Journal of Sports and Motor Development and Learning
Scientific Journal

Comparing the Effect of Transcranial Direct Current Stimulation of Cerebellum and Dorsolateral Prefrontal Cortex on Static Balance of Elderly Men

Document Type : Research Paper I Open Access I Released under CC BY-NC 4.0 license

Authors

Muthanna Kadhim Jasim Al-Graee 1
Farzaneh Davari 2
Mazin hadi kzar Altaie 3
Zohreh Meshkati 4

1 Department of Motor Behavior, Faculty of Sport Sciences, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran.

2 Department of Motor Behavior, Faculty of Sport Sciences , Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran.

3 Department of Motor Behavior, Faculty of Sport Sciences , Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan , Iran.

4 Department of Motor Behavior , Faculty of Sport Sciences , Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran.

https://doi.org/10.22059/jsmdl.2024.380894.1794
Abstract
Introduction: Transcranial direct current stimulation (tDCS) has gained attention as a safe, non-invasive neuromodulation technique for enhancing motor and cognitive functions in older adults. Among various brain regions, cerebellar stimulation appears particularly effective in improving postural control and static balance. This study aimed to compare the effects of tDCS applied over the cerebellum and the dorsolateral prefrontal cortex (DLPFC) on the static balance of elderly men.
Methods: In this semi-experimental study with a pretest-posttest design, 60 healthy elderly men aged 60 to 80 years from Ahvaz voluntarily participated and were randomly assigned to four groups: cerebellar tDCS, left DLPFC tDCS, sham cerebellar tDCS, and sham DLPFC tDCS (15 participants each). Static balance was evaluated using a force plate device, during which participants completed three 30-second trials of quiet standing in both the pretest and posttest stages. The intervention consisted of 10 sessions over two weeks (five sessions per week), with each tDCS session lasting 20 minutes. Data were analyzed using one-way analysis of covariance (ANCOVA).
 Results: The findings indicated that both cerebellar and DLPFC tDCS significantly improved static balance by reducing center of pressure displacement in anterior-posterior and medial-lateral directions (p<0.05). However, no statistically significant difference was observed between the effects of cerebellar and DLPFC stimulation (p>0.05).
Conclusion: Based on these results, both cerebellar and DLPFC tDCS protocols can be considered effective interventions for enhancing static balance in elderly men. Health professionals and specialists are encouraged to include these approaches in balance rehabilitation programs for older adults.

Keywords

Noninvasive Brain Stimulation
tDCS
Cerebellum
dlPFC
Balance
Elderly

Aartolahti, E., Tolppanen, A. M., Lönnroos, E., Hartikainen, S., & Häkkinen, A. (2015). Health condition and physical function as predictors of adherence in long-term strength and balance training among community-dwelling older adults. Archives of gerontology and geriatrics, 61(3), 452-457. https://doi.org/10.1016/j.archger.2015.06.016

Alcock, L., Vitório, R., Stuart, S., Rochester, L., & Pantall, A. (2023). Faster walking speeds require greater activity from the primary motor cortex in older adults compared to younger adults. Sensors, 23(15), 6921. https://doi.org/10.3390/s23156921

Baharlouei, H., Saba, M. A., Yazdi, M. J. S., & Jaberzadeh, S. (2020). The effect of transcranial direct current stimulation on balance in healthy young and older adults: A systematic review of the literature. Neurophysiologie Clinique, 50(2), 119-131. https://doi.org/10.1016/j.neucli.2020.01.006

Baharlouei, H., Salehinejad, M. A., Talimkhani, A., & Nitsche, M. A. (2023). The effect of non-invasive brain stimulation on gait in healthy young and older adults: A systematic review of the literature. Neuroscience, 516, 125-140. https://doi.org/10.1016/j.neuroscience.2023.01.026

