Cathodal tDCS and robotic therapy for upper 1 limb rehabilitation in chronic stroke: a 2 randomized controlled trial

Will this be written up in a protocol and distributed to all 10 million yearly survivors? Not therapists or doctors, they don't follow research!

Didn't your competent? doctor create a protocol on this years ago? Or all these other tDCS interventions!

cathodal tDCS (23 posts to July 2013)

anodal tDCS (31 posts to July 2013)

Bicephalic tDCS (1 post to June 2022)

c-tDCS(4 posts to September 2019)

Dual-tDCS(1 post to January 2014)

HD C-tDCS(1 post to June 2023)

HD-tDCS(8 posts to January 2013)

remote tDCS(1 post to August 2022)

RS-tDCS (1 post to August 2022)

tDCS(90 posts to April 2011)

Is anyone ever going to put together a protocol on using tDCS and which type?   Otherwise all this fucking research and reviews are totally worthless.  This is why we need strong stroke leadership, to actually help stroke survivors. 

 Cathodal tDCS and robotic therapy for upper 1 limb rehabilitation in chronic stroke: a 2 randomized controlled trial

Jin  ChenJin Chen1Jingang  DuJingang Du2Chunfang  WangChunfang Wang2*Hongli  YuHongli Yu3*

1Tianjin Third Central Hospital, Tianjin, China

2Tianjin Union Medical Centre, Nankai University, Tianjin, China

3Hebei University of Technology, Tianjin, China

The final, formatted version of the article will be published soon.

This randomized controlled trial evaluated the effect of contralesional cathodal 15 transcranial direct current stimulation (ctDCS) combined with robotic therapy (RT) on 16 upper limb recovery in patients with chronic subcortical ischemic stroke. Thirty-one 17 participants were randomized to receive either active ctDCS or sham stimulation 18 during RT, administered five times per week for four weeks. Outcomes were assessed 19 using clinical rehabilitation scales and robotic evaluation of movement parameters at 20 baseline, immediately post-intervention, and at two-week follow-up. The active group 21 demonstrated significantly greater improvement in Upper Extremity Fugl-Meyer 22 Assessment, with a between-group difference of 4.61 (95% CI: 51.36 to 55.46, p = 23 0.023) post-intervention. Functional efficiency (mean difference: 1.82, 95% CI: 9.13 24 to 12.00) and movement speed (mean difference: 3.46, 95% CI: 51.60 to 56.74) also 25 favored the active group. These findings suggest that combining ctDCS with RT may 26 enhance the efficiency of specific upper limb motor tasks in patients with chronic 27 subcortical ischemic stroke, compared to RT alone.

Keywords: Cathodal transcranial direct current stimulation, Robotic therapy, Stroke, Upper limb rehabilitation, primary motor cortex

Received: 10 Jun 2025; Accepted: 23 Oct 2025.

Copyright: © 2025 Chen, Du, Wang and Yu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence:
Chunfang Wang, chfwang@tju.edu.cn
Hongli Yu, yhlzyn@hebut.edu.cn

Effect of Cathodal Transcranial Direct Current Stimulation for Lower Limb Subacute Stroke Rehabilitation

And you somehow think this is of any use at all when delivery of cathodal tDCS is needed 30 minutes after stroke onset?

Effect of Cathodal Transcranial Direct Current Stimulation for Lower Limb Subacute Stroke Rehabilitation

Qian Duan

,¹Wenying Liu,¹Jinhui Yang,²Ben Huang,¹and Jie Shen

¹

Academic Editor: Laura Baroncelli

Received06 Jan 2023

Revised04 May 2023

Accepted10 May 2023

Published27 May 2023

Abstract

Background and Purpose. 

Motor dysfunction of the lower limb is a common sequela in stroke patients. The aim was to evaluate the efficacy of cathodal transcranial direct current stimulation (ctDCS) combined with conventional gait rehabilitation (CGR) to compare and clarify the clinical rehabilitation efficacy of ctDCS on motor dysfunction of the lower limbs after stroke to improve the walking ability of stroke patients.  

Methods. 

A pilot double-blind and randomized clinical trial. Ninety-one subjects with subacute stroke were treated with cathodal/sham stimulation tDCS based on CGR (physiotherapy 40 min/d and occupational therapy 20 min/d) once daily for 20 consecutive working days. Computer-based stratified randomization (1 : 1) was employed by considering age and sex, with concealed assignments in opaque envelopes to ensure no allocation errors after disclosure at the study’s end. Patients were evaluated at T0 before treatment, T1 immediately after the posttreatment assessment, and T2 assessment one month after the end of the treatment. The primary outcome index was assessed: lower limb Fugl-Meyer motor score (FMA-LE); secondary endpoints were other gait assessment and relevant stroke scale assessment.  

Results. 

Patients in the trial group performed significantly better than the control group in all primary outcome indicators assessed post treatment T1 and at follow-up T2: FMA-LE outcome indicators between the two groups in T1 (P=0.032; effect size 1.00, 95% CI: 0.00 to 2.00) and FMA-LE outcome indicators between the two groups in T2 (P=0.010; effect size 2.00, 95% CI: 1.00 to 3.00). 

Conclusion. 

In the current pilot study, ctDCS plus CGR was an effective treatment modality to improve lower limb motor function with subacute stroke. The effectiveness of cathodal tDCS in poststroke lower limb motor dysfunction is inconclusive. Therefore, a large randomized controlled trial is needed to verify its effectiveness.

1. Introduction

Stroke is the third leading cause of disability worldwide, resulting in permanent disability in 15% to 30% of survivors. Gait balance dysfunction is the most common complication in stroke patients, and it is estimated that more than 50% of hemiplegic patients are left with lower limb gait balance dysfunction, which causes falls, increases the risk of trauma, affects independence in daily life, and increases the burden on families and society [1].

