Role of Transcranial Direct Current Stimulation in Rehabilitation of Gait in Hypokinetic Gait Disorders

Abstract

Gait is a complex function that depends on multiple factors, including spinal locomotor pattern generators with supraspinal control. Multiple brain regions, connected by white matter tracts, are involved in this supraspinal control of gait (la Fougere et al., 2010). Gait impairments are the hallmark of hypokinetic gait disorders, and an important cause of disability later in the disease course. They lead to abnormalities in two main components of postural control: orientation (maintaining a normal postural arrangement and alignment) and stabilization (maintaining equilibrium) (Vaugoyeau & Azulay, 2010). Gait disorders, along with turning and balance disturbances, are the most important determinants of falls, which occur despite maximal treatment with levodopa (likely due to extranigral and non-dopaminergic brain lesions). Falls often have dramatic consequences, such as traumas (Nicola et al., 2011) and high risk of fractures (more than two-fold increased risk of fall related fracture) (Vestergaard et al., 2007).