Concurrent transcranial direct current stimulation and progressive resistance training in Parkinson’s disease: study protocol for a randomised controlled trial
Identifieur interne : 000D18 ( Pmc/Curation ); précédent : 000D17; suivant : 000D19Concurrent transcranial direct current stimulation and progressive resistance training in Parkinson’s disease: study protocol for a randomised controlled trial
Auteurs : Ashlee M. Hendy [Australie] ; Alex Tillman [Australie] ; Timo Rantalainen ; Makii Muthalib [France] ; Liam Johnson [Australie] ; Dawson J. Kidgell [Australie] ; Daniel Wundersitz [Australie] ; Peter G. Enticott [Australie] ; Wei-Peng Teo [Australie]Source :
- Trials [ 1745-6215 ] ; 2016.
Abstract
Parkinson’s disease (PD) results from a loss of dopamine in the brain, leading to movement dysfunctions such as bradykinesia, postural instability, resting tremor and muscle rigidity. Furthermore, dopamine deficiency in PD has been shown to result in maladaptive plasticity of the primary motor cortex (M1). Progressive resistance training (PRT) is a popular intervention in PD that improves muscular strength and results in clinically significant improvements on the Unified Parkinson’s Disease Rating Scale (UPDRS). In separate studies, the application of anodal transcranial direct current stimulation (a-tDCS) to the M1 has been shown to improve motor function in PD; however, the combined use of tDCS and PRT has not been investigated.
We propose a 6-week, double-blind randomised controlled trial combining M1 tDCS and PRT of the lower body in participants (
This will be the first randomised controlled trial to combine PRT and a-tDCS targeting balance and gait in people with PD. The study will elucidate the functional, clinical and neurophysiological outcomes of combined PRT and a-tDCS. It is hypothesised that combined PRT and a-tDCS will significantly improve lower limb strength, postural sway, gait speed and stride variability compared with PRT with sham tDCS. Further, we hypothesise that pre-frontal cortex activation during dual-task cognitive and gait/balance activities will be reduced, and that M1 excitability and inhibition will be augmented, following the combined PRT and a-tDCS intervention.
Australian New Zealand Clinical Trials Registry
Url:
DOI: 10.1186/s13063-016-1461-7
PubMed: 27430304
PubMed Central: 4949761
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Timo Rantalainen<affiliation><nlm:aff id="Aff2">Institute for Physical Activity and Nutrition (IPAN), Deakin University, Burwood, 3125 Melbourne, VIC Australia</nlm:aff>
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<affiliation><nlm:aff id="Aff2">Institute for Physical Activity and Nutrition (IPAN), Deakin University, Burwood, 3125 Melbourne, VIC Australia</nlm:aff>
<wicri:noCountry code="subfield">VIC Australia</wicri:noCountry>
</affiliation>
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<front><div type="abstract" xml:lang="en"><sec><title>Background</title>
<p>Parkinson’s disease (PD) results from a loss of dopamine in the brain, leading to movement dysfunctions such as bradykinesia, postural instability, resting tremor and muscle rigidity. Furthermore, dopamine deficiency in PD has been shown to result in maladaptive plasticity of the primary motor cortex (M1). Progressive resistance training (PRT) is a popular intervention in PD that improves muscular strength and results in clinically significant improvements on the Unified Parkinson’s Disease Rating Scale (UPDRS). In separate studies, the application of anodal transcranial direct current stimulation (a-tDCS) to the M1 has been shown to improve motor function in PD; however, the combined use of tDCS and PRT has not been investigated.</p>
</sec>
<sec><title>Methods/design</title>
<p>We propose a 6-week, double-blind randomised controlled trial combining M1 tDCS and PRT of the lower body in participants (<italic>n</italic>
= 42) with moderate PD (Hoehn and Yahr scale score 2–4). Supervised lower body PRT combined with functional balance tasks will be performed three times per week with concurrent a-tDCS delivered at 2 mA for 20 minutes (a-tDCS group) or with sham tDCS (sham group). Control participants will receive standard care (control group). Outcome measures will include functional strength, gait speed and variability, balance, neurophysiological function at rest and during movement execution, and the UPDRS motor subscale, measured at baseline, 3 weeks (during), 6 weeks (post), and 9 weeks (retention). Ethical approval has been granted by the Deakin University Human Research Ethics Committee (project number 2015-014), and the trial has been registered with the Australian New Zealand Clinical Trials Registry (ACTRN12615001241527).</p>
</sec>
<sec><title>Discussion</title>