Walking is a complicated motor pattern [2]. Dynamic standing balance, strength, motor control, and precise movement of the center of pressure are all necessary for normal walking. Most improvements in standing balance and walking ability after the stroke occur within 5 to 8 weeks [3]. However, rehabilitation training (proprioceptive training, gait walking training, lower limb robotic training, and ankle-foot orthosis) can improve gait balance, but the effect of rehabilitation is relatively slow [4]. Therefore, new rehabilitation techniques have become a hot topic of research. Studies have shown that restoring spontaneous neuroplasticity is crucial in gait recovery [5]. Transcranial direct current stimulation (tDCS) is an efficient, simple, portable, safe, and economical noninvasive brain neuromodulation technique [6] that regulates GABAergic and glutamatergic synapses in the cortex by generating low-intensity direct current (usually 1 to 2 mA) through electrodes placed in the cranial area. Synapses, depending on the polarity of the stimulus, cause a change in the depolarization or hyperpolarization of the resting membrane potential of neurons, increasing or decreasing cortical excitability at the anode and cathode, respectively. In addition, it increases cortical blood flow, promotes cortical reorganization, and noninvasively increases neuroplasticity to improve motor skills [7]. Functional magnetic resonance imaging (fMRI) after anodal tDCS stimulation of the M1 area has been shown to significantly increase functional connectivity in the premotor and motor areas of the stimulated hemisphere and modulates the imbalance of connectivity between the left and right hemispheres [8]. Bicephalic tDCS plus functional electrical stimulation improves reaching motor performance after stroke [9].

Rehabilitation of the lower limbs seriously affects daily life. The study of tDCS to improve gait balance disorders in the lower limbs after stroke is an emerging area of research in which treatment with tDCS promotes neurological remodeling on the affected side of the stroke and a certain degree of improvement in gait balance. Still, the stimulation site is seen mainly in the cranially related area where anodal tDCS is placed [10, 11]. One study by Saeys et al. showed a significant improvement in the Tinetti scores compared to the control group in 31 stroke patients after 16 sessions of 1.5 mA, 20 min anodal tDCS [12]. In a chronic stroke patient, Dumont et al. performed 20 min, 2 mA tDCS combined with motor plank training, with anodal tDCS placed in the motor cortex on the side of the lesion, and found that training reduced anterior-posterior sway of the center of gravity (6.18%), displacement trajectory (3.3%), and sway speed (3.3%) [13].

Until now, there are few reports about treating lower limb gait balance disorder with cathodal transcranial direct current stimulation (ctDCS) after stroke [14], primarily seen in rehabilitating upper limb function. A study reported that ctDCS has no beneficial effects on upper motor deficits and quality of life based after stroke compared to sham tDCS. The Fugl-Meyer assessment of motor recovery- (FMA-) upper limb motor, Barthel index (BI), and stroke impact scale (SIS) were assessed before and after treatment [15]. However, in a study of 59 patients divided into a cathodal stimulation group, virtual reality group, and cathodal stimulation combined with the virtual reality training group, the results showed that ctDCS stimulation combined with the virtual reality training group improved upper limb function more significantly than the other two groups [16]. Andrade et al. showed significant improvements in 6MWT and balance BBS indicators in the lower limb of patients after cathodal tDCS stimulation [17], while Fusco et al. did not find improvements in gait-related indicators in their study [18].

TDCS as a noninvasive tool for stroke therapy has shown great potential in the acute phases after cerebral ischemia [19]. A study [20] explored the effects of ctDCS 6 h after focal forelimb M1 ischemia in mice; ctDCS improved motor functionality of the affected forelimbs without changing the ischemic volume. Motor recovery following an ischemic event is correlated with a decrease in the number of microglial cells in the area surrounding the ischemic core; at the same time, microglia morphology shifted toward a healthier state with less phagocytic anti-inflammatory activity.

The initial acute study conducted to mice treated with cathodal tDCS starting after the first 30 minutes of middle cerebral artery occlusion (MCAO) demonstrated that an even earlier intervention using cathodal tDCS led to positive effects on preserving cortical neurons from the ischemic damage, reducing inflammation, and promoting better clinical recovery compared with sham and anodal treatments [21]. These findings suggest a positive role for early ctDCS in neuroprotective effect and motor recovery. However, the effectiveness of ctDCS in poststroke lower limb function is inconclusive; therefore, a large randomized controlled trial is needed to verify its effectiveness. Our paper is aimed at investigating the clinical rehabilitation efficacy of ctDCS on poststroke lower limb motor dysfunction.

More at link.

Effect of Anodal Versus Cathodal Transcranial Direct Current Stimulation on Stroke Rehabilitation: A Pilot Randomized Controlled Trial

 9 and a half years. Has your stroke hospital done one damn thing with this ? Or are they incompetent as usual?

Effect of Anodal Versus Cathodal Transcranial Direct Current Stimulation on Stroke Rehabilitation: A Pilot Randomized Controlled Trial

Eman M. Khedr, MD, Ola A. Shawky, MD, […], and Amal M. Tohamy, MD+4View all authors and affiliations

Volume 27, Issue 7

https://doi.org/10.1177/1545968313484808

First published online April 22, 2013

Abstract

Objective. 

We compared the long-term effect of anodal versus cathodal transcranial direct current stimulation (tDCS) on motor recovery in patients after subacute stroke.  

Methods. 

Forty patients with ischemic stroke undergoing rehabilitation were randomly assigned to 1 of 3 groups: Anodal, Cathodal (over-affected and unaffected hemisphere, respectively), and Sham. Each group received tDCS at an intensity of 2 mA for 25 minutes daily for 6 consecutive days over of the motor cortex hand area. Patients were assessed with the National Institutes of Health Stroke Scale (NIHSS), Orgogozo’s MCA scale (OMCASS), the Barthel index (BI), and the Medical Research Council (MRC) muscle strength scale at baseline, after the sixth tDCS session and then 1, 2, and 3 months later. Motor cortical excitability was measured with transcranial magnetic stimulation (TMS) at baseline and after the sixth session.  

Results. 

By the 3-month follow-up, all groups had improved on all scales with P values ranging from .01 to .0001. Improvement was equal in the Anodal and Cathodal groups. When these treated groups were combined and compared with Sham, significant interactions were seen for the OMCASS and BI scales of functional ability (P = .002 for each). There was increased cortical excitability of the affected hemisphere in all groups with the changes being greater in the real versus sham groups. There were borderline significant improvements in muscle strength.  

Conclusion. 

A brief course of 2 types of tDCS stimulation is superior to sham stimulation in enhancing the effect of rehabilitation training to improve motor recovery after stroke.

