Effects of transcranial direct current stimulation (tDCS) on balance improvement: a systematic review and meta-analysis

Background: Transcranial direct current stimulation (tDCS) has emerged as a promising therapeutic tool to improve balance and optimize rehabilitation strategies. However, current literature shows the methodological heterogeneity of tDCS protocols and results, hindering any clear conclusions about th...

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Published in:	Somatosensory & motor research Vol. 36; no. 2; pp. 122 - 135
Main Authors:	de Moura, Maria Clara D. Soares, Hazime, Fuad A., Marotti Aparicio, Luana V., Grecco, Luanda A. C., Brunoni, André R., Hasue, Renata Hydeé
Format:	Journal Article
Language:	English
Published:	England Taylor & Francis 03-04-2019
Subjects:	Cerebral Palsy - physiopathology Cerebral Palsy - therapy Humans meta-analysis Motor Cortex - physiology Postural balance Postural Balance - physiology Randomized Controlled Trials as Topic - methods transcranial direct current stimulation Transcranial Direct Current Stimulation - methods Transcranial Direct Current Stimulation - trends Treatment Outcome meta-analysis Postural balance transcranial direct current stimulation
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Summary:	Background: Transcranial direct current stimulation (tDCS) has emerged as a promising therapeutic tool to improve balance and optimize rehabilitation strategies. However, current literature shows the methodological heterogeneity of tDCS protocols and results, hindering any clear conclusions about the effects of tDCS on postural control. Objective: Evaluate the effectiveness of tDCS on postural control, and identify the most beneficial target brain areas and the effect on different populations. Methods: Two independent reviewers selected randomized tDCS clinical-trials studies from PubMed, Scopus, Web of Science, and reference lists of retrieved articles published between 1998 and 2017. Most frequently reported centre of pressure (COP) variables were selected for meta-analysis. Other postural control outcomes were discussed in the review. Results: Thirty studies were included in the systematic review, and 11 were submitted to a meta-analysis. A reduction of COP displacement area has been significantly achieved by tDCS, evidencing an improvement in balance control. Individuals with cerebral palsy (CP) and healthy young adults are mostly affected by stimulation. The analysis of the impact of tDCS over different brain areas revealed a significant effect after primary motor cortex (M1) stimulation, however, with no clear results after cerebellar stimulation due to divergent results among studies. Conclusions: tDCS appears to improve balance control, more evident in healthy and CP subjects. Effects are observed when primary MI is stimulated. Cerebellar stimulation should be better investigated.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 content type line 23 ObjectType-Undefined-3
ISSN:	0899-0220 1369-1651
DOI:	10.1080/08990220.2019.1624517