Investigating of Transcranial Direct Current Stimulation and Robot-Assisted Gait Training Effects in Subjects with Stroke

In recent years, strokes have been ranked as number two among the top 10 causes of mortality in Taiwan. Stroke is a leading cause of long-term disability and affects cognition function, walking ability, balance, functional activity, sleep, quality of life and etc. It is usually difficult for most of post-stroke patients to undertake gait training programs immediately after stroke. Therefore, therapists have to manually facilitate the patients’ extremities to appropriately perform continuous and smooth reciprocal movements for gait training. Robot-assisted gait training system (RGTS; Lokomat) and transcranial direct current stimulation (tDCS) are both important issues in the advanced rehabilitation medicine. RGTS allow delivering continuous support and guidance for the legs in a physiological gait pattern, higher repetition accuracy, and prolonged training duration. Despite an increasing amount of available RGTS (Lokomat), determination of their effectiveness has remained controversial. Most studies of robot-assisted gait training have focused on the demonstration of its effect on walking ability. Few studies have focused on the possible effect of robot-assisted gait training on brain plasticity and excitability, cognitive role, social function, mental health, emotional (depressive) status, and quality of life. Therefore, further clinical trials and evidence-based basic medical studies are needed to confirm its potential effects on the mentioned outcomes of individuals with subacute stroke. . tDCS can change the excitability of regional cortex. According to the polarity of the electrode, inhibitory and excitatory effects can be achieved. tDCS has been applied in clinical conditions such as depression, insomnia, anxiety, aphasia, chronic stroke disorders and showed some positive effects. Few studies reported tDCS treatment on individuals with subacute stroke. In this project, We will investigate the effects of RGTS(LoKomat) and tDCS on individuals with subacute stroke via repetitive training and neuromodulation mechanisms. We expect the study can help us to further understand the potential effects of Lokomat and tDSC in treating individuals with subacute stroke.