BaniAsadi, T., Sheikh, M., & Salehian, M. H. (2022). The Effect of Cerebellar Transcranial Direct Current Stimulation (ctDCS) on Postural Control Strategies in Elderly Population. Journal of Humanistic approach to sport and exercise studies, 2(2), 212-219. https://doi.org.10.52547/hases.2.2.4

Bernard, J. A., & Seidler, R. D. (2014). Moving forward: age effects on the cerebellum underlie cognitive and motor declines. Neuroscience & Biobehavioral Reviews, 42, 193-207. https://doi.org/10.1016/j.neubiorev.2014.02.011

Cavallari, M., Moscufo, N., Skudlarski, P., Meier, D., Panzer, V. P., Pearlson, G. D., ... & Guttmann, C. R. (2013). Mobility impairment is associated with reduced microstructural integrity of the inferior and superior cerebellar peduncles in elderly with no clinical signs of cerebellar dysfunction. NeuroImage: Clinical, 2, 332-340. https://doi.org/10.1016/j.nicl.2013.02.003

Celnik, P. (2015). Understanding and modulating motor learning with cerebellar stimulation. The Cerebellum, 14, 171-174. https://doi.org/10.1007/s12311-014-0607-y

Dong, K., Meng, S., Guo, Z., Zhang, R., Xu, P., Yuan, E., & Lian, T. (2021). The effects of transcranial direct current stimulation on balance and gait in stroke patients: a systematic review and meta-analysis. Frontiers in neurology, 12, 650925. https://doi.org/10.3389/fneur.2021.650925

Ehsani, F., Samaei, A., Zoghi, M., Hedayati, R., & Jaberzadeh, S. (2017). The effects of cerebellar transcranial direct current stimulation on static and dynamic postural stability in older individuals: a randomized double‐blind sham‐controlled study. European Journal of Neuroscience, 46(12), 2875-2884. https://doi.org/10.1111/ejn.13731

Fregni, F., Boggio, P. S., Bermpohl, F., Maia, F., Rigonatti, S. P., Barbosa, E. R., & Pascual-Leone, A. (2006). Immediate placebo effect in Parkinson’s disease–is the subjective relief accompanied by objective improvement?. European neurology, 56(4), 222-229. https://doi.org/10.1159/000096490

Guo, Z., Bao, D., Manor, B., & Zhou, J. (2020). The effects of transcranial direct current stimulation (tDCS) on balance control in older adults: A systematic review and meta-analysis. Frontiers in Aging Neuroscience, 12, 275. https://doi.org/10.3389/fnagi.2020.00275

Hamacher, D., Herold, F., Wiegel, P., Hamacher, D., & Schega, L. (2015). Brain activity during walking: a systematic review. Neuroscience & Biobehavioral Reviews, 57, 310-327. https://doi.org/10.1016/j.neubiorev.2015.08.002

Kinker Mishra, R., & Thrasher, A. T. (2021). Transcranial direct current stimulation of dorsolateral prefrontal cortex improves dual-task gait performance in patients with Parkinson’s disease: a double blind, sham-controlled study. Gait & Posture, 84, 11-16. https://doi.org/10.1016/j.gaitpost.2020.11.012

Lamm, C., Windischberger, C., Moser, E., & Bauer, H. (2007). The functional role of dorso-lateral premotor cortex during mental rotation: an event-related fMRI study separating cognitive processing steps using a novel task paradigm. NeuroImage, 36(4), 1374-1386. https://doi.org/10.1016/j.neuroimage.2007.04.012

Liao, Y. Y., Liu, M. N., Wang, H. C., Walsh, V., & Lau, C. I. (2021). Combining transcranial direct current stimulation with tai chi to improve dual-task gait performance in older adults with mild cognitive impairment: a randomized controlled trial. Frontiers in Aging Neuroscience, 13, 766649. https://doi.org/10.3389/fnagi.2021.766649

Lim, C. Y., & Shin, H. I. (2011). Noninvasive DC stimulation on neck changes MEP. Neuroreport, 22(16), 819-823.https://doi.org/10.1097/WNR.0b013e32834b939d

