Effects of cerebellar non-invasive brain stimulation on balance and gait performance in individuals with stroke: a systematic review and meta-analysis.

Abstract

Introduction: Non-invasive brain stimulation (NIBS) is widely used for motor recovery after stroke. Recent studies have investigated the efficacy of cerebellar NIBS (cNIBS) in enhancing lower limb functional recovery in individuals with stroke. Thus, this study aims to investigate the effect of cNIBS on balance and gait recovery in individuals with stroke.

Evidence acquisition: A systematic literature search was conducted in CINAHL, Cochrane Library, MEDLINE, Physiotherapy Evidence Database, PsyclNFO, PubMed, and Scopus from inception to April 29, 2024. Randomized controlled trials (RCTs) that investigated the effects of cNIBS on gait or balance performance in individuals with stroke were included. Studies involving participants with cerebellar or brainstem stroke were excluded. Two researchers independently conducted study selection and data extraction and examined the methodological quality of the included RCTs and the certainty of evidence. A random-effects meta-analysis was performed to estimate the between-group mean difference (MD) or standardized MD (SMD) based on pre-post changes along with the 95% confidence interval (CI).

Evidence synthesis: Fourteen RCTs involving 382 participants were included. The methodological quality of the included studies ranged from fair to excellent. Compared with sham conditions, cNIBS significantly improved balance, as measured using the Berg Balance Scale (MD=4.17, 95% CI=2.28-6.05, P<0.01, low certainty of evidence); walking speed, as assessed using the 10-m walk test and 25-Feet Walk Test (SMD=-0.36, 95% CI=-0.68 to -0.03, P=0.03, moderate certainty of evidence); and functional mobility, as measured using the Timed Up and Go test (MD: -3.34, 95% CI=-5.14 to -1.54, P<0.01, low certainty of evidence).

Conclusions: With low-to-moderate certainty, the evidence indicates that cNIBS, including tDCS and TMS, can improve balance in individuals with stroke. cNIBS is also a promising approach to facilitate gait and functional mobility in stroke survivors. Future studies should determine optimal stimulation protocols and elucidate the mechanisms underlying the treatment effects.