Improving standing balance after stroke with tDCS and postural feedback therapy.

Postural instability, balance problems and subsequent falls are very common in patients with a stroke and strongly associated with future functional recovery. The early period after stroke is characterized by a critical time window of neuroplasticity. Postural feedback training (PFT) is a common rehabilitative therapy to improve standing balance control in patients with stroke, and is equally effective to improve balance control as usual care. Studies suggest that a positive, reproducible effect on motor learning may be achieved by simultaneous non-invasive transcranial direct current stimulation (tDCS) and motor training. A combination of early applied tDCS and PFT by modern virtual reality techniques (VR-PFT) may therefore improve balance in patients with stroke to a level unattained by VR-PFT alone. To date, non-invasive brain stimulation has not been applied in combination with modern balance training techniques in stroke.

VR-based postural feedback training combined with non-invasive cerebellar tDCS is more effective as compared to the same balance training program with sham-stimulation in improving postural balance control parameters and standing balance performance in sub-acute stroke patients

3 months

A tree week VR-PFT intervention applied five days per week for one hour will be started within five weeks post-stroke, in addition to usual care. This intensive training will be given in order to test if VR-PFT in combination with cerebellar tDCS is more effective in improving standing balance than VR-PFT alone. Patients train in groups and go along workstations consisting of a virtual reality setup in which instantaneous visual feedback is given regarding centre of gravity or trunk movements during several balance tasks. These tasks requiring active control of body posture and equilibrium in a virtual environment. The training program is individually tailored and progressive with systematic increments in task difficulty. tDCS will be simultaneously applied with the training during the first 25 minutes of each session using a pre-programmed stimulation paradigm. Sham-tDCS starts with a ramped stimulation of 30s followed by 0 mA current without the subject knowing this.