Manor, B., Zhou, J., Harrison, R., Lo, O. Y., Travison, T. G., Hausdorff, J. M., ... & Lipsitz, L. (2018). Transcranial direct current stimulation may improve cognitive-motor function in functionally limited older adults. Neurorehabilitation and neural repair, 32(9), 788-798. https://doi.org/10.1177/1545968318792616

Manor, B., Zhou, J., Jor'dan, A., Zhang, J., Fang, J., & Pascual-Leone, A. (2016). Reduction of dual-task costs by noninvasive modulation of prefrontal activity in healthy elders. Journal of cognitive neuroscience, 28(2), 275-281. https://doi.org/10.1162/jocn_a_00897

Manto, M., Bower, J. M., Conforto, A. B., Delgado-García, J. M., Da Guarda, S. N. F., Gerwig, M., ... & Timmann, D. (2012). Consensus paper: roles of the cerebellum in motor control—the diversity of ideas on cerebellar involvement in movement. The Cerebellum, 11, 457-487. https://doi.org/10.1007/s12311-011-0331-9

Mao, Y., Chen, P., Li, L., & Huang, D. (2014). Virtual reality training improves balance function. Neural regeneration research, 9(17), 1628-1634. https://doi.org/10.4103/1673-5374.141795

Nitsche, M. A., & Paulus, W. (2000). Excitability changes induced in the human motor cortex by weak transcranial direct current stimulation. The Journal of physiology, 527(Pt 3), 633. https://doi.org/10.1111/j.1469-7793.2000.t01-1-00633.x

Paquette, M. R., Li, Y., Hoekstra, J., & Bravo, J. (2015). An 8-week reactive balance training program in older healthy adults: A preliminary investigation. Journal of Sport and Health Science, 4(3), 263-269. https://doi.org/10.1016/j.jshs.2014.06.004

Parsaee, S., Shohani, M., & Jalilian, M. (2023). The effect of cerebellar TDCS on static and dynamic balance of inactive elderly men. Gerontology and Geriatric Medicine, 9, 23337214231159760. https://doi.org/10.1177/23337214231159760

Picard, N., & Strick, P. L. (2001). Imaging the premotor areas. Current opinion in neurobiology, 11(6), 663-672. https://doi.org/10.1016/S0959-4388(01)00266-5

Prentice, S. D., & Drew, T. (2001). Contributions of the reticulospinal system to the postural adjustments occurring during voluntary gait modifications. Journal of neurophysiology, 85(2), 679-698. https://doi.org/10.1152/jn.2001.85.2.679

Priori, A., Ciocca, M., Parazzini, M., Vergari, M., & Ferrucci, R. (2014). Transcranial cerebellar direct current stimulation and transcutaneous spinal cord direct current stimulation as innovative tools for neuroscientists. The Journal of physiology, 592(16), 3345-3369. https://doi.org/10.1113/jphysiol.2013.270280

Rauscher, M., Yavari, F., Batsikadze, G., Ludolph, N., Ilg, W., Nitsche, M. A., ... & Steiner, K. M. (2020). Lack of cerebellar tDCS effects on learning of a complex whole body dynamic balance task in middle-aged (50–65 years) adults. Neurological Research and Practice, 2, 1-8. https://doi.org/10.1186/s42466-020-00085-x

Steiner, K. M., Enders, A., Thier, W., Batsikadze, G., Ludolph, N., Ilg, W., & Timmann, D. (2016). Cerebellar tDCS does not improve learning in a complex whole body dynamic balance task in young healthy subjects. PloS one, 11(9), e0163598. https://doi.org/10.1371/journal.pone.0163598

Truini, A., Vergari, M., Biasiotta, A., La Cesa, S., Gabriele, M., Di Stefano, G., ... & Priori, A. (2011). Transcutaneous spinal direct current stimulation inhibits nociceptive spinal pathway conduction and increases pain tolerance in humans. European Journal of Pain, 15(10), 1023-1027. https://doi.org/10.1016/j.ejpain.2011.04.009

