Efficacy of Transcranial Direct Current Stimulation and Sensorimotor Training on Balance and Gait in Stroke Patients: A Randomized Controlled Trial

Stroke is the second major cause of death and the third most frequent cause of impairments worldwide. The global burden of stroke is approximated to be more than 80 million stroke patients reported in 2016.  The number of stroke cases is increasing in India, due to demographic transition. The prevalence rate of stroke ranges from 84–262/100,000 in rural and 334–424/100,000 in cities of India. Based on recent data approximately 119-145/100,000 cases of stroke are noted. It leads to motor and sensory impairment including muscle weakness, spasticity, incoordination, proprioception which leads to residual deficits, imbalance and gait abnormalities.Noninvasive neuromodulatory techniques are hypothesised to change synaptic effectiveness in glutamatergic and GABAergic circuits, which are important for motor learning. Among the NIBS techniques, Transcranial direct current stimulation is extensively used alone or in combination with other therapies in past decade to improve motor functions, balance and gait in stroke patients and has shown significant results in improving post stroke residual impairments. tDCS has been proved to be promising approach in treating imbalance and gait abnormalities. Sensorimotor training (SMT) is thought to influence the control of equilibrium and posture by active & passive facilitation of afferents.SMT affects the higher centers of subcortical structures through spinothalamic, vestibulospinal, and vestibulocerebellar pathways that influence the coordinated posture and equilibrium. So, the combination of the tDCS with sensorimotor training may prove to be beneficial in improving balance and gait in stroke patients. But so far, the combined effect of tDCS and sensorimotor training has not been investigated. Therefore, the main aim of this study is to evaluate the effect of tDCS with sensorimotor training on the balance and gait in stroke patients.