Protocol for a home-based self-delivered prehabilitation intervention to proactively reduce fall risk in older adults: a pilot randomized controlled trial of transcranial direct current stimulation and motor imagery

Background Several changes occur in the central nervous system with increasing age that contribute toward declines in mobility. Neurorehabilitation has proven effective in improving motor function though achieving sustained behavioral and neuroplastic adaptations is more challenging. While effective, rehabilitation usually follows adverse health outcomes, such as injurious falls. This reactive intervention approach may be less beneficial than prevention interventions. Therefore, we propose the development of a prehabilitation intervention approach to address mobility problems before they lead to adverse health outcomes. This protocol article describes a pilot study to examine the feasibility and acceptability of a home-based, self-delivered prehabilitation intervention that combines motor imagery (mentally rehearsing motor actions without physical movement) and neuromodulation (transcranial direct current stimulation, tDCS; to the frontal lobes). A secondary objective is to examine preliminary evidence of improved mobility following the intervention. Methods This pilot study has a double-blind randomized controlled design. Thirty-four participants aged 70–95 who self-report having experienced a fall within the prior 12 months or have a fear of falling will be recruited. Participants will be randomly assigned to either an active or sham tDCS group for the combined tDCS and motor imagery intervention. The intervention will include six 40-min sessions delivered every other day. Participants will simultaneously practice the motor imagery tasks while receiving tDCS. Those individuals assigned to the active group will receive 20 min of 2.0-mA direct current to frontal lobes, while those in the sham group will receive 30 s of stimulation to the frontal lobes. The motor imagery practice includes six instructional videos presenting different mobility tasks related to activities of daily living. Prior to and following the intervention, participants will undergo laboratory-based mobility and cognitive assessments, questionnaires, and free-living activity monitoring. Discussion Previous studies report that home-based, self-delivered tDCS is safe and feasible for various populations, including neurotypical older adults. Additionally, research indicates that motor imagery practice can augment motor learning and performance. By assessing the feasibility (specifically, screening rate (per month), recruitment rate (per month), randomization (screen eligible who enroll), retention rate, and compliance (percent of completed intervention sessions)) and acceptability of the home-based motor imagery and tDCS intervention, this study aims to provide preliminary data for planning larger studies. Trial registration This study is registered on ClinicalTrials.gov (NCT05583578). Registered October 13, 2022. https://www.clinicaltrials.gov/study/NCT05583578

背景在中央神经系统中发生了一些变化，而神经康复的年龄有所增加。因此，这种反应性干预方法可能不如预防干预措施提议在导致不良健康结果之前，开发了一种解决流动性问题的方法。无需物理运动的运动动作）和神经调节（经颅直流刺激，TDC；额叶爱情）。干预后的提高流动性的初步证据。被招募。每隔一天，参与者将在收到TDC的同时练习运动图像任务。对额叶的爱情练习包括六个与日常生活活动有关的教学视频。经过实验室的移动性和认知评估，问卷调查和自由生活的活动监测。图像练习可以通过评估可行性（特别是筛选率（每月），招聘率（每月），随机化来增强运动学习和性能。 （符合屏幕的招募），保留率和合规性（占干预课程的百分比）以及基于家庭的汽车成像和TDCS干预的可接受性，本研究的目的是为规划较大的研究提供初步数据。在ClinicalTrials.gov上注册（NCT05583578）。