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Multi-session anodal tDCS enhances the effects of postural training on balance and postural stability in older adults with high fall risk: Primary motor cortex versus cerebellar stimulation
Authors:Mohaddeseh Hafez Yosephi  Fatemeh Ehsani  Maryam Zoghi  Shapour Jaberzadeh
Institution:1. Student Research Committee, Semnan University of Medical Sciences, Semnan, Iran;2. Neuromuscular Rehabilitation Research Centre, Semnan University of Medical Sciences, Semnan, Iran;3. Discipline of Physiotherapy, Department of Rehabilitation, Nutrition and Sport, School of Allied Health, La Trobe University, Bundoora, Victoria, 3086, Australia;4. Department of Physiotherapy, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
Abstract:

Background

Postural control impairment is a key target for rehabilitation of older adults with high fall risk.

Objective

To investigate whether anodal transcranial direct current stimulation (a-tDCS) over primary motor cortex (M1) or cerebellum can enhance the positive effects of postural training on balance and postural stability in older adults with high fall risk.

Method

In this randomised, double-blinded sham-controlled study, 65 participants were randomly assigned into five groups; M1 a-tDCS with postural training, bilateral cerebellar a-tDCS with postural training, sham a-tDCS with postural training, postural training alone and cerebellar a-tDCS alone. Participants in the first two a-tDCS groups received 2?mA stimulation for 20?min concurrently with postural training. Postural training was conducted for three sessions of 20?min per week for two weeks. The Berg Balance Score (BBS) and the stability indices at both static and dynamic levels of the Biodex Balance System were evaluated before and after intervention. A general linear model repeated measure ANOVA was used to assess the effects of variables among groups.

Result

Simultaneous postural training with M1 or bilateral cerebellar a-tDCS significantly improved postural stability indices (p?<?0.05) and BBS scores (p?<?0.05). Besides, the effects of bilateral cerebellar a-tDCS were significantly higher than that of M1 stimulation on these indices (p?<?0.05). Moreover, two weeks postural training alone or cerebellar a-tDCS alone is not an adequate intervention to improve the postural stability indices (p?>?0.05).

Conclusion

Postural training with M1 or bilateral cerebellar a-tDCS, especially bilateral cerebellar a-tDCS, can significantly improve postural control or balance in older adults with high fall risk, while two weeks of postural training alone or two weeks cerebellar a-tDCS alone is not a sufficient intervention.
Keywords:Older adult  High fall risk  Transcranial direct current stimulation  Cerebellum  Motor cortex  Balance  Postural training  a-tDCS  anodal transcranial direct current stimulation  M1  primary motor cortex  BBS  Berg Balance Score  APSI  Anterior-posterior stability index  MLSI  medial-lateral stability index  OSI  overall stability index  SEM  standard error of measurement  FOF  fear of falling
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