The effect of transcranial direct current stimulation associated with video game training on the postural balance of older women in the community: A blind, randomized, clinical trial

BACKGROUND

Falls are frequent in older adults and can cause trauma, injury, and death. Fall prevention with virtual reality presents good results in improving postural control. Transcranial Direct Current Stimulation (tDCS) has been used with the same aim; however, the combination of the two techniques has still been little studied.

PURPOSE

To assess whether tDCS can enhance the effect of video game training (VGT) on improving the postural balance of healthy older women.

METHOD

A blinded, randomized, controlled clinical trial was conducted with 57 older women who were randomized to three balance training groups: Control Group (VGT), Anodal Group (VGT combined with anodic tDCS-atDCS), and Sham Group (VGT combined with sham tDCS-stDCS). Balance training was performed twice a week for four weeks, totalizing eight 20-min sessions using VGT associated with tDCS. Postural balance was assessed pre-and post-training and 30 days after the end of the eight sessions using the Mini-Balance Evaluation Systems Test.

RESULTS

Compared to pre-intervention the Mini BEST test increased similarly in the three groups in post-intervention (control: pre 23.7 ± 2.8 to post 27.0 ± 2.2; anodal: pre 24.4 ± 1 to post 27.7 ± 0.8 and sham: pre 24.2 ± 1.9 to post 26.5 ± 1.6; p < 0.001) and follow-up (control: pre 23.7 ± 2.8 to follow-up 26.8 ± 2.3; anodal: pre 24.4 ± 1 to follow-up 27.3 ± 1.4 and sham: pre 24.2 ± 1.9 to follow-up 26.8 ± 1.5; p < 0.001).

CONCLUSION

There was an improvement in the postural balance of the three training groups that were independent of tDCS.

DISCUSSION

Some studies have shown the positive tDCS effects associated with other tasks to improve balance. However, these results convey the effects of only anodic-tDCS compared to sham-tDCS. Possibly, the effect of VGT surpassed the tDCS effects, promoting a ceiling effect from the combination of these two therapies. However, studies with other therapies combined with tDCS for older adults deserve to be investigated, as well as in frail older people.

Protocol for a controlled, randomized, blind, clinical trial to assess the effects of anodal transcranial direct current stimulation dorsolateral prefrontal cortex associated with balance training using games in the postural balance of older people

Aims: This study aims to evaluate the additional effect of anodal transcranial direct current stimulation (a-tDCS) applied on dorsolateral pré-frontal cortex on training postural balance with the use of video games in the aged.

Methods: This is a blinded, randomized, controlled clinical trial protocol, with older people of both genders. Participants will be randomized into three training groups: Group 1 (videogame balance training), group 2 (videogame balance training associated with anodal tDCS), group 3 (videogame balance training associated with sham tDCS). The training will be carried out twice a week for four weeks, totaling eight sessions, and will be performed with the Nintendo Wii videogame console, using games that stimulate the postural balance associated with tDCS, with anode applied over the left dorsolateral prefrontal cortex and cathode on the contralateral supraorbital region at 2 mA for 20 minutes. The postural balance will be assessed using the Mini Test of the Balance Assessment System and posturography. Evaluations will be carried out before and after eight training sessions and 30 days after the end of treatment.

Discussion: Some studies show favorable results from the use of video games in improving postural balance in older people; however, their effect does not remain long-term. TDCS associated with other therapies can potentiate and prolong the effects of these therapies owing to its ability to stimulate neurotrophins important for neurogenesis, facilitating tasks that require attention, and helping to consolidate learning and memory. The effect of the two associated techniques on balance has not yet been tested in this population.

Registration: Brazilian Registry of Clinical Trials ID U1111-1213-4266; registered on 15 October 2018.

Protocol for a controlled, randomized, blind, clinical trial to assess the effects of anodal transcranial direct current stimulation dorsolateral prefrontal cortex associated with balance training using games in the postural balance of older people

Aims: This study aims to evaluate the additional effect of anodal transcranial direct current stimulation (a-tDCS) applied on dorsolateral pré-frontal cortex on training postural balance with the use of video games in the aged. Methods: This is a blinded, randomized, controlled clinical trial protocol, with older people of both genders. Participants will be randomized into three training groups: Group 1 (videogame balance training), group 2 (videogame balance training associated with anodal tDCS), group 3 (videogame balance training associated with sham tDCS). The training will be carried out twice a week for four weeks, totaling eight sessions, and will be performed with the Nintendo Wii videogame console, using games that stimulate the postural balance associated with tDCS, with anode applied over the left dorsolateral prefrontal cortex and cathode on the contralateral supraorbital region at 2 mA for 20 minutes. The postural balance will be assessed using the Mini Test of the Balance Assessment System and posturography. Evaluations will be carried out before and after eight training sessions and 30 days after the end of treatment. Discussion: Some studies show favorable results from the use of video games in improving postural balance in older people; however, their effect does not remain long-term. TDCS associated with other therapies can potentiate and prolong the effects of these therapies owing to its ability to stimulate neurotrophins important for neurogenesis, facilitating tasks that require attention, and helping to consolidate learning and memory. The effect of the two associated techniques on balance has not yet been tested in this population. Registration: Brazilian Registry of Clinical Trials ID U1111-1213-4266; registered on 15 October 2018.