AUTHOR=Corominas-Teruel Xavier , Mozo Rosa María San Segundo , Simó Montserrat Fibla , Colomina Fosch Maria Teresa , Valero-Cabré Antoni 

TITLE=Transcranial direct current stimulation for gait recovery following stroke: A systematic review of current literature and beyond

JOURNAL=Frontiers in Neurology

VOLUME=13

YEAR=2022

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2022.953939

DOI=10.3389/fneur.2022.953939

ISSN=1664-2295

ABSTRACT=<sec><title>Background</title><p>Over the last decade, transcranial direct current stimulation (tDCS) has set promise contributing to post-stroke gait rehabilitation. Even so, results are still inconsistent due to low sample size, heterogeneity of samples, and tDCS design differences preventing comparability. Nonetheless, updated knowledge in post-stroke neurophysiology and stimulation technologies opens up opportunities to massively improve treatments.</p></sec><sec><title>Objective</title><p>The current systematic review aims to summarize the current state-of-the-art on the effects of tDCS applied to stroke subjects for gait rehabilitation, discuss tDCS strategies factoring individual subject profiles, and highlight new promising strategies.</p></sec><sec><title>Methods</title><p>MEDLINE, SCOPUS, CENTRAL, and CINAHL were searched for stroke randomized clinical trials using tDCS for the recovery of gait before 7 February 2022. In order to provide statistical support to the current review, we analyzed the achieved effect sizes and performed statistical comparisons.</p></sec><sec><title>Results</title><p>A total of 24 records were finally included in our review, totaling <italic>n</italic> = 651 subjects. Detailed analyses revealed <italic>n</italic> = 4 (17%) studies with large effect sizes (≥0.8), <italic>n</italic> = 6 (25%) studies with medium ones (≥0.5), and <italic>n</italic> = 6 (25%) studies yielding low effects sizes (≤ 0.2). Statistically significant negative correlations (rho = −0.65, <italic>p</italic> = 0.04) and differences (<italic>p</italic> = 0.03) argued in favor of tDCS interventions in the sub-acute phase. Finally, significant differences (<italic>p</italic> = 0.03) were argued in favor of a bifocal stimulation montage (anodal M1 ipsilesional and cathodal M1 contralesional) with respect to anodal ipsilesional M1.</p></sec><sec><title>Conclusion</title><p>Our systematic review highlights the potential of tDCS to contribute to gait recovery following stroke, although also the urgent need to improve current stimulation strategies and subject-customized interventions considering stroke severity, type or time-course, and the use of network-based multifocal stimulation approaches guided by computational biophysical modeling.</p></sec><sec><title>Systematic review registration</title><p>PROSPERO: CRD42021256347.</p></sec>