Abstract 28: Bihemispheric transcranial direct current stimulation did not add benefit to stance-phase gait training using virtual reality setting for chronic motor deficits after stroke

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Introduction: Chronic gait deficits after stroke are prevalent. Current therapy fails to restore normal gait for many stroke survivors. Transcranial Direct Current Stimulation (tDCS), a form of non-invasive brain stimulation, is a promising adjunct intervention that may enhance motor-learning induced neuroplasticity. tDCS is readily deployable into the clinic owing to its safety, ease of set-up, and feasibility to be paired with gait therapies. Our objective was to test whether bihemispheric tDCS would improve response to stance-phase focused gait therapy in a double-blind randomized control trial. Methods: 44 subjects (65.2±9.8 y/o; 27.3% female; 4.5±4.2 years post-stroke) were randomized to active or sham tDCS+gait training. Ten treatment sessions consisted of 30 min of virtual-reality obstacle clearance training on a treadmill followed by 30 min of overground stance phase training. 2mA tDCS with anode over ipsilesional primary motor cortex (M1) and cathode over contralesional M1 was applied during the first 15 min of training. Individuals were assigned custom home exercises. Primary outcome was fastest gait speed with 10-meter walk test(10MWT) and secondary outcomes were preferred gait speed during 2-min walk test(2MWT), Fugl-Meyer(FM), Timed Up and Go(TUG), Functional Gait Assessment (FGA), and Gait Assessment and Intervention Tool(GAIT). Outcomes were collected at baseline, mid-treatment, post-treatment, and 6-week follow up. Statistical analyses included longitudinal linear mixed-effects models and analysis of treatment group by time interaction effects. Results: At baseline(mean(SD)): 10MWT=0.71(0.40) m/s, 2MWT=0.55(0.28) m/s, FM=25.0(3.7), TUG =33.2(30.6) s; FGA=12.7(4.1) points, GAIT=16.9(7.3) points. None of the longitudinal linear mixed-effects models detected a significant group by time interaction. However, there were significant improvements from baseline for all measures as follows (median(95%CI)): 10MWT(m/s) of 0.12(0.08, 0.16) post-treatment, and 0.11(0.07, 0.16) at follow-up; 2MWT(m/s) of 0.05(0.03, 0.07) and 0.05(0.02, 0.09); FM (points) of 2.5(2, 3) and 3(2.5,3.5); TUG(s) of 3.9(2.5, 5.6) and 3.3(2, 5.2); FGA(points) 3(2.5,3.5) and 3(2,3.5); GAIT(points) of 2.5(2, 3.5) and 3(2,4). Conclusions: Bihemispheric tDCS did not enhance improvements that were achieved by a 10-session gait training intervention targeting stance phase.

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