Combining physical training with transcranial direct current stimulation to improve gait in Parkinson's disease: a pilot randomized controlled study

Clin Rehabil. 2014 Nov;28(11):1115-24. doi: 10.1177/0269215514534277. Epub 2014 May 21.


Objective: To improve gait and balance in patients with Parkinson's disease by combining anodal transcranial direct current stimulation with physical training.

Design: In a double-blind design, one group (physical training; n = 8) underwent gait and balance training during transcranial direct current stimulation (tDCS; real/sham). Real stimulation consisted of 15 minutes of 2 mA transcranial direct current stimulation over primary motor and premotor cortex. For sham, the current was switched off after 30 seconds. Patients received the opposite stimulation (sham/real) with physical training one week later; the second group (No physical training; n = 8) received stimulation (real/sham) but no training, and also repeated a sequential transcranial direct current stimulation session one week later (sham/real).

Setting: Hospital Srio Libanes, Buenos Aires, Argentina.

Subjects: Sixteen community-dwelling patients with Parkinson's disease.

Interventions: Transcranial direct current stimulation with and without concomitant physical training.

Main measures: Gait velocity (primary gait outcome), stride length, timed 6-minute walk test, Timed Up and Go Test (secondary outcomes), and performance on the pull test (primary balance outcome).

Results: Transcranial direct current stimulation with physical training increased gait velocity (mean = 29.5%, SD = 13; p < 0.01) and improved balance (pull test: mean = 50.9%, SD = 37; p = 0.01) compared with transcranial direct current stimulation alone. There was no isolated benefit of transcranial direct current stimulation alone. Although physical training improved gait velocity (mean = 15.5%, SD = 12.3; p = 0.03), these effects were comparatively less than with combined tDCS + physical therapy (p < 0.025). Greater stimulation-related improvements were seen in patients with more advanced disease.

Conclusions: Anodal transcranial direct current stimulation during physical training improves gait and balance in patients with Parkinson's disease. Power calculations revealed that 14 patients per treatment arm (α = 0.05; power = 0.8) are required for a definitive trial.

Keywords: Cerebral cortex; Parkinson’s disease; electrical stimulation therapy; exercise therapy; gait.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Combined Modality Therapy
  • Double-Blind Method
  • Exercise Therapy / methods*
  • Female
  • Follow-Up Studies
  • Gait / physiology
  • Gait Disorders, Neurologic / etiology
  • Gait Disorders, Neurologic / physiopathology
  • Gait Disorders, Neurologic / rehabilitation*
  • Humans
  • Male
  • Middle Aged
  • Parkinson Disease / complications
  • Parkinson Disease / diagnosis
  • Parkinson Disease / rehabilitation*
  • Pilot Projects
  • Postural Balance / physiology*
  • Recovery of Function
  • Severity of Illness Index
  • Transcranial Direct Current Stimulation / methods*
  • Treatment Outcome