Efeito da estimulação transcraniana por corrente contínua na capacidade funcional e dupla tarefa em indivíduos com diabetes mellitus: ensaio clínico randomizado

Abstract

Introduction: People with type 2 diabetes mellitus may present changes in the neuromotor system such as reduced muscle strength, changes in the motor gait pattern, balance and proprioception deficits. The use of transcranial direct current stimulation (tDCS) in recent years has become an interesting strategy with positive results on gait motor pattern, postural control, functionality and independence. Objective: To evaluate the effect of transcranial direct current stimulation on the functional capacity of individuals with diabetes when performing dual motor and cognitive tasks. Methodology: This is a randomized clinical trial. The study groups were made up of 45 adult volunteers of both sexes, randomized into an intervention group (IG) and a control/sham group (CG). Initial assessment was carried out to investigate aspects related to diabetes through the Michigan questionnaire (MNSI-Brazil) and inspection of the feet, screening test for cognitive screening through the MoCA, evaluation of different postures with the Berg balance scale, grip strength manual. Functional capacity assessment consisted of the gait speed test, the timed up and go (TUG) and cognitive timed up go (TUG cognitive) and the cost of the dual task, the tests measured by Baiobit. The intervention was carried out with gait training on a treadmill and concomitant application of transcranial direct current stimulation or not (sham) in the primary motor cortex associated with a dual task. Statistical analysis: Data were described by mean and confidence interval (95%). Normal distribution parameters were evaluated using the Shapiro-Wilk test (p>0.05). The intraclass correlation coefficient was performed according to Koo et al (2016). An independent Student's t-test was applied at baseline to compare the groups' general characteristics. Homogeneity analysis was performed using Levene's test (p>0.05). Two-way analysis of variance with covariance (ANCOVA) for repeated measures was performed and the assumption of sphericity was assessed with the Mauchly, Greenhouse-Geisser test for significant violations. Results: Gait speed, TUG and cognitive TUG were not influenced by the use of tDCS. Gait cadence increased between the baseline and post-intervention periods, as well as a reduction in the cognitive TUG execution time for both groups, demonstrating the effect of training independent of the use of tDCS for these variables. Secondary measures such as the MoCA test, Berg balance scale and handgrip strength were similar between pre- and post-intervention groups. Conclusion: The use of tDCS did not influence the functional capacity of people with type 2 diabetes. However, gait training on a treadmill with dual tasks can favor an increase in cadence and reduce the cost of dual tasks.