Introduction

Recent studies in people with chronic stroke have shown that transcranial direct current stimulation (tDCS) can facilitate upper limb motor performance.^1,2 There are fewer descriptions of the effects of tDCS on lower limb function,³ but published work does suggest that anodal tDCS can transiently enhance the maximum force of the lower extremities and cortical excitability of the lower limb representation in healthy subjects.^4,5 This pilot trial evaluates the effect of 6 daily sessions of anodal versus cathodal tDCS on motor recovery during inpatient stroke rehabilitation and compares motor and functional changes to sham intervention. The study also assesses cortical excitability prestimulation and poststimulation aiming to understand the mechanism of action of tDCS.

Transcranial direct current stimulation in stroke neurorehabilitation: have you ever been to electric rehab-land?

 I couldn't get into some research for this because I had zero hand opening ability. So what the fuck is the recovery solution for my hand? WHOM do I ask that simple question?

Transcranial direct current stimulation in stroke neurorehabilitation: have you ever been to electric rehab-land?

By Vincenza Amoruso, MD – Università Cattolica del Sacro Cuore, Rome

Giuseppe Reale, MD – Fondazione Policlinico Universitario A. Gemelli, Rome

Stroke Neurorehabilitation involves many different approaches. Alongside the “conventional” techniques, there are several “unconventional” treatments, ranging from drugs for recovery (you might want to read the post on fluoxetine), to robotics and invasive and non-invasive brain stimulation.

Transcranial Direct Current Stimulation (tDCS) is a non-invasive brain stimulation technique involving low voltage currents applied to the scalp[1]. Two electrodes generate a 1-2 mA current that flows from the anode to the cathode in order to enhance or diminish neuronal excitability of the brain areas just below the electrodes. In particular, the target area placed under the anode (anodal-tDCS) is excited and the resting membrane potential shifts towards depolarization and shows increased rate of spontaneous neuronal firing. On the opposite, the target area placed under the cathode (cathodal-tDCS) is inhibited and the resting membrane potential shifts towards hyperpolarization with reduced neuronal firing[2;3]. The mechanisms of action underlying the modulation of neuronal activity induced by tDCS are still not well demonstrated[4;5]. Several reports have suggested that tDCS could have an effect on cerebral cells, altering the activity of NMDA and GABA receptors[6]. In particular, anodal tDCS causes a local reduction in the inhibitory neurotransmitter GABA, whereas cathodal stimulation causes a reduction in glutamatergic neuronal activity, which is excitatory[7]. Moreover, tDCS could facilitate the plasticity cellular processes, such as long-term potentiation and long-term depression and changes in protein synthesis and gene expression[8;9;10], and blood flow changes with an increase in oxygen supply on cortical areas as assessed at a neuroimaging study[11].

In the last decades, tDCS has been tested in several medical conditions due to its low cost, ease of application, and safety. Several studies have found that tDCS can improve motor and cognitive functions both in healthy subjects and in various neurological conditions, such as stroke, Parkinson’s disease, multiple sclerosis, and many others[1;5].

Regarding stroke neurorehabilitation, two main tDCS approaches have been studied: stimulation of the affected hemisphere with anodal-tDCS and/or inhibition of the unaffected hemisphere with cathodal-tDCS. The latter approach is thought to reduce interhemispheric inhibition, a well-known phenomenon in which the healthy hemisphere inhibits the contralateral affected hemisphere, slowing the recovery process[12;13]. Recent studies have shown greater clinical efficacy of cathodal tDCS applied on the unaffected hemisphere in improving the performance in activities of daily living in stroke patients[14]. However, the contribution of tDCS in the various phases of recovery post-stroke (acute, sub-acute, and chronic) is still object of study[15].

The most recent review concluded that stroke patients who received tDCS have better clinical outcomes in terms of disability, although no clear improvement in arm and leg function, muscle strength or cognitive abilities has been found[16]. This review included 67 studies involving a total of 1729 adult participants with acute, subacute or chronic ischemic or hemorrhagic stroke. It must be noted that the included studies were quite heterogeneous, investigating different types of stimulation, different treatment durations and different current features. Besides, the stroke etiology was mixed and the control groups received sham tDCS (electrodes placed but no or irrelevant current applied) or an active, different intervention.

In conclusion, future research is needed in this fascinating area to investigate the reproducibility of the aforementioned findings, especially regarding arm and leg function, muscle strength and cognitive abilities (including spatial neglect). This could be done by conducting larger and more homogeneous randomized controlled trials.

The magic carpet waits for you. So don’t you be late!

REFERENCES

1. Lefaucheur, J.P., Antal, A., Ayache, S.S., et al. Evidence-based guidelines on the therapeutic use of transcranial direct current stimulation (tDCS). Clin. Neurophysiol. 2017;
2. Nitsche, M.A., Liebetanz, D., Tergau, et al. Modulation kortikaler erregbarkeit beim menschen durch transkranielle gleichstromstimulation. 2002;
3. Fritsch B, Reis J, Martinowich K, Schambra HM, Ji Y, et al. Direct Current Stimulation Promotes BDNF-Dependent Synaptic Plasticity: Potential Implications for Motor Learning. Neuron 66, 198–204, April 29, 2010
4. Stagg CJ, Nitsche MA. Physiological basis of transcranial direct current stimulation. Neuroscientist.17(1):37–53;2014.
5. Santos Ferreira, I., Teixeira Costa, B., Lima Ramos, et al. Searching for the optimal tDCS target for motor rehabilitation. Journal of neuroengineering and rehabilitation,2019.
6. Rothwell JC. Plasticity in the Human Motor System. Folia Phoniatr Logop ; 62(4): 153–157;2010.
7. Stagg, C.J., Best, J.G., Stephenson, et al.Polarity-sensitive modulation of cortical neurotransmitters by transcranial stimulation. J. Neurosci. 29, 5202–5206;2009.
8. Polanía R, Paulus W, Antal A, et al; Introducing graph theory to track for neuroplastic alterations in the resting human brain : a transcranial direct current stimulation study. Neuroimage.54(3):2287–96; 2011.
9. Ranieri, F., Podda, M. V.,Riccardi, et al; Modulation of LTP at rat hippocampal CA3-CA1 synapses by direct current stimulation. Journal of neurophysiology, 107(7), 1868–1880; 2012.
10. Ahn, S. M., Jung, D. H., Lee, H. J.,et al. Contralesional Application of Transcranial Direct Current Stimulation on Functional Improvement in Ischemic Stroke Mice. Stroke, 51(7), 2208–2218; 2020
11. Zheng X, Alsop DC, Schlaug G. Effects of transcranial direct current stimulation ( tDCS ) on human regional cerebral blood flow. Neuroimage. 58(1):26–33;2011.
12. Beaulé, V. , Tremblay, S. , & Théoret, H. Interhemispheric control of unilateral movement. Neural Plasticity, 2012,
13. Boddington, L. J. , & Reynolds, J. Targeting interhemispheric inhibition with neuromodulation to enhance stroke rehabilitation. Brain Stimulation, 10(2), 214–222. 2017.
14. Elsner B, Kwakkel G, Kugler J, Mehrholz J. Transcranial direct current stimulation (tDCS) for improving capacity in activities and arm function after stroke: a network meta-analysis of randomized controlled trials. J Neuroeng Rehabil. 2017;
15. Kang N, Weingart A, Cauraugh JH. Transcranial direct current stimulation and suppression of contralesional primary motor cortex post-stroke: a systematic review and meta-analysis. Brain Inj. ; 32(9):1063-1070.2018.
16. Elsner B, Kugler J, Pohl M, Mehrholz J. Transcranial direct current stimulation (tDCS) for improving activities of daily living, and physical and cognitive functioning, in people after stroke. Cochrane Database Syst Rev. 2020.

