Neuromodulação e treinamento de marcha na função motora e equilíbrio na Doença de Parkinson: um ensaio clínico randomizado, controlado e duplo-cego

Abstract

Introduction: Bradykinesia, resting tremor, postural instability, rigidity, as well as anxiety and depression are motor and non-motor symptoms of Parkinson's Disease (PD). As a therapeutic alternative, treadmill training comprises a type of exercise considered safe and effective that allows the modification of gait speed, step length, cadence and postural stability in PD. It was hypothesized that the association of Transcranial Direct Current Stimulation (tDCS/tDCS) with treadmill gait training (TGT) would promote an increase in functional mobility, gait speed, motor function, balance and quality of life in people with PD. Objectives: To analyze the influence of the association of tDCS with TGT on functional mobility, gait speed, motor function, balance and quality of life of people with PD. Methods: People with idiopathic PD, aged 40-80 years, disease stage 1.5-3 on the modified Hoehn and Yahr scale were randomly allocated into two groups: 1) Experimental Group: application of tDCS for 20 minutes followed by 20 minutes of treadmill gait training and 2) Control Group: application of tDCS sham followed by the same gait training. Participants were evaluated at three moments (AV1, AV2 and AV3) by the Timed Up and Go (TUG), Ten meter walk test (10MWT), 5x Sit to Stand test (5XSTS), Unified Parkinson's Disease Scale part III (MDS-UPDRS-III), Mini Balance Evaluation Systems Test (Mini-BESTest), Activity-specific Balance Confidence Scale (ABC scale) and Parkinson's disease questionnaire-39 (PDQ-39). Outcome measures were analyzed using repeated measures ANOVA (3x2) in the statistical package Statistical Package for Social Sciences – SPSS 20.0 and a value of P≤0.05 was considered significant. Results: tDCS was able to potentiate the TGT by improving the balance of people with PD (P=0.043). Over time,

both groups showed improvement in the TUG, 10MWT, 5XSTS, MDS-UPDRS III, Mini- BESTest and PDQ-39 tests. Conclusions: The association of tDCS with TME was superior to

treadmill training alone to improve balance in people with PD, but it did not influence functional mobility, gait speed, motor function and quality of life in the sample studied.