Cortical priming strategies for gait training after stroke: a controlled, stratified trial.
Sangeetha Madhavan, Brice T Cleland, Anjali Sivaramakrishnan and 4 others
PMID 32799922WHAT IT FOUND
High-intensity treadmill training improved walking speed and endurance in all groups, but adding cortical priming did not enhance these gains.
One subgroup showed brain excitability changes, but this did not translate to better walking performance.
Key findings
01Four weeks of high-intensity speed-based treadmill training improved comfortable and maximal walking speed, walking endurance, balance, and mobility across all groups, with gains partially retained at 3 months.
02Cortical priming with tDCS, movement-based priming, or both combined did not improve walking speed more than high-intensity treadmill training alone, as there were no significant group-by-time interactions for the primary outcome.
03Participants who responded to tDCS with increased brain excitability showed greater improvements in walking speed over time compared to those who did not respond, suggesting individual variability in tDCS effects.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The study was stopped early for futility after an interim analysis showed no benefit of priming, meaning it may have been underpowered to detect small differences. The 15-minute priming sessions were much shorter than the 40-minute training sessions, which may have masked potential effects. Brain excitability measures (TMS) were only available for participants with higher motor function, limiting generalizability to more severely impaired patients. Individual variability in response to tDCS was high, suggesting that priming effects may depend on specific patient characteristics not fully accounted for in the group analysis.
Declared interests
The study was funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development. No other conflicts of interest were declared.
The easy way to misread this
Do not interpret the brain excitability changes in the combined priming group as evidence of clinical benefit. The physiological changes did not translate to improved walking speed or endurance compared to treadmill training alone.