 

Neuroprotection by Transcranial Direct Current Stimulation in Rodent Models of Focal Ischemic Stroke: A Meta-Analysis

 Lots of words but I don't know if it said anything useful. Could never tell when tDCS was applied but since neuroprotection is mentioned it must have been in the first day.

Neuroprotection by Transcranial Direct Current Stimulation in Rodent Models of Focal Ischemic Stroke: A Meta-Analysis

 

Jiapeng Huang^1,2,3, Kehong Zhao^1,2,3, Ziqi Zhao^1,2,3 and Yun Qu^1,2,3*

• ¹Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
• ²Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
• ³Research Laboratory of Neurorehabilitation, Research Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China

Infarct size is associated with stroke severity in clinical studies, so reducing it has become an important target and research hotspot in the treatment of ischemic stroke. Some preclinical studies have shown transcranial direct current stimulation (tDCS) reduced infarct size and improved neurological deficit, but others have not found beneficial effects. Besides, the optimal pattern of tDCS for ischemic stroke remains largely unknown. To shed light on the current circumstance and future research directions, the systematic review evaluated the effect of different tDCS paradigms in reducing infarct size and improving neurological deficit in rodent models of ischemic stroke and assessed the methodological quality of current literature. We searched the MEDLINE (via PubMed), EMBASE, Web of Science, and Scopus from their inception to August 18, 2021, to identify studies evaluating the effects of tDCS in rodent models of ischemic stroke. Eight studies were included, of which seven studies were included in the meta-analysis. The results showed cathodal tDCS, rather than anodal tDCS, reduced infarct size mainly measured by tetrazolium chloride and magnetic resonance imaging (standardized mean difference: −1.13; 95% CI: −1.72, −0.53; p = 0.0002) and improved neurological deficit assessed by a modified neurological severity score (standardized mean difference: −2.10; 95% CI: −3.78, −0.42; p = 0.01) in an early stage of focal ischemic stroke in rodent models. Subgroup analyses showed effects of cathodal tDCS on infarct size were not varied by ischemia duration (ischemia for 1, 1.5, and 2 h or permanent ischemia) and anesthesia (involving isoflurane and ketamine). The overall quality of studies included was low, thus the results must be interpreted cautiously. Published studies suggest that cathodal tDCS may be a promising avenue to explore for augmenting rehabilitation from focal ischemic stroke. Considering the methodological limitations, it is unreliable to blindly extrapolate the animal data to the clinical practice. Future research is needed to investigate the mechanism of tDCS in a randomized and blinded fashion in clinically relevant stroke models, such as elderly animals, female animals, and animals with comorbidities, to find an optimal treatment protocol.

More at link.

Effect of Anodal Versus Cathodal Transcranial Direct Current Stimulation on Stroke Rehabilitation: A Pilot Randomized Controlled Trial

 So these were failures in getting to 100% recovery? But you declared success anyway? Will you please talk to survivors and ask what recovery percentage they want.

Effect of Anodal Versus Cathodal Transcranial Direct Current Stimulation on Stroke Rehabilitation: A Pilot Randomized Controlled Trial

Show all authors

Eman M. Khedr, MD, Ola A. Shawky, MD, Dina H. El-Hammady, MD, ...

First Published April 22, 2013 Research Article Find in PubMed 

https://doi.org/10.1177/1545968313484808

Article information

Abstract

Objective. 

We compared the long-term effect of anodal versus cathodal transcranial direct current stimulation (tDCS) on motor recovery in patients after subacute stroke. 

Methods. 

Forty patients with ischemic stroke undergoing rehabilitation were randomly assigned to 1 of 3 groups: Anodal, Cathodal (over-affected and unaffected hemisphere, respectively), and Sham. Each group received tDCS at an intensity of 2 mA for 25 minutes daily for 6 consecutive days over of the motor cortex hand area. Patients were assessed with the National Institutes of Health Stroke Scale (NIHSS), Orgogozo’s MCA scale (OMCASS), the Barthel index (BI), and the Medical Research Council (MRC) muscle strength scale at baseline, after the sixth tDCS session and then 1, 2, and 3 months later. Motor cortical excitability was measured with transcranial magnetic stimulation (TMS) at baseline and after the sixth session.  

Results. By the 3-month follow-up, all groups had improved on all scales with P values ranging from .01 to .0001. Improvement was equal in the Anodal and Cathodal groups. When these treated groups were combined and compared with Sham, significant interactions were seen for the OMCASS and BI scales of functional ability (P = .002 for each). There was increased cortical excitability of the affected hemisphere in all groups with the changes being greater in the real versus sham groups. There were borderline significant improvements in muscle strength.  

