Non-invasive brain stimulation for improving gait, balance, and lower limbs motor function in stroke

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Abstract

Objectives

This systematic review and meta-analysis aim to summarize and analyze the available evidence of non-invasive brain stimulation/spinal cord stimulation on gait, balance and/or lower limb motor recovery in stroke patients.

Methods

The PubMed database was searched from its inception through to 31/03/2021 for randomized controlled trials investigating repetitive transcranial magnetic stimulation or transcranial/trans-spinal direct current/alternating current stimulation for improving gait, balance and/or lower limb motor function in stroke patients.

Results

Overall, 25 appropriate studies (including 657 stroke subjects) were found. The data indicates that non-invasive brain stimulation/spinal cord stimulation is effective in supporting recovery. However, the effects are inhomogeneous across studies: (1) transcranial/trans-spinal direct current/alternating current stimulation induce greater effects than repetitive transcranial magnetic stimulation, and (2) bilateral application of non-invasive brain stimulation is superior to unilateral stimulation.

Conclusions

The current evidence encourages further research and suggests that more individualized approaches are necessary for increasing effect sizes in stroke patients.

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Most cited references 93

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Excitability changes induced in the human motor cortex by weak transcranial direct current stimulation.

M A Nitsche, W Paulus (2000)

In this paper we demonstrate in the intact human the possibility of a non-invasive modulation of motor cortex excitability by the application of weak direct current through the scalp. Excitability changes of up to 40 %, revealed by transcranial magnetic stimulation, were accomplished and lasted for several minutes after the end of current stimulation. Excitation could be achieved selectively by anodal stimulation, and inhibition by cathodal stimulation. By varying the current intensity and duration, the strength and duration of the after-effects could be controlled. The effects were probably induced by modification of membrane polarisation. Functional alterations related to post-tetanic potentiation, short-term potentiation and processes similar to postexcitatory central inhibition are the likely candidates for the excitability changes after the end of stimulation. Transcranial electrical stimulation using weak current may thus be a promising tool to modulate cerebral excitability in a non-invasive, painless, reversible, selective and focal way.

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Author and article information

Contributors

Jitka Veldema:

ORCID: http://orcid.org/0000-0002-9184-9776

jitka.veldema@uni-bielefeld.de

Journal

Journal ID (nlm-ta): J Neuroeng Rehabil

Journal ID (iso-abbrev): J Neuroeng Rehabil

Title: Journal of NeuroEngineering and Rehabilitation

Publisher: BioMed Central (London )

ISSN (Electronic): 1743-0003

Publication date (Electronic): 3 August 2022

Publication date PMC-release: 3 August 2022

Publication date Collection: 2022

Volume: 19

Electronic Location Identifier: 84

Affiliations

[1 ]GRID grid.7491.b, ISNI 0000 0001 0944 9128, Department of Sport Science, , Bielefeld University, ; 33 501 Bielefeld, Germany

[2 ]GRID grid.10392.39, ISNI 0000 0001 2190 1447, Institute for Neuromodulation and Neurotechnology, , University Hospital and University of Tübingen, ; Tübingen, Germany

Author information

Jitka Veldema http://orcid.org/0000-0002-9184-9776

Article

Publisher ID: 1062

DOI: 10.1186/s12984-022-01062-y

PMC ID: 9351139

PubMed ID: 35922846

SO-VID: 8f36591d-5b19-438c-80ce-4aabd8d3eb40

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 15 February 2022

Date accepted : 21 July 2022

Funding

Funded by: Universität Bielefeld (3146)

Open Access :

Open Access funding enabled and organized by Projekt DEAL.

Custom metadata

ScienceOpen disciplines: Neurosciences

Keywords: rtms,tdcs,tacs,tsdcs,stroke,gait,balance,lower limb function

Data availability:

ScienceOpen disciplines: Neurosciences

Keywords: rtms, tdcs, tacs, tsdcs, stroke, gait, balance, lower limb function

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Non-invasive brain stimulation for improving gait, balance, and lower limbs motor function in stroke

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Abstract

Objectives

Methods

Results

Conclusions

Related collections

Neuronal Signaling

Most cited references 93

Measuring inconsistency in meta-analyses.

Heart Disease and Stroke Statistics—2020 Update

Excitability changes induced in the human motor cortex by weak transcranial direct current stimulation.

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Cited by 33

Most referenced authors 1,532