عنوان مقاله [English]
Background and Aims: Postural and balance control is essential for almost all daily activities. The purpose of the present study was to investigate the effect of cerebellar transcranial direct current stimulation (tDCS) on balance and somatosensory, vision, and vestibular systems function of the elderly.
Materials and Methods: An experimental, pre- and posttest design study was carried out on 20 elderlies (60-75 year olds) of both sexes who referred to Tehran Rehabilitation Center of Red Crescent Society in the summer of 1396. They were selected based on inclusion criteria and available and targeted sampling method, and were randomly assigned to two “Intervention” (real) and “control” (Placebo) groups (n=10). After a preliminary assessment of equilibrium parameters using Computerized Dynamic Posturorghraphy, “Intervention” group received direct current stimulation over the cerebellum at 2mA and “Placebo” group received sham stimulation, for 20 minutes in five sessions. At each session, immediately after stimulation, participants performed half-hour equilibrium exercises on the Huber apparatus. After completing five sessions, the variables were re-measured. Shapiro–Wilk, Levene's Test for Equality of Error Variances, the homogeneity of slope regression, and covariance analysis (MANCOVA and ANCOVA) were used to analyze the data.
Results: The results of the current study showed that direct electric stimulation of the cerebellum has significant effects on the postural control equilibrium variables in the first sensory condition absent vision and fixed support (P = 0.036), and the fifth sensory condition with absent vision and sway support (P = 0.034). Also, the electrical stimulation of the cerebellum increased the ability of the elderly group to use vestibular system input to maintain balance (P = 0.014), but did not have a significant effect on the ability to use the somatosensory, vision, and vestibular systems inputs (P>0/05).
Conclusion: The results of the present study showed that cerebellar TDCS with balance has beneficial effects on postural control and balance of elderly people probably by improving the processing of vestibular inputs and can improve motor adaptation and facilitate motor skills learning.
10. Ferrucci R, Cortese F, Priori A. Cerebellar tDCS: how to do it. The Cerebellum. 2015;14(1):27-30. ##
11. Grimaldi G, Argyropoulos GP, Bastian A, Cortes M, Davis NJ, Edwards DJ, et al. Cerebellar Transcranial Direct Current Stimulation (ctDCS) a novel approach to understanding cerebellar function in health and disease. The Neuroscientist. 2016;22(1):83-97. ##
12. ten Donkelaar HJ, Lammens M, Wesseling P, Hori A. Development and Developmental Disorders of the Human Cerebellum. Clinical Neuroembryology: Development and Developmental Disorders of the Human Central Nervous System. Berlin, Heidelberg: Springer Berlin Heidelberg; 2014. p. 371-420. ##
13. Nitsche MA, Paulus W. Excitability changes induced in the human motor cortex by weak transcranial direct current stimulation. The Journal of physiology. 2000;527 Pt 3:633-9. ##
14. Inukai Y, Saito K, Sasaki R, Kotan S, Nakagawa M, Onishi H. Influence of Transcranial Direct Current Stimulation to the Cerebellum on Standing Posture Control. Frontiers in human neuroscience. 2016;10:325. ##
15. Foerster Á, Melo L, Mello M, Castro R, Shirahige L, Rocha S, et al. Cerebellar transcranial direct current stimulation (ctDCS) impairs balance control in healthy individuals. The Cerebellum. 2017;16(4):872-5. ##
16. Galea JM, Vazquez A, Pasricha N, Orban de Xivry J-J, Celnik P. Dissociating the roles of the cerebellum and motor cortex during adaptive learning: the motor cortex retains what the cerebellum learns. Cerebral cortex. 2010;21(8):1761-70. ##
17. Ferrucci R, Marceglia S, Vergari M, Cogiamanian F, Mrakic-Sposta S, Mameli F, et al. Cerebellar transcranial direct current stimulation impairs the practice-dependent proficiency increase in working memory. Journal of cognitive neuroscience. 2008;20(9):1687-97. ##
