Optimizing Motor Functions in Incomplete Spinal Cord Injury with Simultaneous Application of Transcranial Direct Current Stimulation and Virtual Reality Assisted Treadmill Training: A Study Protocol for a Randomized Controlled Trail

Background Incomplete complete spinal cord injury (iSCI) leads to significant motor impairments, affecting mobility and quality of life. Emerging rehabilitation strategies, including neuromodulation and virtual reality treadmill training, have shown potential in enhancing motor recovery among individuals with neurological conditions. However, the synergistic effects of their simultaneous application remain underexplored. This study protocol outlines a randomized controlled trial (RCT) to investigate the synergistic effects of transcranial direct current stimulation (tDCS) and virtual reality-assisted treadmill training (VRATT) on motor functions in individuals with iSCI. Methodology This study is a single-blind, two-group randomized controlled trial. 52 individuals with incomplete spinal cord injury will be recruited based on inclusion criteria. They will be randomly allocated to transcranial direct current stimulation (active or sham group). Both the groups will simultaneously receive virtual reality-assisted treadmill training. The intervention will be provided for 15 sessions over a span of four weeks. Outcome measure Lower extremity motor score will be used for assessment of muscle strength of lower extremities; balance assessment will be done through Berg balance scale and functional reach test. Kinetic and kinematic parameters of the gait cycle will be analyzed with the Walker View treadmill. Walking ability and walking speed will be determined using the Walking Index for Spinal Cord Injury (version II) and the 10-meter walk test, respectively. Discussion The trial will provide new knowledge about the effectiveness of combined transcranial direct current stimulation with VR-assisted treadmill training on motor functions, functional independence, and quality of life of individuals with SCI. Trail Registration Clinical Trials Registry – India, CTRI/2024/11/076226, Registered on 04/11/2024