Closed-loop system for gait-synchronized brain stimulation can improve post-stroke gait disturbance
Tatsuya MIMA1, Satoko Koganemaru1, Ryosuke Kitatani1, Ayaka Fukushima-Maeda1, Yusuke Mikami1, Yusuke Okita1, Masao Matsuhashi1, Koji Ohata.1
Hemiparesis due to stroke can exhibit gait disturbance, which is a srious burden to the patients’ daily life. The patients often show reduced hip and knee joint flexion and ankle dorsiflexion of the affected lower limbs during the swing phase of gait. Previous studies suggested that this impairment is associated with the dysfunction of motor coretx control of the gait. In the present study, we tested whether closed-loop system for gait-synchronized brain stimulation targeting swing phase can improve post-stroke gait disturbance. Eleven stroke patients in the chronic stage is included in this project. The study design is the single-blind crossover study. Slow oscillatory transcranial direct current stimulation over the affected foot motor area and sham stimulation during treadmill gait were given to the patient in a randomized order. The slow oscillatory stimulation was synchronized with the each patient’s gait cycle, whose anodal current reached the maximal peaks immediately before initiation of the swing phase of the paretic leg. Ankle dorsiflexion was assisted by electrical neuromuscular stimulation.After we administered the intervention repeatedly (2 times a week, 5 weeks), self- and maximum-paced gait speed and timed up and go test (TUG) performance were significantly improved, along with improved balance function and increased joint flexion of the paretic limbs during gait.For the first time, we showed that Closed-loop system for gait-synchronized brain stimulation over the affected foot motor area combined with neuromuscular stimulation can improve gait performance, particularly walking speed.