YOU'RE FIRED! Post stroke fatigue has been known forever, solve the problem! YOUR INCOMPETENT? DOCTOR AND HOSPITAL NEEDS TO SOLVE THE FUCKING PROBLEM!
At
least half of all stroke survivors experience fatigue Known since March 2017
Or is it 70%? Known since March 2015
Or is it 40%? Known since September 2017
The latest here:
Behavioral and Neural correlates of Post-STROKE Fatigue: A randomized controlled trial protocol
PLOS One | https://doi.org/10.1371/journal.pone.0324591 June 6, 2025 1 / 12
OPEN ACCESS
Citation: Liao K-C, Christian I, Stewart J,
Trudelle-Jackson E, Wang W, Shang T, et al.
(2025) Behavioral and Neural correlates of
Post-stroke fatigue: A randomized controlled
trial protocol. PLoS One 20(6): e0324591.
https://doi.org/10.1371/journal.pone.0324591
Editor: Jennifer Tucker, PLOS: Public Library
of Science, UNITED KINGDOM OF GREAT
BRITAIN AND NORTHERN IRELAND
Received: April 7, 2025
Accepted: April 14, 2025
Published: June 6, 2025
Peer Review History: PLOS recognizes the
benefits of transparency in the peer review
process; therefore, we enable the publication
of all of the content of peer review and
author responses alongside final, published
articles. The editorial history of this article is
available here: https://doi.org/10.1371/journal.
pone.0324591
Copyright: © 2025 Liao et al
. This is an open
access article distributed under the terms of
the Creative Commons Attribution License,
which permits unrestricted use, distribution,
STUDY PROTOCOL
Behavioral and Neural correlates of Post-
STROKE Fatigue: A randomized controlled trial
protocol
Kuan-Chun Liao1, Isabelle Christian1, Jill Stewart2, Elaine Trudelle-Jackson1,
Wanyi Wang3, Ty Shang4, Hui-Ting Goh 1*,
1 School of Physical Therapy, Texas Woman’s University, Dallas, Texas, United States of America,
2 Physical Therapy Program, Department of Exercise Science, University of South Carolina, Columbus,
South Carolina, United States of America, 3 Center for Research Design and Analysis, Texas Woman’s
University, Houston, Texas, United States of America, 4
OPEN ACCESS
Citation: Liao K-C, Christian I, Stewart J,
Trudelle-Jackson E, Wang W, Shang T, et al.
(2025) Behavioral and Neural correlates of
Post-stroke fatigue: A randomized controlled
trial protocol. PLoS One 20(6): e0324591.
https://doi.org/10.1371/journal.pone.0324591
Editor: Jennifer Tucker, PLOS: Public Library
of Science, UNITED KINGDOM OF GREAT
BRITAIN AND NORTHERN IRELAND
Received: April 7, 2025
Accepted: April 14, 2025
Published: June 6, 2025
Peer Review History: PLOS recognizes the
benefits of transparency in the peer review
process; therefore, we enable the publication
of all of the content of peer review and
author responses alongside final, published
articles. The editorial history of this article is
available here: https://doi.org/10.1371/journal.
pone.0324591
Copyright: © 2025 Liao et al
. This is an open
access article distributed under the terms of
the Creative Commons Attribution License,
which permits unrestricted use, distribution,
STUDY PROTOCOL
Behavioral and Neural correlates of Post-
STROKE Fatigue: A randomized controlled trial
protocol
Kuan-Chun Liao1, Isabelle Christian1, Jill Stewart2, Elaine Trudelle-Jackson1,
Wanyi Wang3, Ty Shang4, Hui-Ting Goh 1*,
1 School of Physical Therapy, Texas Woman’s University, Dallas, Texas, United States of America,
2 Physical Therapy Program, Department of Exercise Science, University of South Carolina, Columbus,
South Carolina, United States of America, 3 Center for Research Design and Analysis, Texas Woman’s
University, Houston, Texas, United States of America, 4
Abstract
Introduction
Post-stroke fatigue (PSF) is highly prevalent and lacks of effective management.
Recent evidence suggest the use of transcranial direct current stimulation (tDCS) to
reduce PSF. However, the effect was not lasting and the working mechanisms was
unclear. The purpose of this study is to determine the behavioral and neurophysiolog-
ical effects of five daily sessions of tDCS on PSF.
Methods and analysis
This will be a double-blind randomized controlled trial targeting an enrollment of 32
participants with subacute-chronic stroke and significant fatigue (average Fatigue
Severity Scale (FSS) > 4). Participants will be equally randomized to either anodal
tDCS or sham tDCS groups. The anodal tDCS group will receive 20 minutes of 2-mA
anodal tDCS applied to the ipsilesional primary motor cortex (M1) for five consecu-
tive days. The sham tDCS group will receive the same protocol except there will be
to randomization), immediately after the intervention, and at one-month follow-up. The primary behavioral outcome will be the FSS and the primary neurophysiological outcome will be an input-output curve of motor cortex excitability derived using tran-
scranial magnetic stimulation. Secondary behavioral outcomes will include Fatigue
Scale for Motor and Cognitive Function, Visual Analog Scale-Fatigue, Borg Rating
of Perceived Exertion, and Paas Mental Effort Rating Scale. Secondary neurophys-
iological outcome will be the functional connectivity of the fronto-striato-thalamic
network acquired using resting state functional Magnetic Resonance Imaging (MRI).PLOS One | https://doi.org/10.1371/journal.pone.0324591 June 6, 2025 2 / 12
Repeated measure ANOVA or ANCOVA will be conducted for all outcomes to com-
pare the change between groups.
Discussion
Little is known about effective treatments for PSF and the underlying mechanisms of PSF. tDCS is a promising tool to provide targeted intervention to reduce PSF. The results of this clinical trial will offer critical information for PSF management and investigation.
Trial registration This trial was registered in February 1 2024 with ClinicalTrials.gov under the registra
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