Conclusion. A brief course of 2 types of tDCS stimulation is superior to sham stimulation in enhancing the effect of rehabilitation training to improve motor recovery after stroke.

Keywords stroke rehabilitation, transcranial direct current stimulation, motor threshold

Introduction

Recent studies in people with chronic stroke have shown that transcranial direct current stimulation (tDCS) can facilitate upper limb motor performance.^1,2 There are fewer descriptions of the effects of tDCS on lower limb function,³ but published work does suggest that anodal tDCS can transiently enhance the maximum force of the lower extremities and cortical excitability of the lower limb representation in healthy subjects.^4,5 This pilot trial evaluates the effect of 6 daily sessions of anodal versus cathodal tDCS on motor recovery during inpatient stroke rehabilitation and compares motor and functional changes to sham intervention. The study also assesses cortical excitability prestimulation and poststimulation aiming to understand the mechanism of action of tDCS.

 

 

Cathodal Transcranial Direct Current Stimulation in Acute Ischemic Stroke: Pilot Randomized Controlled Trial

Now we need human testing which your doctors and stroke hospital will do nothing to initiate.

Cathodal Transcranial Direct Current Stimulation in Acute Ischemic Stroke: Pilot Randomized Controlled Trial

Estelle Pruvost-Robieux

,

Joseph Benzakoun

,

Guillaume Turc

,

Angela Marchi

,

Rossella Letizia Mancusi

,

Catherine Lamy

,

Valérie Domigo

,

Catherine Oppenheim

,

David Calvet

, … See all authors

Originally published19 Apr 2021https://doi.org/10.1161/STROKEAHA.120.032056Stroke. 2021;52:1951–1960

Abstract

• Download figure
• Download PowerPoint

Background and Purpose:

In acute stroke, preventing infarct growth until complete recanalization occurs is a promising approach as an adjunct to reperfusion therapies to reduce infarct size and improve outcome. In rodent models, cathodal transcranial direct current stimulation (C-tDCS) decreases peri-infarct depolarizations and reduces infarct volume. We hypothesized that C-tDCS would nonpharmacologically reduce infarct growth in hyperacute middle cerebral artery territory stroke patients receiving reperfusion therapy.

Methods:

STICA (Cathodal Transcranial Direct Stimulation in Acute Middle Cerebral Artery Stroke) was a pilot single-center, double-blind, 2-arms 1:1 randomized trial evaluating the safety, feasibility, and efficacy of C-tDCS versus sham stimulation in patients eligible for recanalization therapies. Magnetic resonance imaging was obtained both on admission and 24 hours later. The primary end point was 24-hour infarct growth. Secondary outcomes were (1) National Institutes of Health Stroke Scale score difference between day 7 and admission and (2) 3-month modified Rankin Scale score.

Results:

Forty-five patients were randomized. Median magnetic resonance imaging-to-C-tDCS start time was 45 minutes; C-tDCS was started before completion of recanalization procedure in all patients. The intervention proved feasible in all patients. No major adverse effects occurred in either group. There was no significant difference between active and sham groups for any end point. However, an apparent trend towards smaller infarct growth in the C-tDCS arm was observed in the whole group (unadjusted median difference [IC_95%]: −2.2 mL [−12.2 to 1.5]) and in the prespecified subsamples with moderate-to-severe stroke and large vessel occlusion (−5.7 mL [−21.6 to 2.6] and −7.7 mL [−24.2 to 2.6], respectively).

Conclusions:

C-tDCS was feasible and well tolerated. No significant difference was found between the active and sham groups. However, the data suggest potential benefits of C-tDCS in patients with National Institutes of Health Stroke Scale score of >10 or large vessel occlusion. Using the observed effect size and standard α=5% and β=20%, samples of 102 and 86, respectively, can be estimated for future trials in patients with these characteristics. Randomized trials particularly targeting these populations may be warranted.

 

Effect of anodal versus cathodal transcranial direct current stimulation on stroke rehabilitation: a pilot randomized controlled trial

Well then write this up as a protocol AND DISTRIBUTE it to all stroke hospitals in the world.  This is your responsibility since our fucking failures of stroke associations are DOING NOTHING FOR SURVIVORS.

Is anyone ever going to put together a protocol on using tDCS and which type?   Otherwise all this fucking research and reviews are totally worthless.  This is why we need strong stroke leadership, to actually help stroke survivors.

• HD-tDCS (3)

• cathodal tDCS (6)   

• anodal tDCS (9)  

• tDCS (61)

Effect of anodal versus cathodal transcranial direct current stimulation on stroke rehabilitation: a pilot randomized controlled trial

2013, Neurorehabilitation and Neural Repair
 Eman M. Khedr, MD 1, 

Ola A. Shawky, MD 1, 

Dina H. El-Hammady, MD 2, 

John C. Rothwell, MD 3, 

Essam S. Darwish, MD 1, 

Omar M. Mostafa, MD 4, 

and Amal M. Tohamy, MD 1

Abstract

Objective
We compared the long-term effect of anodal versus cathodal transcranial direct current stimulation (tDCS) on motor recovery in patients after subacute stroke.
Methods
Forty patients with ischemic stroke undergoing rehabilitation were randomly assigned to 1 of 3 groups: Anodal, Cathodal (over-affected and unaffected hemisphere, respectively), and Sham. Each group received tDCS at an intensity of 2 mA for 25 minutes daily for 6 consecutive days over of the motor cortex hand area. Patients were assessed with the National Institutes of Health Stroke Scale (NIHSS), Orgogozo’s MCA scale (OMCASS), the Barthel index (BI), and the Medical Research Council (MRC) muscle strength scale at baseline, after the sixth tDCS session and then 1, 2, and 3 months later. Motor cortical excitability was measured with transcranial magnetic stimulation (TMS) at baseline and after the sixth session.
Results
By the 3-month follow-up, all groups had improved on all scales with P  values ranging from .01 to .0001. Improvement was equal in the Anodal and Cathodal groups. When these treated groups were combined and compared with Sham, significant interactions were seen for the OMCASS and BI scales of functional ability (P = .002 for each). There was increased cortical excitability of the affected hemisphere in all groups with the changes being greater in the real versus sham groups. There were borderline significant improvements in muscle strength.
Conclusion
A brief course of 2 types of tDCS stimulation is superior to sham stimulation in enhancing the effect of rehabilitation training to improve motor recovery after stroke.
 

