Introduction
Methods
Strategy for search
Criteria for eligibility
Data extraction and selection of studies
Assessment of methodological quality (MQ) and risk of bias (ROB)
Data analysis
Results
Qualitative synthesis of the results
Identification and selection of eligible studies
MQ of the relevant included studies
Study/Author (year) | Item 1 | Item 2 | Item 3 | Item 4 | Item 5 | Item 6 | Item 7 | Item 8 | Item 9 | Item 10 | Item 11 | Total Score | Overall Quality assessment |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Dumont (2023) | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | 10 | Excellent quality |
Heinz (2020) | Yes | Yes | Yes | Yes | Yes | No | Yes | Yes | Yes | Yes | Yes | 9 | Excellent quality |
Kumari (2020) | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | 10 | Excellent quality |
Madhavan (2016) | Yes | Yes | No | Yes | No | No | No | Yes | Yes | Yes | Yes | 6 | Good quality |
Madhavan (2020) | Yes | Yes | Yes | Yes | No | No | Yes | Yes | Yes | Yes | Yes | 8 | Good quality |
Manji (2018) | Yes | Yes | No | Yes | Yes | Yes | No | Yes | Yes | Yes | Yes | 8 | Good quality |
Seamon (2023) | Yes | Yes | No | Yes | Yes | Yes | No | Yes | Yes | Yes | Yes | 8 | Good quality |
Wong (2023) | Yes | Yes | Yes | Yes | Yes | No | Yes | Yes | Yes | Yes | Yes | 9 | Excellent quality |
ROB in the relevant included studies
Characteristics of the relevant included studies
Author (Year) | Design | N Sex | Age (years) Mean ± SD | Clinical Characteristics of the patient population | Intervention(s)/ Groups | Outcomes | Treadmill training protocols Evaluation period |
---|---|---|---|---|---|---|---|
Dumont (2023) [28] | RCT-P | 28 13 M,11 F | EG: 58.5 ± 10.04 CG: 58.4 ± 11.44 | Chronicity: Chronic Stroke duration (m): EG:39.2(20.2); CG: 25.5 (19.4) Stroke type: IS = 15; HM = 9 Side affected: R = 10; L = 14 | EG: a-tDCS + TT CG: Sham + TT | Gait speed (GS), spatiotemporal and kinematic variables, and functional capacity | 20 min of TT with no BWS, 5 times/week for 2 weeks Pre and post |
Heinz (2020) [29] | RCT-CR | 12 8 M,4 F | 59 ± 7.00 | Chronicity: Chronic Stroke duration (m): 65.45 ± 54.86 Stroke type: IS = 9; HM = 3 Side affected: R = 7; L = 5 | ECN: a-tDCS + TT CCN: Sham + TT | Heart rate variability (HRV), variability in systolic blood pressure (VSBP), | 20 min of TT Pre and post tDCS and during the exercise |
Kumari (2020) [30] | RCT-P | 4 2 M,2 F | 67.25 | Chronicity: Chronic Stroke duration (m): 121.25 Stroke type: IS = 2; HM = 2 Side affected: R = 2; L = 2 | EG: c-tDCS + TT CG: Sham + TT | Motor learning, step length symmetry, walking speed, step length | 15 min of TT Pre and post intervention |
Madhavan (2016) [24] | RCT-CR | 11 4 M,7 F | 58 ± 2.7 | Chronicity: Chronic Stroke duration (y): 9 ± 1.8 Stroke type: IS = 7; HM = 4 Side affected: R = 7; L = 4 | ECN: e-tDCS + HIIT CCN: HIIT alone | GS, corticomotor excitability (CME), rating of perceived exertion, Heart rate | 15 min of TT Prior and at the end |
Madhavan (2020) [27] | RCT-P | 81 55 M,26 F | A. tDCS + HISST: 58 ± 11 B. CG: 58 ± 10 C. AMT + HISST: 60 ± 9 D. tDCS + AMT + HISST: 59 ± 9 | Chronicity: Chronic Stroke duration (y): A (4.3 ± 3.6), B (6.1 ± 4.2), C (5.6 ± 3.6) and D (5.9 ± 5.6) Stroke type: IS = 53; HM = 26 Side affected: R = 37; L = 44 | (A) tDCS + HISST (B) G HISST only G C. AMT + HISST G D. tDCS + AMT + HISST G | Walking speed, CME, paretic active motor threshold, paretic MEP, mobility (TUG) balance (BBT, miniBESTest, & ABC), motor function (FMLE), walking endurance (6mWT) & stroke impact (SIS) | 40 min of TT, 3 sessions per week for 4 weeks Pre post and 3 month follow up |
Manji (2018) [25] | RCT-CR | 30 21 M,9 F | EG: 62.2 ± 10.10 CG: 63.7 ± 11.0 | Chronicity: Subacute Stroke duration (m): EG = 4.48 ± 1.86, CG = 4.99 ± 0.81 Stroke type: IS = 17; HM = 13 | EG: a-tDCS + BWSTT CG: Sham + BWSTT | Walking speed (10 MWT), Mobility (TUG, POMA), balance (TCT &TIS), motor function (FMLE) | 20 min of BWSTT, once a day for a week Pretest, posttest 1 and 2 |
Seamon (2023) [26] | RCT-CR | 16 11 M,5 F | 59 ± 11.5 (30–77) | Chronicity: Chronic Stroke duration (m): 54.56 ± 76.5 (10–325) Stroke type: Side affected: R = 9; L = 7 | ECN: a-tDCS + TT ICN: ct-tDCS + TT DCN: ECN + ICN Sham: Sham + TT | Gait speed, paretic step ratio, paretic propulsion, walking performance (PF), motor function (FMLE), balance (BBS), DGI, & modules, muscle activation (EMG) | 15 min of TT Pre and post |
