Accidental Fall, Aging, Fall, Gait, Unsteady
Conditions
Brief summary
This pilot work will determine the feasibility of tDCS intervention as an effective adjunct intervention to PT aimed at improving gait, balance, and mobility in older adults at risk of falling.
Detailed description
Falls are correlated with both physical and cognitive declines in older adults. Recurrent fallers and those at high risk of falls are often referred to physical therapy (PT) for gait and balance training. Although physical therapists are aware of the importance of cortical control of gait and balance, there is no available tool to directly yet non-invasively intervene brain in the clinical setting. Transcranial direct current stimulation (tDCS) is a noninvasive and safe mean of modulating the excitability of specific brain regions and their connected neural networks. Our group and others have shown that tDCS intervention designed to facilitate the excitability of the left dorsal lateral prefrontal cortex (DLPFC) improves numerous aspects of executive function related to mobility in older adults. However, no studies to date have assessed the feasibility and effectiveness of applying tDCS as an adjunct to PT to improve gait and balance within the geriatric rehabilitation setting. This study aims to 1) assess the feasibility of implementing tDCS prior to each of their first 10 PT sessions, and 2) gather estimates of variability in outcomes related to gait, balance, cognition, and quality of life over time within older adults referred to PT for recurrent falls.
Interventions
OTHERReal tDCS and Physical Therapy
The participant will receive 20-minute sessions of real tDCS before each physical therapy visit for up to 10 combined sessions, over approximately 6 weeks.
OTHERSham stimulation and Physical Therapy
The participant will receive 20-minute sessions of sham stimulation before each physical therapy visit for up to 10 combined sessions, over approximately 6 weeks.
Sponsors
Hebrew SeniorLife
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
65 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Ages 65 years old and above * Admitted to Physical Therapy for gait and balance training due to the high risk of falls
Exclusion criteria
* Inability to stand or walk unassisted for 60 seconds * Severe cognitive impairment defined as a Montreal Cognitive Assessment (MoCA) score \< 18 * Any unstable medical condition * Any unstable psychiatric co-morbidity including major depressive disorder, schizophrenia or psychosis * Active cancer for which chemo/radiation therapy id being received * Significant vision and hearing problems that cannot be corrected with visual and hearing aids * Contraindications to tDCS, including seizure within the past two years, use of neuro-active drugs, the risk of metal objects in the brain, implanted medical devices, or the presence of dermatological conditions such as eczema on the scalp.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change from baseline in Trail Making Test B - A (reduced time after intervention means a better outcome) | Before and after the intervention (~ 6 weeks per participant) | The change from baseline in cognitive executive function |
| Intervention adherence rate (%, 0-100, higher ratio means a better outcome) | The whole data collection period (~ 6 months for the whole study) | Number of tDCS sessions completed |
| Adherence rate (%, 0-100, higher ratio means a better outcome) | The whole data collection period (~ 6 months for the whole study) | The portion of enrolled participants who complete and adhere to the intervention who complete and adhere to the intervention |
| Side effects | The whole data collection period (~ 6 months for the whole study) | The number, type, severity and duration of reported side effects |
| Change from baseline in the dual task cost to gait speed (reduced dual task cost after intervention means a better outcome) | Before and after the intervention (~ 6 weeks per participant) | The change from baseline in the degree to which performing a secondary cognitive task diminishes gait speed |
| Change from baseline in the dual task cost to standing postural sway speed (reduced dual task cost after intervention means a better outcome) | Before and after the intervention (~ 6 weeks per participant) | The change from baseline in the degree to which performing a secondary cognitive task diminishes the control of standing posture. |
| Screening to enrollment ratio (%, 0-100, higher ratio means a better outcome) | The whole data collection period (~ 6 months for the whole study) | The number of screenings needed to enroll one participant |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change from baseline in gait variability (reduced value after intervention means a better outcome) | Before and after the intervention (~ 6 weeks per participant) | The change from baseline in gait speed |
| Change from baseline in gradual-onset continuous performance test (gradCPT) ( increased accuracy after intervention means a better outcome) | Before and after the intervention (~ 6 weeks per participant) | The change from baseline in cognitive sustained attention |
| Change from baseline in Timed Up-and-Go (TUG) (reduced time after intervention means a better outcome) | Before and after the intervention (~ 6 weeks per participant) | The change from baseline in overall mobility function |
| Change from baseline in Montreal Cognitive Assessment (MoCA) total score (increased score after intervention means a better outcome) | Before and after the intervention (~ 6 weeks per participant) | The change from baseline in global cognitive function |
| Change from baseline in gait speed (increased value after intervention means a better outcome) | Before and after the intervention (~ 6 weeks per participant) | The change from baseline in gait speed |
Countries
United States
Outcome results
None listed