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Meta-Analysis
. 2016 Mar 21;3(3):CD009645.
doi: 10.1002/14651858.CD009645.pub3.

Transcranial direct current stimulation (tDCS) for improving activities of daily living, and physical and cognitive functioning, in people after stroke

Bernhard Elsner  1 , Joachim Kugler, Marcus Pohl, Jan Mehrholz
Affiliations
Meta-Analysis

Transcranial direct current stimulation (tDCS) for improving activities of daily living, and physical and cognitive functioning, in people after stroke

Bernhard Elsner et al. Cochrane Database Syst Rev. .

Update in

Abstract

Background: Stroke is one of the leading causes of disability worldwide. Functional impairment, resulting in poor performance in activities of daily living (ADLs) among stroke survivors is common. Current rehabilitation approaches have limited effectiveness in improving ADL performance, function, muscle strength and cognitive abilities (including spatial neglect) after stroke, but a possible adjunct to stroke rehabilitation might be non-invasive brain stimulation by transcranial direct current stimulation (tDCS) to modulate cortical excitability, and hence to improve ADL performance, arm and leg function, muscle strength and cognitive abilities (including spatial neglect), dropouts and adverse events in people after stroke.

Objectives: To assess the effects of tDCS on ADLs, arm and leg function, muscle strength and cognitive abilities (including spatial neglect), dropouts and adverse events in people after stroke.

Search methods: We searched the Cochrane Stroke Group Trials Register (February 2015), the Cochrane Central Register of Controlled Trials (CENTRAL; the Cochrane Library; 2015, Issue 2), MEDLINE (1948 to February 2015), EMBASE (1980 to February 2015), CINAHL (1982 to February 2015), AMED (1985 to February 2015), Science Citation Index (1899 to February 2015) and four additional databases. In an effort to identify further published, unpublished and ongoing trials, we searched trials registers and reference lists, handsearched conference proceedings and contacted authors and equipment manufacturers.

Selection criteria: This is the update of an existing review. In the previous version of this review we focused on the effects of tDCS on ADLs and function. In this update, we broadened our inclusion criteria to compare any kind of active tDCS for improving ADLs, function, muscle strength and cognitive abilities (including spatial neglect) versus any kind of placebo or control intervention.

Data collection and analysis: Two review authors independently assessed trial quality and risk of bias (JM and MP) and extracted data (BE and JM). If necessary, we contacted study authors to ask for additional information. We collected information on dropouts and adverse events from the trial reports.

Main results: We included 32 studies involving a total of 748 participants aged above 18 with acute, postacute or chronic ischaemic or haemorrhagic stroke. We also identified 55 ongoing studies. The risk of bias did not differ substantially for different comparisons and outcomes.We found nine studies with 396 participants examining the effects of tDCS versus sham tDCS (or any other passive intervention) on our primary outcome measure, ADLs after stroke. We found evidence of effect regarding ADL performance at the end of the intervention period (standardised mean difference (SMD) 0.24, 95% confidence interval (CI) 0.03 to 0.44; inverse variance method with random-effects model; moderate quality evidence). Six studies with 269 participants assessed the effects of tDCS on ADLs at the end of follow-up, and found improved ADL performance (SMD 0.31, 95% CI 0.01 to 0.62; inverse variance method with random-effects model; moderate quality evidence). However, the results did not persist in a sensitivity analysis including only trials of good methodological quality.One of our secondary outcome measures was upper extremity function: 12 trials with a total of 431 participants measured upper extremity function at the end of the intervention period, revealing no evidence of an effect in favour of tDCS (SMD 0.01, 95% CI -0.48 to 0.50 for studies presenting absolute values (low quality evidence) and SMD 0.32, 95% CI -0.51 to 1.15 (low quality evidence) for studies presenting change values; inverse variance method with random-effects model). Regarding the effects of tDCS on upper extremity function at the end of follow-up, we identified four studies with a total of 187 participants (absolute values) that showed no evidence of an effect (SMD 0.01, 95% CI -0.48 to 0.50; inverse variance method with random-effects model; low quality evidence). Ten studies with 313 participants reported outcome data for muscle strength at the end of the intervention period, but in the corresponding meta-analysis there was no evidence of an effect. Three studies with 156 participants reported outcome data on muscle strength at follow-up, but there was no evidence of an effect.In six of 23 studies (26%), dropouts, adverse events or deaths that occurred during the intervention period were reported, and the proportions of dropouts and adverse events were comparable between groups (risk difference (RD) 0.01, 95% CI -0.02 to 0.03; Mantel-Haenszel method with random-effects model; low quality evidence; analysis based only on studies that reported either on dropouts, or on adverse events, or on both). However, this effect may be underestimated due to reporting bias.