Wong (2023) [31] | RCT-P | 45 32 M,10 F | A. b-tDCS + TT: 55.43 ± 5.39 B. ct-tDCS + TT: 60.64 ± 11.3 C. Sham + TT: 64.05 ± 9.4 | Chronicity: Chronic Stroke duration (m): A (70.71 ± 48.0), B (54.43 ± 38.7), C (72.57 ± 57.10) Stroke type: IS = 26, HM = 16 Side affected: R = 28; L = 14 | G1: tDCS + TT G2: ct-tDCS + TT G3: Sham + TT | Dual-task walking (DTW) PF, walking PF, gait spatiotemporal parameters, contralesional cortical activity (RMT, MEP, & SICI), motor control of lower extremity (FMLE), cognitive DTW PF, & motor DTW PF. | 30 min of TT, 3 sessions per week for 4 weeks Pre and post |
Described outcomes
Mobility
Other gait spatiotemporal and related parameters
Balance-related parameters
Other brain-related parameters
tDCS procedures
Types of stimulation
Site of electrodes during tDCS
Intensity and duration of stimulation
Size of electrodes
Number of stimulation sessions
Side effects of tDCS
Studies | Stimulation | Findings | |||||
---|---|---|---|---|---|---|---|
Author (Year) | Type | Site (Based on 10–20 EEG electrode placement and nomenclature system) | Intensity (mA) Period (minutes) | Size of electrode No. of stimulation session | Side effects | Results | Conclusion |
Dumont (2023) [28] | Anodal | AN: Primary motor cortex (C3 or c4) CT: Contralateral supraorbital region | 2 mA 20 min | 5cm2 10 | NI | There is significant difference in EG in kinematic gait parameters such as PT-IC, HAA-ROM, KMSW, K-ROM, AMSt, AMSw, and A-ROMst. But no significant difference in gait spatiotemporal variables between groups | tDCS combined with simultaneous TT did not have significant effect on gait spatiotemporal parameters, but has significant effect on gait kinematic parameters. |
Heinz (2020) [29] | Anodal | AN: Left temporal cortex CT: Middle deltoid muscle | 2 mA 20 min | 5 × 5cm2 1 | NR | There was no difference in VSBP and HRV between groups compared to baseline data. | tDCS does not generate immediate effects on HRV and VSBP except larger participation in parasympathetic regulation in active tDCS group. |
Kumari (2020) [30] | Anodal | AN: Lateral to the inion CT: Ipsilateral buccinator | 2 mA 10 min | 5 × 5cm2 3 | Cheek twitching and mild cheek tingling | The result showed that the planned RCT protocol and ctDCS-SBTT intervention are not feasible. | The study showed substantial variability in the direction of step length asymmetry affecting the recruitment and delivery of SBTT. |
Madhavan (2016) [24] | Anodal | AN: Hotspot of paretic leg M1 CT: Forehead above the contralateral orbit | 1 mA 15 min | AN: 8cm2 CT: 35cm2 2 | No | e-tDCS + HIIT induced an increase in CME of the paretic TA, and corresponding increase in CME of the nonparetic TA. Both HIIT and e-tDCS showed trend towards improved overground gait speed. | Single session of HIIT has the potential to exacerbate suppressed corticomotor excitability of paretic lower limb muscle representations in some individuals with stroke. |
Madhavan (2020) [27] | Anodal | AN: Leg representation of ipsilesional motor cortex (M1) CT: Contralateral supraorbital region | 1 mA 15 min | AN: 5 × 2.5 cm CT: 4.5 × 5.5 cm 12 | Minimal | Four weeks of HISTT result in improvement in walking speed and endurance, which were maintained partially 3 months after training. | HISTT is a feasible and effective gait training paradigm for individuals with chronic stroke. |
Manji (2018) [25] | Anodal | AN: 3.5 cm anterior to Cz CT: Over the inion | 1 mA 20 min | 5 × 5 cm 7 | NR | Anodal tDCS over the SMA may enhance improvement in gait ability in combination with BWSTT in hemiparetic stroke survivors. | Therapy with tDCS over the SMA combined with BWSTT contributes to an improvement in gait ability in stroke. |
Seamon (2023) [26] | Anodal Cathodal Dual | ECN: AC (AN): Ipsilesional leg M1 area), RF: Ipsilateral shoulder ICN: AC (CT): Contralesional leg M1 area, RF: Ipsilateral shoulder DCN: Simultaneous application of montages in ECN and ICN To target both leg M1 areas. | 2 mA 20 min | 1.75cm2 4 | NR | No group main effects for any of the tDCS electrode montages compared with sham stimulation on walking performance immediately post one session of tDCS. | A single tDCS session may affect clinical and biomechanical walking performance, but effects seem to be dependent on individual response variability to different electrode montages. |
Wong (2023) [31] | Bilateral Cathodal | b-tDCS + TT G: AN: Ipsilesional M1, CT: contralateral M1, ct-tDCS + TT G: AN: contralateral supra orbital ridge, CT: contralesional M1 Sham + TT G: as obtained in ct-tDCS + TT G | 2 mA 20 min | 35cm2 12 | No | Cathodal tDCS followed by TT can lead to better effects on the CDTW, speed, cadence, and step time of the paretic leg than TT alone. It also significantly increased inhibition and decrease the excitability of the contralesional M1 more than TT alone. | There were superior positive effects of cathodal tDCS followed by TT on CDTW performance and contralesional cortical activity than TT alone. |