Cathodal transcranial direct current stimulation suppresses ipsilateral projections to presumed propriospinal neurons of the proximal upper limb

Whatever the fuck this says, I have no clue. Bet your doctor doesn't either.  And throwing in Motor Evoked Potentials to make this sound important is not helping any survivor get recovered.

So completely and totally fucking useless. 

Maybe that line will get a stroke medical professional to tell me exactly how I'm wrong and an idiot. 

 

Cathodal transcranial direct current stimulation suppresses ipsilateral projections to presumed propriospinal neurons of the proximal upper limb

Lynley V. Bradnam,
1,3
Cathy M. Stinear,
2,3
and Winston D. Byblow
1,3
1
 Movement Neuroscience Laboratory,
 2
 Department of Medicine, and
 3
Centre for Brain Research, The University of Auckland, Auckland, New Zealand
Submitted 14 December 2010; accepted in final form 7 March 2011
Bradnam LV, Stinear CM, Byblow WD.
 Cathodal transcranial direct current stimulation suppresses ipsilateral projections to presumed propriospinal neurons of the proximal upper limb.
 J Neuro- physiol
 105: 2582–2589, 2011. First published March 9, 2011;doi:10.1152/jn.01084.2010.—This study investigated whether cathodal transcranial direct current stimulation (c-tDCS) of left primary motor cortex (M1) modulates excitability of ipsilateral propriospinal premotoneurons (PNs) in healthy humans. Transcranial magnetic stimulation (TMS) of the right motor cortex was used to obtain motor evoked potentials (MEPs) from the left biceps brachii (BB) while participants maintained contraction of the left BB. To examine presumed PN excitability, left BB MEPs were compared with those conditioned by median nerve stimulation (MNS) at the left elbow.Interstimulus intervals between TMS and MNS were set to produce summation at the C3–C4 level of the spinal cord. MNS facilitated BBMEPs elicited at TMS intensities near active motor threshold but inhibited BB MEPs at slightly higher intensities, indicative of putative PN modulation. c-tDCS suppressed the facilitatory and inhibitory effects of MNS. Sham tDCS did not alter either component. There was no effect of c-tDCS and sham tDCS on nonconditioned left BBMEPs or on the ipsilateral silent period of left BB. Right first dorsal interosseous MEPs were suppressed by c-tDCS. These results indicatethat M1 c-tDCS can be used to modulate excitability of ipsilateral projections to presumed PNs controlling the proximal arm muscle BB.This technique may hold promise for promoting motor recovery of proximal upper limb function after stroke.human; motor evoked potential; biceps brachii
PROPRIOSPINAL NEURONS
 (PNs) located in the 3rd and 4th segments in the spinal cord (C3–C4) mediate descending com-mands for target reaching in the cat and nonhuman primate (Alstermark et al. 2007). Also known as cervical “premotoneurons,” presumed PNs integrate sensory feedback with descending cortical output to update rapidly the motor command during a reaching task (Pierrot-Deseilligny and Burke 2005). Inhuman and nonhuman primates, PNs are held under tonic suppression (Alstermark et al. 2007; Isa et al. 2006; Pierrot-Deseilligny 1996; Pierrot-Deseilligny and Burke 2005) that is released during activities requiring cocontraction of proximal and distal upper limb muscles (Iglesias et al. 2007; Nicolas etal. 2001; Roberts et al. 2008). As such, PNs facilitate the formation of muscle synergies (Pierrot-Deseilligny and Burke2005). Interestingly, descending inputs to presumed PNs orig-inate in both the contralateral hemisphere (Boudrias et al.2010; Mazevet et al. 1996; Nicolas et al. 2001) and ipsilateral hemisphere via the reticulospinal tract (Illert et al. 1978, 1981).Therefore, input from both hemispheres ultimately determines task-specific selective muscle activation and formation of nor-mal muscle synergies in the production of goal-directed upper limb movements such as reaching.The propriospinal system can be studied indirectly in hu-mans using single-pulse transcranial magnetic stimulation(TMS) combined with peripheral nerve stimulation. Usinginterstimulus intervals (ISIs) that permit summation at pre-sumed C3–C4 PNs (e.g., Nicolas et al. 2001), combining a weak cortical stimulus with submotor threshold peripheral stimulation facilitates contralateral motor evoked potentials(MEPs). Conversely, a stronger cortical stimulus and the same peripheral stimulus suppresses MEPs, presumably due to the cortical stimulus recruiting higher threshold descending path-ways reaching inhibitory interneurons within the spinal cord(Fig. 1; Iglesias et al. 2007; Nicolas et al. 2001; Roberts et al.2008; Stinear and Byblow 2004b). The present study examinedmodulation of inputs from the ipsilateral hemisphere to pre-sumed PNs during an upper limb task.Transcranial direct current stimulation (tDCS) is a noninvasive brain stimulation technique that can be used to transientlyalter membrane potential of neuronal populations within pri-mary motor cortex (M1), resulting in aftereffects that last several minutes. tDCS increases excitability when the anode is placed over M1, whereas with the cathode placed over M1,excitability is reduced (Lang et al. 2004; Nitsche and Paulus2000, 2001; Nitsche et al. 2003a,b, 2005). Interestingly, there have been reports of enhanced ipsilateral arm function after cathodal tDCs (c-tDCS) in healthy humans (Vines et al. 2006)and enhanced paretic arm function in stroke patients after tDCS(Boggio et al. 2007; Fregni et al. 2005). c-tDCS has been shown to decrease excitability of uncrossed projections to ipsilateral proximal upper limb

-motoneurons (MNs) (Brad-nam et al. 2010b), which may explain observed effects on the ipsilateral arm. Improvements in function may also be due to reduced transcallosal inhibition from stimulated to nonstimulated hemisphere following c-tDCS (Schlaug et al. 2008; Wil-liams et al. 2010).The aim of the current study was to examine whetherc-tDCS can indirectly downregulate presumed PNs and inhibitory interneurons intercalated in uncrossed pathways to the ipsilateral arm in healthy adults. Our hypothesis was thatc-tDCS of left M1 would suppress ipsilateral descending inputsto PNs and inhibitory interneurons. The aftereffects of tDCS were examined on presumed PNs converging onto
 
MNs of the ipsilateral (left) biceps brachii (BB) by applying single-pulse TMS to right M1 in conjunction with median nerve stimulation (MNS) at the left elbow. c-tDCS of left M1 was
Address for reprint requests and other correspondence: W. D. Byblow,Movement Neuroscience Laboratory, Centre for Brain Research, The Univ. of Auckland, Auckland 1142, New Zealand (e-mail: w.byblow@auckland.ac.nz).

