Transcranial stimulation and/or physical therapy improves walking speed in Parkinson's disease

June 27, 2017

Noninvasive brain stimulation and physical therapy—alone or in combination—improve some measures of walking ability in patients with Parkinson's disease (PD), concludes a clinical trial in the American Journal of Physical Medicine & Rehabilitation, the official journal of the Association of Academic Physiatrists.

Transcranial direct current stimulation and "could be used alone or together as a combination treatment protocol to improve walking speed and step length among patients with PD," according to the study by Krisna Piravej, MD, and colleagues of King Chulalongkorn Memorial Hospital, Bangkok, Thailand. In addition to showing a benefit of brain stimulation, the results suggest that physical therapy has benefits beyond symptom relief for patients with PD.

Alone or Together, Both Treatments Improve Walking in PD

The study included 60 patients, average age 65, with slow walking speed due to stage 2 or 3 PD. Patients were randomly assigned to three groups. One group received a noninvasive brain stimulation technique called transcranial direct current stimulation (tDCS). This procedure delivers a mild electrical current through the brain, with the goal of stimulating neural networks involved in motor coordination. Patients received a total of six 30-minute tDCS sessions over two weeks.

Another group received a physical therapy program, focusing on joint range of motion and flexibility, leg muscle strengthening, and balance and gait training. The third group received both tDCS and physical therapy. Using a computerized motion capture system, the researchers performed gait analysis to assess walking speed and other characteristics before and after treatment. Fifty-three patients completed the study.

The three groups had similar and significant improvement in some measures of gait. Walking speed increased by an average of about 19 percent, with only minor differences between groups. Step length increased by approximately 12 percent. Both improvements lasted for at least eight weeks after the end of treatment.

Other gait measurements—step width and cadence—showed little or no change. All groups also had a small improvement in scores on a standard PD rating scale, although the clinical relevance of this change was unclear.

Slow walking is a disabling problem for patients with PD, a progressive movement disorder. Deep brain stimulation is an effective treatment for slow walking and other manifestations of PD. However, its use is limited by the risk of potentially severe complications due surgery to place brain electrodes.

As a noninvasive, nonsurgical procedure, tDCS avoids these risks. Electrical stimulation is delivered via electrodes placed on the scalp. In the study, a few patients experienced a burning sensation during tDCS; otherwise, there were no complications.

While physical therapy has been used to treat symptoms in patients with PD, it has not been regarded as a standard . The new study adds to previous evidence that physical therapy targeting joint motion, flexibility, muscle strength, cardiovascular fitness, and balance can improve problems with gait abnormality in patients with PD.

"Our study demonstrated that both tDCS and physical therapy are effective in improving the walking ability in with PD," Dr. Piravej and coauthors conclude. "A combination of the treatments did not demonstrate a significantly better outcome." They suggest that physical could provide an alternative in "resource limited" settings without access to tDCS. In the future, the ability to provide "patient-specific stimulation" tDCS at home could offer additional advantages.

Explore further: Stimulating the brain makes exercising the legs feel easier

More information: Pattarapol Yotnuengnit et al. Effects of Transcranial Direct Current Stimulation Plus Physical Therapy on Gait in Patients With Parkinson Disease, American Journal of Physical Medicine & Rehabilitation (2017). DOI: 10.1097/PHM.0000000000000783

Related Stories

Stimulating the brain makes exercising the legs feel easier

November 1, 2016
Research led by the University of Kent shows stimulation of the brain impacts on endurance exercise performance by decreasing perception of effort.

Transcranial direct current stimulation improves mental manipulation of body part imagery

June 13, 2017
Transcranial direct current stimulation (tDCS) is a method by which a very weak direct current is applied to the head of a subject for 10 to 20 minutes to induce changes in the activities of cranial nerves. It has recently ...

Implanted neuroprosthesis improves walking ability in stroke patient

May 31, 2016
A surgically implanted neuroprosthesis—programmed to stimulate coordinated activity of hip, knee, and ankle muscles—has led to substantial improvement in walking speed and distance in a patient with limited mobility after ...

Researchers study mild electrical stimulation for schizophrenia patients

September 29, 2016
A safe, noninvasive weak electrical current delivery called transcranial direct current stimulation (tDCS) will be investigated for its potential in treating schizophrenia patients in a study led by Raymond Cho, M.D., M.Sc., ...

Robotic therapy works better if stroke patients' brains are stimulated by electricity

December 2, 2015
Research that could help stroke victims with severe disabilities to regain control over their limbs has been produced by a team at A*STAR. They have shown that stimulating the brain with electric current can help stroke victims ...

Recommended for you

Researchers find new path to promising Parkinson's treatment

September 19, 2017
Three researchers at The University of Alabama are part of work that is leading to a new direction for drug discovery in the quest to treat Parkinson's disease.

Tug of war between Parkinson's protein and growth factor

September 18, 2017
Alpha-synuclein, a sticky and sometimes toxic protein involved in Parkinson's disease (PD), blocks signals from an important brain growth factor, Emory researchers have discovered.

Medical history can point to earlier Parkinson's disease diagnosis

September 15, 2017
Before symptoms become pronounced, there is no reliable way to identify who is on track to develop Parkinson's disease, a debilitating movement disorder characterized by tremors, slowness of movement, stiffness, and difficulty ...

Brain rewiring in Parkinson's disease may contribute to abnormal movement

September 14, 2017
The brain's own mechanisms for dealing with the loss of dopamine neurons in Parkinson's disease may be a source of the disorder's abnormal movement, according to a Northwestern Medicine study published in Neuron.

Treating with antioxidants early in Parkinson's disease process may halt degeneration and improve neuronal function

September 7, 2017
Northwestern Medicine scientists have identified a toxic cascade that leads to neuronal degeneration in patients with Parkinson's disease (PD) and figured out how to interrupt it, reports a study to be published September ...

New diagnostic tool spots first signs of Parkinson's disease

September 6, 2017
Researchers have developed the first tool that can diagnose Parkinson's disease when there are no physical symptoms, offering hope for more effective treatment of the condition.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.