Priming of postural training with cerebellar anodal transcranial direct current stimulation for its effects on postural balance and fear of falling in patients with multiple sclerosis: A randomized, double-blind, sham-controlled study

Postural impairment is one of the most disorders in patients with multiple sclerosis (MS), while fear of falling can exacerbate it in these patients. One of the leading causes of postural impairment and fear of falling in patients with MS is the cerebellum region's abnormalities, which may be modulated by cerebellar anodal transcranial direct current stimulation (a-tDCS). The present study aimed to investigate the effects of cerebellar a-tDCS concurrent with postural training (cerebellar a-CS_C-PT) on postureand fear of falling in patients with MS. Thirty-seven patients with MS were assessed to randomly assign into cerebellar a-tDCS_C-PT, sham tDCS_C-PT, and postural training alone groups. All groups received 10-session postural training, while 20-minute cerebellar a-tDCS was added in the tDCS groups. Before, immediately and one month after the intervention, posture, balance and fear of falling were assessed using Biodex Balance System, Berg Balance Scale (BBS), and Fall Efficacy Scale-International (FES-I), respectively. Postural stability indices, BBS, and FES-I scores improved immediately and one month after the intervention in the cerebellar a-tDCS_C-PT group (p < 0.001). Postural stability indices were immediately improved after intervention in the control groups (P < 0.05), while the changes were not maintained one month after intervention (P > 0.05). However, FES-I was not changed after the intervention in the control groups (P > 0.05). Cerebellar a-tDCS induces the effects of postural training on posture and balance and controls the fear of falling. This knowledge helps the physicians/therapists plan tDCS interventions to improve the balance, posture, and fear of falling in MS patients.