The Effects of Transcranial Direct Current Stimulation and Robot Assisted Gait Training on Motor Function in Patients with Spinal Cord Injury: A Case Series

Abstract

In recent years, transcranial direct current stimulation (tDCS) has emerged as a possible therapeutic modality in enhancing functionality following spinal cord injury (SCI). However, the role of tDCS in enhancing locomotion when used alongside other methods of gait training in patients with incomplete SCI remains inadequately addressed in the literature. Here we present the results of an observational case series on the effects of tDCS, robot assisted gait training (RAGT) and physical therapy (PT) on the development of muscle power, locomotor skills, balance and activities of daily living (ADL) in five patients with a history of chronic incomplete SCI. Five patients received two hours of PT, twenty minutes of tDCS and thirty minutes of RAGT five times a week to a total of thirty sessions on an inpatient basis. Patients were evaluated before and following the treatment program using manual muscle testing (MMT), a ten meter walking test (10MWT), Function in Sitting Test (FIST), the Walking Index for SCI (WISCI) and the Spinal Cord Independence Measure III (SCIM III) rating scale. Mean age of the five patients was 28.45.13 years. Mean time since SCI was 5.81.30 years. Aetiology of SCI was trauma in all cases. Improvements in MMT, 10 MWT, FIST, WISCI, SCIM III were recorded. The findings of this study suggest that this combination of treatment is effective in improving locomotor skills in those with chronic SCI. These findings need to be consolidated using a larger patient sample and compared to sham tDCS, RAGT and PT and PT alone.