Effects of electrode configurations in transcranial direct current stimulation after stroke

 Useless. I see nothing here that any objective starting points were identified, so not repeatable. No protocols came from it so not helpful in any regard for survivors.

Using Fugl-Meyer for anything in stroke is the height of stupidity, nothing objective in it, so nothing is repeatable.

tDCS wouldn't work on me since it is not going to enervate dead neurons, so I'm still screwed until something more useful comes along.  

And they didn't do hd-tDCS so more research still needed. 

Do mentors and senior researchers even think before starting research?

Effects of electrode configurations in transcranial direct current stimulation after stroke

  Kenneth Chelette
¹
, Cheryl Carrico
¹
, Laurie Nichols
¹
, Emily Salyers
¹
, Lumy Sawaki
¹

¹
 University of Kentucky, Physical Medicine and Rehabilitation Cardinal Hill Rehabilitation Hospital Lexington, KY, USA

 Abstract

 —Transcranial direct current stimulation (tDCS) is a form of non-invasive brain stimulation that can modulate neuroplasticity (the capacity for brain reorganization). Neuroplastic change correlates with upper extremity (UE) recovery after brain lesions. Different electrode configurations of tDCS paired with UE motor training can have different effects in distinct populations. We are conducting the first randomized, double-blind, placebo-controlled trial to investigate which tDCS configuration may best enhance outcomes of UE motor training for stroke survivors with chronic,
severe hemiparesis (i.e., little or no wrist or hand movement). We have assigned subjects to 1 of 4 groups: 1) “Anodal”: anodal tDCS to excite ipsilesional motor cortex; 2) “Cathodal”: cathodal tDCS to inhibit contralesional motor cortex; 3) “Dual”: a simultaneous combination of anodal and cathodal tDCS; or 4) “Sham” tDCS. Intervention (10 sessions) consists of tDCS followed by 3 hours of intensive, task-oriented UE training in each session. Our primary outcome measure is Fugl-Meyer Assessment. Our secondary outcome measures are Action Research Arm Test and Stroke Impact Scale. We have conducted evaluations at baseline and post-intervention. Preliminary results from 26 of (projected) 44 subjects indicate substantially greater improvement for the “Cathodal” group than other groups. These findings differ from evidence about tDCS in rehabilitation of mild-to-moderate hemiparesis. Completion of our study will include full analysis of neuroplastic change associated with intervention.

Contralesional Hemisphere Control of the Proximal Paretic Upper Limb following Stroke

So you found something interesting. WHAT THE HELL are you doing about it? 

1. Nothing

2. Wrote a protocol on it and distributed it worldwide. 

   Your choice how you want to be perceived, a success or a do nothing person.

Contralesional Hemisphere Control of the Proximal Paretic Upper Limb following Stroke

 Lynley V. Bradnam
1,2
, Cathy M. Stinear
2,3
, P. Alan Barber
2,3
and Winston D. Byblow
1,21
Movement Neuroscience Laboratory, Department of Sport & Exercise Science, and
 2
Centre for Brain Research and
 3
Neurology Research Group, Department of Medicine, The University of Auckland, Auckland, New Zealand 1142.
 Address correspondence to Winston D. Byblow, Movement Neuroscience Laboratory, Department of Sport & Exercise Science, The University of  Auckland, Auckland, New Zealand 1142. Email: w.byblow@auckland.ac.nz.
Cathodal transcranial direct current stimulation (c-tDCS) canreduce excitability of neurons in primary motor cortex (M1) and may facilitate motor recovery after stroke. However, little is known about the neurophysiological effects of tDCS on proximal upper limb function. We hypothesized that suppression of contralesionalM1 (cM1) excitability would produce neurophysiological effects that depended on the severity of upper limb impairment. Twelve patients with varying upper limb impairment after subcortical stroke were assessed on clinical scales of upper limb spasticity, impairment, and function. Magnetic resonance imaging was used to determine lesion size and fractional anisotropy (FA) within the posterior limbs of the internal capsules indicative of corticospinaltract integrity. Excitability within paretic M1 biceps brachii representation was determined from motor-evoked potentials during selective isometric tasks, after cM1 sham stimulation andafter c-tDCS. These neurophysiological data indicate that c-tDCSimproved selective proximal upper limb control for mildly impairedpatients and worsened it for moderate to severely impairedpatients. The direction of the neurophysiological after effects ofc-tDCS was strongly related to upper limb spasticity, impairment, function, and FA asymmetry between the posterior limbs of the internal capsules. These results indicate systematic variation ofcM1 for proximal upper limb control after stroke and that suppression of cM1 excitability is not a ‘‘one size fits all’’ approach. (Oh god, weasel words to justify doing nothing.)

Task-Dependent Modulation of Inputs to Proximal Upper Limb Following Transcranial Direct Current Stimulation of Primary Motor Cortex

You can read these 8 pages on your own. Way too many incomprehensible big words for most stroke survivors to understand and figure out a way to communicate this to their therapists. Useless.  I blame the mentors and senior researchers for not enforcing any readability on this writing.  A great stroke association president would challenge everyone to make stroke research readable.