<p>This will be the first randomised controlled trial to combine PRT and a-tDCS targeting balance and gait in people with PD. The study will elucidate the functional, clinical and neurophysiological outcomes of combined PRT and a-tDCS. It is hypothesised that combined PRT and a-tDCS will significantly improve lower limb strength, postural sway, gait speed and stride variability compared with PRT with sham tDCS. Further, we hypothesise that pre-frontal cortex activation during dual-task cognitive and gait/balance activities will be reduced, and that M1 excitability and inhibition will be augmented, following the combined PRT and a-tDCS intervention.</p>
</sec>
<sec><title>Trial registration</title>
<p>Australian New Zealand Clinical Trials Registry <ext-link ext-link-type="uri" xlink:href="https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=369592">ACTRN12615001241527</ext-link>
. Registered on 12 November 2015.</p>
</sec>
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</TEI>
<pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Trials</journal-id>
<journal-id journal-id-type="iso-abbrev">Trials</journal-id>
<journal-title-group><journal-title>Trials</journal-title>
</journal-title-group>
<issn pub-type="epub">1745-6215</issn>
<publisher><publisher-name>BioMed Central</publisher-name>
<publisher-loc>London</publisher-loc>
</publisher>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">27430304</article-id>
<article-id pub-id-type="pmc">4949761</article-id>
<article-id pub-id-type="publisher-id">1461</article-id>
<article-id pub-id-type="doi">10.1186/s13063-016-1461-7</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Study Protocol</subject>
</subj-group>
</article-categories>
<title-group><article-title>Concurrent transcranial direct current stimulation and progressive resistance training in Parkinson’s disease: study protocol for a randomised controlled trial</article-title>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Hendy</surname>
<given-names>Ashlee M.</given-names>
</name>
<address><email>a.hendy@deakin.edu.au</email>
</address>
<xref ref-type="aff" rid="Aff1"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Tillman</surname>
<given-names>Alex</given-names>
</name>
<address><email>atillman@deakin.edu.au</email>
</address>
<xref ref-type="aff" rid="Aff1"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Rantalainen</surname>
<given-names>Timo</given-names>
</name>
<address><email>t.rantalainen@deakin.edu.au</email>
</address>
<xref ref-type="aff" rid="Aff2"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Muthalib</surname>
<given-names>Makii</given-names>
</name>
<address><email>makii.muthalib@gmail.com</email>
</address>
<xref ref-type="aff" rid="Aff3"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Johnson</surname>
<given-names>Liam</given-names>
</name>
<address><email>l.johnson@florey.edu.au</email>
</address>
<xref ref-type="aff" rid="Aff4"></xref>
<xref ref-type="aff" rid="Aff5"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Kidgell</surname>
<given-names>Dawson J.</given-names>
</name>
<address><email>dawson.kidgell@latrobe.edu.au</email>
</address>
<xref ref-type="aff" rid="Aff6"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Wundersitz</surname>
<given-names>Daniel</given-names>
</name>
<address><email>d.wundersitz@latrobe.edu.au</email>
</address>
<xref ref-type="aff" rid="Aff1"></xref>
<xref ref-type="aff" rid="Aff7"></xref>
</contrib>
<contrib contrib-type="author"><name><surname>Enticott</surname>
<given-names>Peter G.</given-names>
</name>
<address><email>peter.enticott@deakin.edu.au</email>
</address>
<xref ref-type="aff" rid="Aff8"></xref>
</contrib>
<contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">http://orcid.org/0000-0003-3929-9778</contrib-id>
<name><surname>Teo</surname>
<given-names>Wei-Peng</given-names>
</name>
<address><phone>+61 3 9244 5229</phone>
<email>weipeng.teo@deakin.edu.au</email>
</address>
<xref ref-type="aff" rid="Aff1"></xref>
<xref ref-type="aff" rid="Aff2"></xref>
</contrib>
<aff id="Aff1"><label></label>
School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia</aff>
<aff id="Aff2"><label></label>
Institute for Physical Activity and Nutrition (IPAN), Deakin University, Burwood, 3125 Melbourne, VIC Australia</aff>
<aff id="Aff3"><label></label>
EuroMov, University of Montpellier, Montpellier, France</aff>
<aff id="Aff4"><label></label>
Clinical Exercise Science Research Program, Institute of Sport, Exercise and Active Living, Victoria University, Melbourne, Australia</aff>
<aff id="Aff5"><label></label>
Stroke Division, The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Australia</aff>
<aff id="Aff6"><label></label>
La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, La Trobe University, Melbourne, Australia</aff>