Zandvliet, S. B., Meskers, C. G., Kwakkel, G., & van Wegen, E. E. (2018). Short-term effects of cerebellar tDCS on standing balance performance in patients with chronic stroke and healthy age-matched elderly. The Cerebellum, 17, 575-589. https://doi.org/10.1007/s12311-018-0939-0

Zhou, J., Hao, Y., Wang, Y., Jor'dan, A., Pascual‐Leone, A., Zhang, J., ... & Manor, B. (2014). Transcranial direct current stimulation reduces the cost of performing a cognitive task on gait and postural control. European Journal of Neuroscience, 39(8), 1343-1348. https://doi.org/10.1111/ejn.12492

Zhou, J., Manor, B., Yu, W., Lo, O. Y., Gouskova, N., Salvador, R., ... & Hausdorff, J. M. (2021). Targeted tDCS mitigates dual‐task costs to gait and balance in older adults. Annals of neurology, 90(3), 428-439. https://doi.org/10.1002/ana.26156

Aartolahti, E., Tolppanen, A. M., Lönnroos, E., Hartikainen, S., & Häkkinen, A. (2015). Health condition and physical function as predictors of adherence in long-term strength and balance training among community-dwelling older adults. Archives of gerontology and geriatrics, 61(3), 452-457. https://doi.org/10.1016/j.archger.2015.06.016
Alcock, L., Vitório, R., Stuart, S., Rochester, L., & Pantall, A. (2023). Faster walking speeds require greater activity from the primary motor cortex in older adults compared to younger adults. Sensors, 23(15), 6921. https://doi.org/10.3390/s23156921
Baharlouei, H., Saba, M. A., Yazdi, M. J. S., & Jaberzadeh, S. (2020). The effect of transcranial direct current stimulation on balance in healthy young and older adults: A systematic review of the literature. Neurophysiologie Clinique, 50(2), 119-131. https://doi.org/10.1016/j.neucli.2020.01.006
Baharlouei, H., Salehinejad, M. A., Talimkhani, A., & Nitsche, M. A. (2023). The effect of non-invasive brain stimulation on gait in healthy young and older adults: A systematic review of the literature. Neuroscience, 516, 125-140. https://doi.org/10.1016/j.neuroscience.2023.01.026
BaniAsadi, T., Sheikh, M., & Salehian, M. H. (2022). The Effect of Cerebellar Transcranial Direct Current Stimulation (ctDCS) on Postural Control Strategies in Elderly Population. Journal of Humanistic approach to sport and exercise studies, 2(2), 212-219. https://doi.org.10.52547/hases.2.2.4
Bernard, J. A., & Seidler, R. D. (2014). Moving forward: age effects on the cerebellum underlie cognitive and motor declines. Neuroscience & Biobehavioral Reviews, 42, 193-207. https://doi.org/10.1016/j.neubiorev.2014.02.011
Cavallari, M., Moscufo, N., Skudlarski, P., Meier, D., Panzer, V. P., Pearlson, G. D., ... & Guttmann, C. R. (2013). Mobility impairment is associated with reduced microstructural integrity of the inferior and superior cerebellar peduncles in elderly with no clinical signs of cerebellar dysfunction. NeuroImage: Clinical, 2, 332-340. https://doi.org/10.1016/j.nicl.2013.02.003
Celnik, P. (2015). Understanding and modulating motor learning with cerebellar stimulation. The Cerebellum, 14, 171-174. https://doi.org/10.1007/s12311-014-0607-y
Dong, K., Meng, S., Guo, Z., Zhang, R., Xu, P., Yuan, E., & Lian, T. (2021). The effects of transcranial direct current stimulation on balance and gait in stroke patients: a systematic review and meta-analysis. Frontiers in neurology, 12, 650925. https://doi.org/10.3389/fneur.2021.650925
