Investigating of Transcranial Direct Current Stimulation and Robot-Assisted Gait Training Effects in Subjects with Stroke (II)

Two-year project was development for people with stroke. The first year project is carried out currently. This is the second year project. The robot-assisted gait training system (RGTS; Lokomat) and transcranial direct current stimulation (tDCS) are conducted in this second year project. RGTS ( Lokomat) and tDCS are both important issues in the advanced rehabilitation medicine. RGTS allow delivering continuous support and guidance for the legs in a physiological gait pattern, higher repetition accuracy, and prolonged training duration. Despite an increasing amount of available RGTS (Lokomat), determination of their effectiveness has remained controversial. Most studies of robot-assisted gait training have focused on the demonstration of its effect on walking ability. Few studies have focused on the possible effect of robot-assisted gait training on brain plasticity and excitability, cognitive role, social function, mental health, emotional (depressive) status, and quality of life. Therefore, further clinical trials and evidence-based basic medical studies are needed to confirm its potential effects on the mentioned outcomes of individuals with subacute stroke. . tDCS can change the excitability of regional cortex. According to the polarity of the electrode, inhibitory and excitatory effects can be achieved. tDCS has been applied in clinical conditions such as depression, insomnia, anxiety, aphasia, chronic stroke disorders and showed some positive effects. Few studies reported tDCS treatment on individuals with subacute stroke. In this second project, We will continue to investigate the effects of RGTS (Lokomat) and tDCS on individuals with subacute stroke via repetitive training and neuromodulation mechanisms. The preliminary data of our first year project (from Aug. 1 2013 to now) showed that there were positive effects in brain activity (measured by Near Infrared Spectroscopy; NIRS), lower legs strength, Barthel Index, and gait symmetry of patients after Lokomat intervention. However, our pilot data are still sparse. There is, therefore, a need to conduct longer duration studies, with including more patients in this second year project and the remaining plan of the first year, to get more solid results. We expect this two-year project can help us to further understand the potential effects of Lokomat and tDCS in treating individuals with subacute stroke.