Cathodal Cerebellar tDCS Combined with Visual Feedback Improves Balance Control
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ORIGINAL ARTICLE
Cathodal Cerebellar tDCS Combined with Visual Feedback Improves Balance Control Mehran Emadi Andani 1 & Bernardo Villa-Sánchez 1 & Federico Raneri 1 & Silvia Dametto 1 & Michele Tinazzi 1 & Mirta Fiorio 1
# The Author(s) 2020
Abstract Balance control is essential to maintain a stable body position and to prevent falls. The aim of this study was to determine whether balance control could be improved by using cerebellar transcranial direct current stimulation (tDCS) and visual feedback in a combined approach. A total of 90 healthy volunteers were randomly assigned to six groups defined by the delivery of tDCS (cathodal or anodal or sham) and the provision or not of visual feedback on balance during the acquisition phase. tDCS was delivered over the cerebellar hemisphere ipsilateral to the dominant leg for 20 min at 2 mA during a unipedal stance task. Body sway (i.e., ankle angle and hip position) was measured as an overall maximal unit in anteroposterior and mediolateral direction, together with participant rating of perception of stability, before (baseline), during (acquisition), and after (final) the intervention. We found a reduction in body sway during the acquisition session when visual feedback alone was provided. When the visual feedback was removed (final session), however, body sway increased above baseline. Differently, the reduction in overall maximal body sway was maintained during the final session when the delivery of cathodal tDCS and visual feedback was combined. These findings suggest that cathodal tDCS may support the short-term maintenance of the positive effects of visual feedback on balance and provide the basis for a new approach to optimize balance control, with potential translational implications for the elderly and patients with impaired posture control. Keywords Balance control . Posture . Unipedal stance task . tDCS . Cerebellum . Visual feedback
Introduction Balance is essential to maintain a stable and upright stance necessary for walking and other daily life activities. Impaired balance control in certain cerebellar disorders results in decreased quality of life and increased risk of falls [1–4]. This informs us about the importance of the cerebellum in controlling balance, as well as about the need to develop training methods that optimize balance control. For instance, balance training accompanied by visual feedback has been shown to induce improvement of balance Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12311-020-01172-0) contains supplementary material, which is available to authorized users. * Mirta Fiorio [email protected] 1
Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Via Casorati, 43, 37131 Verona, Italy
control [5, 6] and reduce postural sway [6–8]. Moreover, the elderly take advantage of visual feedback in balance training [9, 10], in which the visual feedback provides useful cues for performing balancing tasks. According to the guidance hypothesis, the pro
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