Transcranial direct stimulation in Parkinson's disease gait rehabilitation
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Gait variability seen in Parkinson's Disorders arise due to cortical changes induced by pathophysiology of the disease process. Gait rehabilitation is focused to harness the adapted connections involved actively to control these variations during the disease progression. Gait variabilities seen are attributed to the defective inputs from the Basal Ganglia.[1][2][3][4] However, there is altered activation of other cortical areas that support the deficient control to bring about a movement and maintain some functional mobility.[5][6][7][8][9]
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Transcranial direct-current stimulation is a modification of the traditionally available direct current applied with 2 saline soaked electrodes (active and reference: 5-35 cm2) with active placed at the area to be stimulated and reference electrode placed at the contralateral supraorbital region in the forehead. Focality of the current passes depends upon the position of the electrode, its dimensions and the current density. The duration of the stimulation varies from 5-20 mins with intensities of 0.5-2.0 mA.[10][11] It has been successfully introduced as a promising therapeutic adjuvant in various rehabilitation procedures. It alters cortical excitability of region of interest that can be harnessed to optimized motor priming and motor learning procedures involved in gait rehabilitation Mechanisms resulting in post synaptic changes to induce long lasting plasticity is like that of LTP (long-term potentiation) and LTD (long-term Depression) depending upon polarity of the current used.[10][11][12][13][14]