Task-Dependent Modulation of Inputs to Proximal Upper Limb Following Transcranial Direct Current Stimulation of Primary Motor Cortex

Recruits sought for study to stimulate the ageing brain - University of Queensland researchers

I know it says healthy adults but be a pain in the ass and ask why such limited research. Then ask whether anodal tDCS, cathodal tDCS,  or HD-tDCS is being used and why that choice.
https://www.uq.edu.au/news/article/2018/05/recruits-sought-study-stimulate-ageing-brain

Brain training and stimulation in older adults may be the key to tackling cognitive decline and dementia, according to University of Queensland researchers.
Associate Professor Paul Dux and his team in the UQ School of Psychology are looking to recruit 200 healthy adults, aged 60 to 75, to take part in a study on cognitive training and brain stimulation.
“The ageing population has been identified as a key global health problem, bringing an increase in age-related disease and disability,” Dr Dux said.
“We need to examine and understand ways to prevent cognitive decline and dementia.
“Our study is using a form of non-invasive brain stimulation called transcranial direct current stimulation (tDCS), where we pass a very weak electrical current through two electrodes on the scalp.
“It’s virtually unnoticeable, causing only a mild sensation, and it has already shown promising effects in young adults.
“We combine the tDCS with a computerised behavioural training program where people try to improve their decision-making reaction times, and test people on a range of other tasks that measure memory and the ability to stay task-focussed.”
The study is being conducted at UQ’s St Lucia campus, where participants take part in eight sessions over a three month period.
“People come into the lab for an initial session where we take a number of base-line measurements assessing cognition, and they return for daily brain stimulation and training across a week,” Dr Dux said.
“There are follow-up sessions after one month and three months so we can see if the benefits continue over time.
“We recognise it’s a large time commitment, with each session ranging from one to four hours, so we will pay people $320 for taking part.
“More importantly, participants will be involved in one of the largest studies of its kind, helping us find ways to enhance cognition in people as they age, and that’s a huge issue facing world health.”
If you would like to participate, contact researcher Kristina Horne, k.horne@uq.edu.au or 0411 641 079.

Facts: ageing population, cognitive decline, dementia

• One of the biggest global health challenges is the ageing population.
• It is predicted that the global population of older adults will more than double by 2050. One in six workers is now aged over 65, and that figure will rise to one in three by 2050.
• Age-related cognitive decline has a profound impact on job performance and on how the health system is run.
• Age-related cognitive decline affects people’s everyday lives, such as the ability to plan, make decisions, solve problems, socialise, and care for themselves.
• About 30 per cent of adults over 65 will experience cognitive decline and face a substantially increased risk of developing dementia.
• The annual cost of dementia in Australia is now estimated at more than $15 billion, and is expected to increase to more than $36.8 billion by 2056.

Media: Associate Professor Paul Dux, p.dux@psy.uq.edu.au, +61 7 3365 6885, @PaulEDux; UQ Communications, habs.media@uq.edu.au +61 7 3346 3037, @UQhealth.
Video: An interview with Associate Professor Paul Dux is available for media repurposing. Contact Dani Nash, UQ Communications, dani.nash@uq.edu.au, +61 7 3346 3035.

Transcranial Direct Current Stimulation Enhances Motor Skill Learning but Not Generalization in Chronic Stroke

Useless, even though it didn't work the protocols are not available for the next researcher to avoid. 

Is anyone ever going to put together a protocol on using tDCS and which type?   Otherwise all this fucking research and reviews are totally worthless.  This is why we need strong stroke leadership, to actually help stroke survivors.

• HD-tDCS (3)

• cathodal tDCS (6)   

• anodal tDCS (9)  

• tDCS (61)

Transcranial Direct Current Stimulation Enhances Motor Skill Learning but Not Generalization in Chronic Stroke

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Manuela Hamoudi¹

Manuela Hamoudi

1University Hospital Freiburg, Freiburg, Germany
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, Heidi M. Schambra, MD²³

Heidi M. Schambra

2New York University, NY, USA3National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
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, Brita Fritsch, MD¹

Brita Fritsch

1University Hospital Freiburg, Freiburg, Germany
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Annika Schoechlin-Marx, MD¹

Annika Schoechlin-Marx

1University Hospital Freiburg, Freiburg, Germany
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, Cornelius Weiller, MD¹

Cornelius Weiller

1University Hospital Freiburg, Freiburg, Germany
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, Leonardo G. Cohen, MD³

Leonardo G. Cohen

3National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
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, Janine Reis, MD¹³

Janine Reis

1University Hospital Freiburg, Freiburg, Germany3National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
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...

First Published April 22, 2018 Research Article

https://doi.org/10.1177/1545968318769164

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Article Information

Article first published online: April 22, 2018

https://doi.org/10.1177/1545968318769164

Manuela Hamoudi¹, Heidi M. Schambra, MD^{2, 3}, Brita Fritsch, MD¹, Annika Schoechlin-Marx, MD¹, Cornelius Weiller, MD¹, Leonardo G. Cohen, MD³, Janine Reis, MD^{1, 3}

¹University Hospital Freiburg, Freiburg, Germany

²New York University, NY, USA

³National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA

Corresponding Author: Janine Reis, MD, Department of Neurology, Albert-Ludwigs-University Freiburg, Breisacher Str 64, 79106 Freiburg, Germany. Email: janine.reis@uniklinik-freiburg.de

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Abstract

Background. Motor training alone or combined with transcranial direct current stimulation (tDCS) positioned over the motor cortex (M1) improves motor function in chronic stroke. Currently, understanding of how tDCS influences the process of motor skill learning after stroke is lacking. Objective. To assess the effects of tDCS on the stages of motor skill learning and on generalization to untrained motor function.  
Methods. In this randomized, sham-controlled, blinded study of 56 mildly impaired chronic stroke patients, tDCS (anode over the ipsilesional M1 and cathode on the contralesional forehead) was applied during 5 days of training on an unfamiliar, challenging fine motor skill task (sequential visual isometric pinch force task). We assessed online and offline learning during the training period and retention over the following 4 months. We additionally assessed the generalization to untrained tasks. Results. With training alone (sham tDCS group), patients acquired a novel motor skill. This skill improved online, remained stable during the offline periods and was largely retained at follow-up. When tDCS was added to training (real tDCS group), motor skill significantly increased relative to sham, mostly in the online stage. Long-term retention was not affected by tDCS. Training effects generalized to untrained tasks, but those performance gains were not enhanced further by tDCS. Conclusions. Training of an unfamiliar skill task represents a strategy to improve fine motor function in chronic stroke. tDCS augments motor skill learning, but its additive effect is restricted to the trained skill.