<aff id="Aff7"><label></label>
La Trobe Rural Health School, College of Science, Health and Engineering, La Trobe University, Bendigo, Australia</aff>
<aff id="Aff8"><label></label>
Cognitive Neuroscience Unit, School of Psychology, Deakin University, Melbourne, Australia</aff>
</contrib-group>
<pub-date pub-type="epub"><day>19</day>
<month>7</month>
<year>2016</year>
</pub-date>
<pub-date pub-type="pmc-release"><day>19</day>
<month>7</month>
<year>2016</year>
</pub-date>
<pub-date pub-type="collection"><year>2016</year>
</pub-date>
<volume>17</volume>
<elocation-id>326</elocation-id>
<history><date date-type="received"><day>19</day>
<month>2</month>
<year>2016</year>
</date>
<date date-type="accepted"><day>23</day>
<month>6</month>
<year>2016</year>
</date>
</history>
<permissions><copyright-statement>© Hendy et al. 2016</copyright-statement>
<license license-type="OpenAccess"><license-p><bold>Open Access</bold>
This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0/">http://creativecommons.org/licenses/by/4.0/</ext-link>
), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/publicdomain/zero/1.0/">http://creativecommons.org/publicdomain/zero/1.0/</ext-link>
) applies to the data made available in this article, unless otherwise stated.</license-p>
</license>
</permissions>
<abstract id="Abs1"><sec><title>Background</title>
<p>Parkinson’s disease (PD) results from a loss of dopamine in the brain, leading to movement dysfunctions such as bradykinesia, postural instability, resting tremor and muscle rigidity. Furthermore, dopamine deficiency in PD has been shown to result in maladaptive plasticity of the primary motor cortex (M1). Progressive resistance training (PRT) is a popular intervention in PD that improves muscular strength and results in clinically significant improvements on the Unified Parkinson’s Disease Rating Scale (UPDRS). In separate studies, the application of anodal transcranial direct current stimulation (a-tDCS) to the M1 has been shown to improve motor function in PD; however, the combined use of tDCS and PRT has not been investigated.</p>
</sec>
<sec><title>Methods/design</title>
<p>We propose a 6-week, double-blind randomised controlled trial combining M1 tDCS and PRT of the lower body in participants (<italic>n</italic>
= 42) with moderate PD (Hoehn and Yahr scale score 2–4). Supervised lower body PRT combined with functional balance tasks will be performed three times per week with concurrent a-tDCS delivered at 2 mA for 20 minutes (a-tDCS group) or with sham tDCS (sham group). Control participants will receive standard care (control group). Outcome measures will include functional strength, gait speed and variability, balance, neurophysiological function at rest and during movement execution, and the UPDRS motor subscale, measured at baseline, 3 weeks (during), 6 weeks (post), and 9 weeks (retention). Ethical approval has been granted by the Deakin University Human Research Ethics Committee (project number 2015-014), and the trial has been registered with the Australian New Zealand Clinical Trials Registry (ACTRN12615001241527).</p>
</sec>
<sec><title>Discussion</title>
<p>This will be the first randomised controlled trial to combine PRT and a-tDCS targeting balance and gait in people with PD. The study will elucidate the functional, clinical and neurophysiological outcomes of combined PRT and a-tDCS. It is hypothesised that combined PRT and a-tDCS will significantly improve lower limb strength, postural sway, gait speed and stride variability compared with PRT with sham tDCS. Further, we hypothesise that pre-frontal cortex activation during dual-task cognitive and gait/balance activities will be reduced, and that M1 excitability and inhibition will be augmented, following the combined PRT and a-tDCS intervention.</p>
</sec>
<sec><title>Trial registration</title>
<p>Australian New Zealand Clinical Trials Registry <ext-link ext-link-type="uri" xlink:href="https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=369592">ACTRN12615001241527</ext-link>
. Registered on 12 November 2015.</p>
</sec>
</abstract>
<kwd-group xml:lang="en"><title>Keywords</title>
<kwd>Parkinson’s disease</kwd>
<kwd>Balance</kwd>
<kwd>Gait</kwd>
<kwd>Neuroplasticity</kwd>
<kwd>Non-invasive brain stimulation</kwd>
<kwd>fNIRS</kwd>
</kwd-group>
<funding-group><award-group><funding-source><institution>Deakin University Central Research Grant Scheme</institution>
</funding-source>
</award-group>
</funding-group>
<custom-meta-group><custom-meta><meta-name>issue-copyright-statement</meta-name>
<meta-value>© The Author(s) 2016</meta-value>
</custom-meta>
</custom-meta-group>
</article-meta>
</front>
</pmc>
</record>
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