Vestibular rehabilitation therapy in combination with transcranial direct current stimulation (tDCS) for treatment of chronic vestibular dysfunction in the elderly: a double-blind randomized controlled trial

Abstract Introduction Dizziness and imbalance are common dysfunctions in the elderly. Vestibular rehabilitation therapy is an effective method to alleviate chronic dizziness in patients with vestibular dysfunction. Transcranial direct current stimulation has reportedly improved balance function in patients with vestibular dysfunction. Objective This study was conducted to investigate the therapeutic efficacy of vestibular rehabilitation combined with transcranial direct current stimulation in elderly patients with vestibular dysfunction. Methods In a double-blinded randomized controlled trial, 36 elderly patients with chronic vestibular dysfunction were randomly assigned to either vestibular rehabilitation and transcranial direct current stimulation (n = 18) or vestibular rehabilitation alone (n = 18) group. The transcranial stimulation protocol consisted of multisession bifrontal electrical stimulation of the dorsolateral prefrontal cortex (2 mA intensity and 20 min duration), followed by rehabilitation exercises. The vestibular rehabilitation protocol consisted of habituation and adaptation exercises combined with gait exercises during a three week period. The primary outcome of this study was the dizziness handicap inventory score, and the secondary outcomes were activities-specific balance confidence and Beck anxiety inventory scores. Results For the dizziness handicap score, the repeated-measures analysis of variance showed a significant main effect of “time”, “stimulation” and stimulation × time interaction effect. There was a significant reduction in the overall dizziness handicap score with “time” for both the groups, which was more pronounced in the vestibular rehabilitation and electrical stimulation group. In terms of activities-specific balance confidence change scores, we found a significant main effect of “time” and “stimulation” main factors, but this effect for stimulation × time interaction was not significant. For the Beck anxiety score, we observed a significant main effect of “time”, but no evidence for the main effect of the “stimulation” factor. Conclusion Bifrontal transcranial direct current stimulation in combination with vestibular rehabilitation therapy is a promising approach to improve chronic vestibular symptoms in the elderly.

摘要 引言：眩晕与平衡障碍是老年人常见的功能障碍。前庭康复治疗（Vestibular Rehabilitation Therapy）是缓解前庭功能障碍患者慢性眩晕的有效手段。已有研究表明，经颅直流电刺激（Transcranial Direct Current Stimulation）可改善前庭功能障碍患者的平衡功能。本研究旨在探讨前庭康复治疗联合经颅直流电刺激对老年前庭功能障碍患者的治疗效果。本研究采用双盲随机对照试验（Double-Blinded Randomized Controlled Trial）设计，将36例慢性前庭功能障碍老年患者随机分为两组：前庭康复治疗联合经颅直流电刺激组（n=18）与单纯前庭康复治疗组（n=18）。经颅电刺激方案为双侧背外侧前额叶皮层（Dorsolateral Prefrontal Cortex）的多疗程电刺激，电流强度2 mA，单次刺激时长20 min，刺激完成后随即开展康复训练。前庭康复治疗方案为期3周，包含习惯化训练、适应训练及步态训练。本研究的主要结局指标为眩晕残障量表（Dizziness Handicap Inventory）评分，次要结局指标为活动特异性平衡信心量表（Activities-Specific Balance Confidence）评分与贝克焦虑量表（Beck Anxiety Inventory）评分。针对眩晕残障量表评分，重复测量方差分析（Repeated-Measures Analysis of Variance）结果显示存在显著的“时间”主效应、“刺激”主效应及刺激×时间交互效应。两组患者的总体眩晕残障量表评分均随时间推移显著降低，且前庭康复治疗联合电刺激组的降低幅度更为显著。在活动特异性平衡信心量表变化评分方面，仅观察到“时间”与“刺激”的显著主效应，未发现刺激×时间的交互效应。对于贝克焦虑量表评分，仅观察到“时间”的显著主效应，未发现“刺激”因素的主效应。结论：双侧前额叶经颅直流电刺激联合前庭康复治疗，可有效改善老年患者的慢性前庭功能相关症状，是一种颇具应用前景的治疗方案。