18. Keel JC, Smith MJ, Wassermann EM. A safety screening questionnaire for transcranial magnetic stimulation. Clinical neurophysiology. 2001;112(4):720. ##
19. Birmingham Uo. TDCS and TACS Safety Questionnaire [Available from: prism.bham.ac.uk/downloads/TDCS_Safety_Qs_ConsentForm_30092015.pdf. ##
20. seyedian m, falah m, novrozyan m, najat s, dlavar a, ghasemzadeh h. Preparation and validation of the Persian version of Mini Mental Status Evaluation (MMSE). journal of medical council of islamic republic of iran. 2007;25(4):408-14. ##
21. Whitney S, Roche J, Marchetti G, Lin C-C, Steed D, Furman G, et al. A comparison of accelerometry and center of pressure measures during computerized dynamic posturography: a measure of balance. Gait & posture. 2011;33(4):594-9. ##
22. Reyes A, Salomonczyk D, Teo W-P, Medina LD, Bartlett D, Pirogovsky-Turk E, et al. Computerised Dynamic Posturography in Premanifest and Manifest individuals with Huntington’s Disease. Scientific reports. 2018;8(1):14615. ##
23. Taylor S. Postural responses to balance perturbation in young and older adults: Manchester Metropolitan University; 2018. ##
24. Cripps AE, Livingston SC. The Head Shake Sensory Organization Test (HS-SOT): Normative Data and Correlation with Dynamic Visual Acuity Testing. Journal of Sports Medicine and Allied Health Sciences: Official Journal of the Ohio Athletic Trainers Association. 2017;3(2):3. ##
25. Couillandre A, Duque Ribeiro MJ, Thoumie P, Portero P. Changes in balance and strength parameters induced by training on a motorised rotating platform: a study on healthy subjects. Annales de readaptation et de medecine physique : revue scientifique de la Societe francaise de reeducation fonctionnelle de readaptation et de medecine physique. 2008;51(2):59-73. ##
26. Folstein MF, Folstein SE, McHugh PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. Journal of psychiatric research. 1975;12(3):189-98. ##
27. Choy NL, Brauer S, Nitz J. Changes in postural stability in women aged 20 to 80 years. The journals of gerontology Series A, Biological sciences and medical sciences. 2003;58(6):525-30. ##
28. Edwards WH. (Motor learning and control: from theory to practice).Mousavi Sadati S. K. (Persian translator). Hatmi; 1393. p. 181-3. ##
29. Park IS, Lee NJ, Rhyu IJ. Roles of the Declive, Folium, and Tuber Cerebellar Vermian Lobules in Sportspeople. Journal of Clinical Neurology. 2018;14(1):1-7. ##
30. Winser SJ, Shubert MC, Chan AY, Kannan P, Whitney SL. Can pre-screening vestibulocerebellar involvement followed by targeted training improve the outcomes of balance in cerebellar ataxia? Medical Hypotheses. 2018. ##
31. Rasman BG, Forbes PA, Tisserand R, Blouin J-S. Sensorimotor manipulations of the balance control loop–beyond imposed external perturbations. Frontiers in Neurology. 2018;9. ##
32. Mousavi Sadati SK. Essentials of Human performance Neuroanatomy and Neurophysiology (In Persian). east tehran banch of islamic azad university 2017. p. 211-2. ##
33. Jacobson S, Marcus EM, Pugsley S. Motor Systems III: The Cerebellum Movement and Major Fiber Pathways of the Cerebellum. Neuroanatomy for the Neuroscientist: Springer; 2018. p. 393-425. ##
34. Zandvliet SB, Meskers CG, Kwakkel G, van Wegen EE. Short-Term Effects of Cerebellar tDCS on Standing Balance Performance in Patients with Chronic Stroke and Healthy Age-Matched Elderly. The Cerebellum. 2018:1-15. ##
35. Poortvliet P, Hsieh B, Cresswell A, Au J, Meinzer M. Cerebellar transcranial direct current stimulation improves adaptive postural control. Clinical Neurophysiology. 2018;129(1):33-41. ##
36. Steiner KM, Enders A, Thier W, Batsikadze G, Ludolph N, Ilg W, et al. Cerebellar tDCS does not improve learning in a complex whole body dynamic balance task in young healthy subjects. PloS one. 2016;11(9):e0163598. ##
37. van Dun K, Bodranghien FC, Mariën P, Manto MU. tDCS of the cerebellum: where do we stand in 2016? Technical issues and critical review of the literature. Frontiers in human neuroscience. 2016;10:199. ##