The Combination of Transcranial Direct Current Stimulation and Virtual Reality Training on Fatigue, Balance and Walking in Patients With Multiple Sclerosis

Purpose: Fatigue, imbalance, and walking disorder were commonly observed in patients with multiple sclerosis (MS) as debilitating symptoms. Therefore, the present study aims to examine the effect of transcranial direct current stimulation (tDCS) separately and in combination with virtual reality (VR) training on fatigue, balance, and walking (speed and stride length) in patients with MS. Methods: The present clinical trial research was conducted with 30 MS patients aged 18-55 years (including 21 women and 9 men). The random assignment of subjects was assessed into one of three groups, tDCS group, VR group, and combined tDCS-VR training group. In the tDCS group, the M1 motor cortex was stimulated by direct electrical current in five sessions, and VR training patients participated in the VR program for six sessions. In the combination intervention, participants were delivered tDCS before each VR session. Fatigue severity scale (FSS), Berg balance scale (BBS), and 25-foot walk test (T25-FW) were used to evaluate the fatigue, balance, and walking speed respectively as pre and post-tests. Statistical analysis of covariance (ANCOVA) was used to compare the results between the three groups. Results: Our results showed a significant effect of tDCS, VR, and tDCS-VR on fatigue and a significant effect of VR and tDCS-VR on balance and walking speed in patients with MS (P0.05). Conclusion: Despite the positive effect of fatigue, we found VR and tDCS-VR to be a more effective method for treating balance and walking of the patient. The combination effect of tDCS with VR therapy, should be investigated further.