A recently published Western Australian study has shown that non-invasive brain stimulation enhances the effect of physiotherapy for balance and mobility impairment in people with multiple sclerosis (MS).
Impairment of balance and gait is common in MS, leading to worsened mobility, restrictions in daily activities and increased risk of falls. The benefits of exercise programs in improving gait and balance are already well documented.
Non-invasive brain stimulation techniques, related to neuronal plasticity processes, have been shown in this study to be promising adjuncts to physical therapy to improve disability.
“The aim was to see if combining transcranial direct current stimulation (tDCS) with conventional exercise therapy enhances balance and mobility in people with MS compared to exercise alone,” said Clinical Professor Soumya Ghosh, head of Restorative Neurology Research at the Perron Institute and Consultant Neurologist at Perron Institute and Sir Charles Gairdner Hospital (SCGH).
In a double-blind randomised controlled trial, MS participants were randomised into a real or sham tDCS group. All received individualised exercise treatment and twelve sessions of real or sham tDCS were administered over the primary motor area of the brain for 20 minutes followed by one hour of physiotherapy focusing on balance, strength, and mobility, twice a week for six weeks.
Outcome measures included balance, mobility, fatigue, quality of life, and pre and post falls questionnaires.
All participants received exercise therapy and showed significant improvement in their balance and mobility after six weeks and at six months. There was reduced risk of falls. The addition of tDCS prior to exercise was found to have additional benefit particularly at the six-month review.
“Our results suggest that the addition of tDCS before exercise provides a significant improvement in walking speed and balance in people with MS which lasts longer, compared to exercise alone.
“Further study is needed to optimise the use of this relatively inexpensive and well tolerated device for rehabilitation,” Professor Ghosh said.
Co-contributors to the study, which has been published in the journal Multiple Sclerosis and Related Disorders are Neurophysiotherapist Claire Tucak (Perron Institute), Clinical Psychologist and Research Associate Jennifer Eisenhauer (Perron Institute), Angela Jacques (SCGH and University of Notre Dame), Dave Hathorn (SCGH), Jesse Dixon (Perron Institute alumni) and Ian Cooper (Perron Institute and CMMIT, Murdoch University).
The study was supported by a MS Research Australia incubator grant, MSWA funding for part of the pilot study, and the Perron Institute.
Photo caption: L-R Clinical Prof Soumya Ghosh Claire Tucak and Jennifer Eisenhauer in the Perron Institute clinic.