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D. Soares de Moura MC1, Ahmad Hazime F2, V. Marotti Aparicio L3, Grecco L4, R. Brunoni A5, Hydeé Hasue R1
1University of São Paulo, Department of Physical Therapy, Speech and Occupational Therapy, São Paulo, Brazil, 2Federal University of Piauí, Department of Physical Therapy, Piauí, Brazil, 3University of Sao Paulo, Department and Institute of Psychiatry, Hospital das Clínicas HCFMUSP, São Paulo, Brazil, 4Universidade Federal do Estado de São Paulo, NANI - Educação e Saúde na Infância e Adolescência, São Paulo, Brazil, 5University of São Paulo, Department and Institute of Psychiatry, Hospital das Clínicas HCFMUSP, São Paulo, Brazil
Background: Transcranial direct current stimulation (tDCS) has emerged as a promising therapeutic tool for improving balance and optimizing rehabilitation strategies. However, current literature shows the methodological heterogeneity of tDCS protocols and results, hindering any clear conclusions about the effects of tDCS on postural control.
Purpose: To systematically investigate the effects of tDCS on postural control, with a secondary analysis of the impact on different populations and stimulated brain areas.
Methods: We performed a systematic review and meta-analysis of randomized tDCS studies and sham-controlled trials published between 1998 and 2017. Every postural control outcome was considered in the qualitative synthesis, and the most frequent outcomes of center of pressure (COP) were selected for meta-analysis, that is, displacement area, anteroposterior (AP) and mediolateral (ML) displacements.
Results: Thirty studies were included in the systematic review, and 11 were subject to a meta-analysis. More than 50% of the studies showed an unclear risk of bias for randomization and allocation concealment. A reduction of postural sway (representation of good postural control) was significantly achieved by tDCS on ML direction and area displacement in individuals with cerebral palsy and in healthy young adults, respectively. The analysis of the impact of tDCS over different brain areas revealed that ML displacement is affected after primary motor cortex stimulation, but with no clear results after cerebellar stimulation.
Conclusion(s): Transcranial direct current stimulation appears to improve balance control among healthy and cerebral palsy subjects, after applying focus to a target area and COP direction. However, these results must be viewed with caution, due to the high degree of heterogeneity, different protocol stimulations, and quality of the studies.
Implications: · Transcranial direct current stimulation (tDCS) can improve postural control
· Evidences suggest that tDCS benefits cerebral palsy and healthy subjects
· Results until now are not consistent to show effects of cerebellar stimulation
· Centre of pressure displacement is affected after primary motor cortex stimulation
Keywords: Balance, Postural control, Transcranial direct current stimulation
Funding acknowledgements: CAPES/ Alexander von Humboldt fellowship award for experienced researchers and a consultant of the Neurocare group GmbH (Munich, Germany).
Purpose: To systematically investigate the effects of tDCS on postural control, with a secondary analysis of the impact on different populations and stimulated brain areas.
Methods: We performed a systematic review and meta-analysis of randomized tDCS studies and sham-controlled trials published between 1998 and 2017. Every postural control outcome was considered in the qualitative synthesis, and the most frequent outcomes of center of pressure (COP) were selected for meta-analysis, that is, displacement area, anteroposterior (AP) and mediolateral (ML) displacements.
Results: Thirty studies were included in the systematic review, and 11 were subject to a meta-analysis. More than 50% of the studies showed an unclear risk of bias for randomization and allocation concealment. A reduction of postural sway (representation of good postural control) was significantly achieved by tDCS on ML direction and area displacement in individuals with cerebral palsy and in healthy young adults, respectively. The analysis of the impact of tDCS over different brain areas revealed that ML displacement is affected after primary motor cortex stimulation, but with no clear results after cerebellar stimulation.
Conclusion(s): Transcranial direct current stimulation appears to improve balance control among healthy and cerebral palsy subjects, after applying focus to a target area and COP direction. However, these results must be viewed with caution, due to the high degree of heterogeneity, different protocol stimulations, and quality of the studies.
Implications: · Transcranial direct current stimulation (tDCS) can improve postural control
· Evidences suggest that tDCS benefits cerebral palsy and healthy subjects
· Results until now are not consistent to show effects of cerebellar stimulation
· Centre of pressure displacement is affected after primary motor cortex stimulation
Keywords: Balance, Postural control, Transcranial direct current stimulation
Funding acknowledgements: CAPES/ Alexander von Humboldt fellowship award for experienced researchers and a consultant of the Neurocare group GmbH (Munich, Germany).
Topic: Neurology; Musculoskeletal: lower limb; Disability & rehabilitation
Ethics approval required: No
Institution: School of Medicine, University of São Paulo
Ethics committee: CAPPESQ
Reason not required: Systematic Review and Meta-analysis
All authors, affiliations and abstracts have been published as submitted.
