Transcranial Direct Current Stimulation (tDCS) may increase the benefits of aerobic exercise and improve gait in patients with Parkinson’s disease immediately after a session. The variability of the step time decreases, the reaction time is shortened, and executive control of gait is improved.
These were the main conclusions of a randomized, double-blind, fictitious-controlled crossover study on 20 volunteers by researchers at the Institute of Biosciences of the State University of São Paulo (IB-UNESP) in Rio Claro. , in Brazil. An article describing the study is published in Neurorehabilitation & Neural Repair.
Participants attended two 30-minute aerobic exercise sessions (moderate-intensity cycling) one week apart, combined with different tDCS, active or “sham” (placebo) conditions.
Cognitive functions and activity of the prefrontal cortex during walking were assessed before and immediately after each session. Spatio-temporal parameters were also included in the analysis to assess gait variability, stride length and processing speed.
“Compared to the pre-assessment, participants decreased step time variability, shortened simple and choice reaction times, and increased prefrontal cortex activity in the stimulated hemisphere while walking only after aerobic exercise. and an active tDCS, ”the article concludes. The authors were supported by FAPESP.
According to Rodrigo Vitório, professor at IB-UNESP and last author of the article, an unbiased comparison was ensured by administering active interventions and a placebo or dummy treatment on different days. Half of the participants received 20 minutes of actual tDCS followed by a simulation of tDCS for 10 seconds. The other half underwent the procedures in reverse order (sham followed by actual treatment).
In the tDCS, two small rectangular electrodes are attached to specific places on the head. The device is portable and battery powered. The current is very weak (2 milliamperes) but sufficient to cross the scalp and stimulate the neurons of the region of interest.
“Despite the limitations of such a small sample size, we found that transcranial stimulation activated the prefrontal cortex, a region of the brain that patients with Parkinson’s disease use more to control walking than healthy individuals. A single session combined with exercise improves cognitive function and produces other improvements, ”said Vitório, currently a researcher at the Faculty of Health and Life Sciences at the University of Northumbria in the UK .
In an interview with Agência FAPESP, Vitório explained that one of the objectives of the study was to explore the effects of tDCS in more depth than previous studies conducted by groups of which he was a member, who had already shown that aerobic exercise improves motor activity. in parkinsonian patients. “Transcranial stimulation is safe and has shown promise in potentiating the effect of interventions and treatments. It is often prescribed for depression, for example,” he said.
According to the World Health Organization (WHO), around 1% of the world’s population over 65 suffered from Parkinson’s disease in 2019. The number of people affected is estimated at 250,000 in Brazil, where the notification n is not mandatory.
About Parkinson’s disease
Parkinson’s disease is a chronic, progressive degenerative disease of the central nervous system, in which damage to nerve cells in the brain causes levels of dopamine, a neurotransmitter that plays a key role in sending messages to the body to drop. brain that controls movement. and coordination.
When dopamine-producing neurons die, symptoms like tremors, sluggishness, stiffness, and balance problems occur. Medications are usually prescribed to conserve dopamine or replace missing dopamine in the brain, but can only control symptoms because the disease is incurable.
Parkinson’s patients present with specific degeneration of areas of the brain involved in automatic movement control and use attentional resources to compensate for this deficit. In the study, aerobic exercise combined with tDSC improved the compensatory capacity of the volunteers.
The main symptoms of the disease are bradykinesia (slowness of movement), stiffness of the wrists, elbows, shoulders, thighs and ankles, and resting tremors in the hands, with loss of balance in severe cases. . Improving gait can lead to a better quality of life and prevent falls, for example.
Another research group from the Bauru campus of UNESP recently found that the synergy of stride length when clearing obstacles is 53% lower in patients with Parkinson’s disease than in healthy individuals. of the same age and weight.
Stride length synergy refers to the ability of the locomotor or musculoskeletal system to adapt movement by combining factors such as speed and foot position when mounting the curb on a curb, for example.
Transcranial stimulation and / or physiotherapy improve walking speed in Parkinson’s disease
Núbia Ribeiro Conceição et al, Aerobic exercise combined with transcranial direct current stimulation on the prefrontal cortex in Parkinson’s disease: effects on cortical activity, walking and cognition, Neurorehabilitation and neural repair (2021). DOI: 10.1177 / 15459683211019344
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