Objective To improve gait and balance in patients with small vessel disease and gait disturbance by combining transcranial direct current stimulation (tDCS) and physical training.
Methods We used anodal tDCS over motor/premotor areas in 17 SVD patients and gait disturbance. One group (physical training—PT; n=9) underwent gait and balance training during tDCS stimulation (real or sham). This was repeated 1 week later and the stimulation crossed-over (sham or real); the second group (No PT; n=8) received tDCS but no training, and also repeated the session 1 week later. Group allocation was randomised in a double-blind design. Assessments included gait velocity, stride length, stride length variability (primary gait outcomes), trunk sway for the ‘timed up and go test’, 6 m walk the Tinetti gait and balance index and, as the primary balance outcome a quantitative retropulsion test.
Results The combination of tDCS+training significantly improved gait velocity (p=0.02), stride length (p=0.018), stride length variability (p=0.04), and trunk velocity (p=0.03). There was an additional effect of training alone for all gait parameters. tDCS improved performance in the pull test (p=0035) and stride length variability (p=0.04), irrespective of training.
Conclusion This is the first study to evaluate tDCS with locomotor training as a treatment for gait disturbance in SVD. The use of anodal tDCS could be an effective adjunct to physical therapy in patients with SVD, although the effect of repeated sessions of tDCS in a larger patient population needs to be explored.