Neurological gait disorders are a common cause of falls, morbidity, and mortality, particularly amongst the elderly. Neurological gait and balance impairment has, however, proved notoriously difficult to treat. The following review discusses some of the first experiments to modulate gait and balance in healthy adults using anodal transcranial direct current stimulation (tDCS) by stimulating both cerebral hemispheres simultaneously. We review and discuss published data using this novel tDCS approach, in combination with physical therapy, to treat locomotor and balance disorders in patients with small vessel disease (leukoaraiosis) and Parkinson’s disease. Finally, we review the use of bihemispheric anodal tDCS to treat gait impairment in patients with stroke in the subacute phase. The findings of these studies suggest that noninvasive electrical stimulation techniques may be a useful adjunct to physical therapy in patients with neurological gait disorders, but further mutlicentre randomized sham-controlled studies are needed to evaluate whether experimental tDCS use can translate into mainstream clinical practice for the treatment of neurological gait disorders. 1. Introduction Disorders of gait are a common presentation in neurological practice and general medical settings, particularly amongst the elderly population. In addition, impairment of postural and righting reactions commonly causes falls when turning or bending over [1] leading to insecure walking and the development of a fear of falling [2]. The following review discusses some of the first ever experiments to modulate gait and balance in healthy adults using anodal transcranial direct current stimulation (tDCS) by stimulating both hemispheres simultaneously (Figure 1) and to treat locomotor and balance disorders in patients with neurological gait disturbance. Figure 1: (a) A novel bihemispheric tDCS montage targeting right and left lower limb motor cortices simultaneously. (b) Illustrative tDCS montage using the international 10–20 EEG electrode placement. The anodal (stimulating) electrode was placed over Cz and covered a region 10–20% anterior to Cz as measured from the midpoint of the electrode. The cathode was placed over the inion. We show in a series of previously published work that bihemispheric electrical stimulation with a novel montage can increase cortical excitability of lower limb muscles and increases locomotor learning in healthy subjects. The same electrode montage increases gait speed and improves balance in patients with Parkinson’s disease and gait disturbance associated
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