCS with robotic-assisted gait training may enhance motor recovery in individuals with incomplete SCI.

Future Research

Further studies are needed to explore the optimal tDCS parameters (e.g., intensity, duration, electrode placement) for maximizing motor recovery in SCI.

Personalized Rehabilitation

Identifying biomarkers that predict responsiveness to tDCS could help personalize rehabilitation strategies for individuals with SCI.

Study Limitations

1
The statistical analyses were not performed as initially planned due to a large number of participants not improving.
2
The study was underpowered for the secondary gait outcome measures.
3
The results cannot be generalized to participants with severe impairment (AIS A and B), higher spasticity, or different rehabilitation treatments.

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