Unlocking trunk potential after stroke: a novel approach combining transcranial direct current stimulation and core stability exercise: a randomized controlled trial

 So, you did some research; BUT COMPLETELY FUCKING FAILED AT CREATING A PROTOCOL AND DELIVERING IT TO ALL 10 MILLION YEARLY SURVIVORS! Your mentors and senior researchers need to be fired for such incompetence!

Unlocking trunk potential after stroke: a novel approach combining transcranial direct current stimulation and core stability exercise: a randomized controlled trial

• Abd El-Hamied Ibrahim El-Sayed Mohammad El-Sherbini,
• Saher Lotfy Elgayar,
• Mohammed Youssef Elhamrawy &
• Tarek M. Youssef 

We are providing an unedited version of this manuscript to give early access to its findings. Before final publication, the manuscript will undergo further editing. Please note there may be errors present which affect the content, and all legal disclaimers apply.

Abstract

Background

Impaired trunk control is a critical contributor to poststroke disability, as it undermines balance, mobility, and independence. Core stability exercises (CSEs) improve trunk function; however, their efficacy may be limited by post-stroke reductions in cortical excitability. Transcranial direct current stimulation (tDCS) is a non-invasive neuromodulation technique that enhances neuroplasticity and may potentiate the effects of rehabilitation.

Objective

To determine whether combining tDCS with CSEs improves trunk control, balance, and functional independence in chronic stroke survivors.

Methods

In this single-blind randomized controlled trial, 60 participants with post-stroke hemiparesis were assigned to either a study group (n = 30) receiving anodal tDCS (2 mA, 20 min) over the ipsilesional primary motor cortex concurrent with CSEs or a control group (n = 30) receiving CSEs alone. Both groups underwent supervised sessions three times per week for 12 weeks. The primary outcome was the Trunk Impairment Scale (TIS). Secondary outcomes included the Postural Assessment Scale for Stroke (PASS), Berg Balance Scale (BBS), and Barthel Index (BI).

Results

Both groups improved significantly across all the outcomes (p < 0.001). The combined intervention produced greater gains than did CSE alone: TIS (+ 2.80 vs. +1.83, p = 0.005), PASS (+ 4.01 vs. +1.31, p = 0.001), BBS (+ 6.64 vs. +2.21, p < 0.001), and BI (+ 9.20 vs. +1.96, p < 0.001). Trunk improvements strongly predicted functional gains (ΔTIS vs. ΔBI, r = 0.72, p < 0.001).

Conclusion

Simultaneous tDCS and CSEs significantly enhance trunk control, balance, and independence beyond the benefits of exercise alone, representing a promising strategy for post-stroke neurorehabilitation.

Trial registration The trial was registered at ClinicalTrials.gov (Identifier: NCT06882213; registered on 12 March 2025). This study was retrospectively registered.

Graphical Abstract

Data availability