Ehsani, F., Samaei, A., Zoghi, M., Hedayati, R., & Jaberzadeh, S. (2017). The effects of cerebellar transcranial direct current stimulation on static and dynamic postural stability in older individuals: a randomized double‐blind sham‐controlled study. European Journal of Neuroscience, 46(12), 2875-2884. https://doi.org/10.1111/ejn.13731
Fregni, F., Boggio, P. S., Bermpohl, F., Maia, F., Rigonatti, S. P., Barbosa, E. R., & Pascual-Leone, A. (2006). Immediate placebo effect in Parkinson’s disease–is the subjective relief accompanied by objective improvement?. European neurology, 56(4), 222-229. https://doi.org/10.1159/000096490
Guo, Z., Bao, D., Manor, B., & Zhou, J. (2020). The effects of transcranial direct current stimulation (tDCS) on balance control in older adults: A systematic review and meta-analysis. Frontiers in Aging Neuroscience, 12, 275. https://doi.org/10.3389/fnagi.2020.00275
Hamacher, D., Herold, F., Wiegel, P., Hamacher, D., & Schega, L. (2015). Brain activity during walking: a systematic review. Neuroscience & Biobehavioral Reviews, 57, 310-327. https://doi.org/10.1016/j.neubiorev.2015.08.002
Kinker Mishra, R., & Thrasher, A. T. (2021). Transcranial direct current stimulation of dorsolateral prefrontal cortex improves dual-task gait performance in patients with Parkinson’s disease: a double blind, sham-controlled study. Gait & Posture, 84, 11-16. https://doi.org/10.1016/j.gaitpost.2020.11.012
Lamm, C., Windischberger, C., Moser, E., & Bauer, H. (2007). The functional role of dorso-lateral premotor cortex during mental rotation: an event-related fMRI study separating cognitive processing steps using a novel task paradigm. NeuroImage, 36(4), 1374-1386. https://doi.org/10.1016/j.neuroimage.2007.04.012
Liao, Y. Y., Liu, M. N., Wang, H. C., Walsh, V., & Lau, C. I. (2021). Combining transcranial direct current stimulation with tai chi to improve dual-task gait performance in older adults with mild cognitive impairment: a randomized controlled trial. Frontiers in Aging Neuroscience, 13, 766649. https://doi.org/10.3389/fnagi.2021.766649
Lim, C. Y., & Shin, H. I. (2011). Noninvasive DC stimulation on neck changes MEP. Neuroreport, 22(16), 819-823.https://doi.org/10.1097/WNR.0b013e32834b939d
Manor, B., Zhou, J., Harrison, R., Lo, O. Y., Travison, T. G., Hausdorff, J. M., ... & Lipsitz, L. (2018). Transcranial direct current stimulation may improve cognitive-motor function in functionally limited older adults. Neurorehabilitation and neural repair, 32(9), 788-798. https://doi.org/10.1177/1545968318792616
Manor, B., Zhou, J., Jor'dan, A., Zhang, J., Fang, J., & Pascual-Leone, A. (2016). Reduction of dual-task costs by noninvasive modulation of prefrontal activity in healthy elders. Journal of cognitive neuroscience, 28(2), 275-281. https://doi.org/10.1162/jocn_a_00897
Manto, M., Bower, J. M., Conforto, A. B., Delgado-García, J. M., Da Guarda, S. N. F., Gerwig, M., ... & Timmann, D. (2012). Consensus paper: roles of the cerebellum in motor control—the diversity of ideas on cerebellar involvement in movement. The Cerebellum, 11, 457-487. https://doi.org/10.1007/s12311-011-0331-9
Mao, Y., Chen, P., Li, L., & Huang, D. (2014). Virtual reality training improves balance function. Neural regeneration research, 9(17), 1628-1634. https://doi.org/10.4103/1673-5374.141795
Nitsche, M. A., & Paulus, W. (2000). Excitability changes induced in the human motor cortex by weak transcranial direct current stimulation. The Journal of physiology, 527(Pt 3), 633. https://doi.org/10.1111/j.1469-7793.2000.t01-1-00633.x
Paquette, M. R., Li, Y., Hoekstra, J., & Bravo, J. (2015). An 8-week reactive balance training program in older healthy adults: A preliminary investigation. Journal of Sport and Health Science, 4(3), 263-269. https://doi.org/10.1016/j.jshs.2014.06.004
Parsaee, S., Shohani, M., & Jalilian, M. (2023). The effect of cerebellar TDCS on static and dynamic balance of inactive elderly men. Gerontology and Geriatric Medicine, 9, 23337214231159760. https://doi.org/10.1177/23337214231159760
Picard, N., & Strick, P. L. (2001). Imaging the premotor areas. Current opinion in neurobiology, 11(6), 663-672. https://doi.org/10.1016/S0959-4388(01)00266-5
Prentice, S. D., & Drew, T. (2001). Contributions of the reticulospinal system to the postural adjustments occurring during voluntary gait modifications. Journal of neurophysiology, 85(2), 679-698. https://doi.org/10.1152/jn.2001.85.2.679
Priori, A., Ciocca, M., Parazzini, M., Vergari, M., & Ferrucci, R. (2014). Transcranial cerebellar direct current stimulation and transcutaneous spinal cord direct current stimulation as innovative tools for neuroscientists. The Journal of physiology, 592(16), 3345-3369. https://doi.org/10.1113/jphysiol.2013.270280
Rauscher, M., Yavari, F., Batsikadze, G., Ludolph, N., Ilg, W., Nitsche, M. A., ... & Steiner, K. M. (2020). Lack of cerebellar tDCS effects on learning of a complex whole body dynamic balance task in middle-aged (50–65 years) adults. Neurological Research and Practice, 2, 1-8. https://doi.org/10.1186/s42466-020-00085-x
Steiner, K. M., Enders, A., Thier, W., Batsikadze, G., Ludolph, N., Ilg, W., & Timmann, D. (2016). Cerebellar tDCS does not improve learning in a complex whole body dynamic balance task in young healthy subjects. PloS one, 11(9), e0163598. https://doi.org/10.1371/journal.pone.0163598
Truini, A., Vergari, M., Biasiotta, A., La Cesa, S., Gabriele, M., Di Stefano, G., ... & Priori, A. (2011). Transcutaneous spinal direct current stimulation inhibits nociceptive spinal pathway conduction and increases pain tolerance in humans. European Journal of Pain, 15(10), 1023-1027. https://doi.org/10.1016/j.ejpain.2011.04.009
Zandvliet, S. B., Meskers, C. G., Kwakkel, G., & van Wegen, E. E. (2018). Short-term effects of cerebellar tDCS on standing balance performance in patients with chronic stroke and healthy age-matched elderly. The Cerebellum, 17, 575-589. https://doi.org/10.1007/s12311-018-0939-0
Zhou, J., Hao, Y., Wang, Y., Jor'dan, A., Pascual‐Leone, A., Zhang, J., ... & Manor, B. (2014). Transcranial direct current stimulation reduces the cost of performing a cognitive task on gait and postural control. European Journal of Neuroscience, 39(8), 1343-1348. https://doi.org/10.1111/ejn.12492
Zhou, J., Manor, B., Yu, W., Lo, O. Y., Gouskova, N., Salvador, R., ... & Hausdorff, J. M. (2021). Targeted tDCS mitigates dual‐task costs to gait and balance in older adults. Annals of neurology, 90(3), 428-439. https://doi.org/10.1002/ana.26156
Journal of Sports and Motor Development and Learning
Volume 17, Issue 2
Summer 2025
Pages 123-136

  • Receive Date 15 August 2024
  • Revise Date 25 November 2024
  • Accept Date 28 December 2024

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