Authors' conclusions: At the moment, evidence of very low to moderate quality is available on the effectiveness of tDCS (anodal/cathodal/dual) versus control (sham/any other intervention) for improving ADL performance after stroke. However, there are many ongoing randomised trials that could change the quality of evidence in the future. Future studies should particularly engage those who may benefit most from tDCS after stroke and in the effects of tDCS on upper and lower limb function, muscle strength and cognitive abilities (including spatial neglect). Dropouts and adverse events should be routinely monitored and presented as secondary outcomes. They should also address methodological issues by adhering to the Consolidated Standards of Reporting Trials (CONSORT) statement.

PubMed Disclaimer

Conflict of interest statement

Two review authors (Jan Mehrholz and Marcus Pohl) were involved in conducting and analysing the largest of the included trials (Hesse 2011). Bernhard Elsner: none known. Joachim Kugler: none known.

Figures

1
1
Study flow diagram. Please note that the number of full‐texts is not necessarily equal to the number of studies (e.g. The studies Di Lazzaro 2014a and Di Lazzaro 2014b have been presented in a single full‐text. Moreover there often are several full‐texts of a single trial (e.g. as is the case for Hesse 2011 or Nair 2011).
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
3
3
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
4
4
Funnel plot of comparison: 1 Primary outcome measure: tDCS for improvement of ADLs versus any type of placebo or control intervention, outcome: 1.1 ADLs at the end of the intervention period, absolute values (BI points).
1.1
1.1. Analysis
Comparison 1 tDCS versus any type of placebo or passive control intervention, Outcome 1 Primary outcome measure: ADLs at the end of the intervention period.
1.2
1.2. Analysis
Comparison 1 tDCS versus any type of placebo or passive control intervention, Outcome 2 Primary outcome measure: ADLs until the end of follow‐up.
1.3
1.3. Analysis
Comparison 1 tDCS versus any type of placebo or passive control intervention, Outcome 3 Secondary outcome measure: upper extremity function at the end of the intervention period.
1.4
1.4. Analysis
Comparison 1 tDCS versus any type of placebo or passive control intervention, Outcome 4 Secondary outcome measure: upper extremity function to the end of follow‐up.
1.5
1.5. Analysis
Comparison 1 tDCS versus any type of placebo or passive control intervention, Outcome 5 Secondary outcome measure: lower extremity function at the end of the intervention period.
1.6
1.6. Analysis
Comparison 1 tDCS versus any type of placebo or passive control intervention, Outcome 6 Secondary outcome measure: muscle strength at the end of the intervention period.
1.7
1.7. Analysis
Comparison 1 tDCS versus any type of placebo or passive control intervention, Outcome 7 Secondary outcome measure: muscle strength at the end of follow‐up.
1.8
1.8. Analysis
Comparison 1 tDCS versus any type of placebo or passive control intervention, Outcome 8 Secondary outcome measure: cognitive abilities at the end of the intervention period.
1.9
1.9. Analysis
Comparison 1 tDCS versus any type of placebo or passive control intervention, Outcome 9 Secondary outcome measure: dropouts, adverse events and deaths during the intervention period.
2.1
2.1. Analysis
Comparison 2 tDCS versus any type of active control intervention, Outcome 1 Primary outcome measure: ADLs at the end of the intervention period, absolute values.
2.2
2.2. Analysis
Comparison 2 tDCS versus any type of active control intervention, Outcome 2 Secondary outcome measure: upper extremity function at the end of the intervention period.
2.3
2.3. Analysis
Comparison 2 tDCS versus any type of active control intervention, Outcome 3 Secondary outcome measure: lower extremity function at the end of the intervention period.
2.4
2.4. Analysis
Comparison 2 tDCS versus any type of active control intervention, Outcome 4 Secondary outcome measure: dropouts, adverse events and deaths during the intervention period.
3.1
3.1. Analysis
Comparison 3 Subgroup analyses for primary outcome measure: ADLs at the end of the intervention period, Outcome 1 Planned analysis: duration of illness ‐ acute/subacute phase versus postacute phase for ADLs at the end of the intervention period.
3.2
3.2. Analysis
Comparison 3 Subgroup analyses for primary outcome measure: ADLs at the end of the intervention period, Outcome 2 Planned analysis: effects of type of stimulation (A‐tDCS/C‐tDCS/dual‐tDCS) and location of stimulation (lesioned/non‐lesioned hemisphere) on ADLs at the end of the intervention period (study groups collapsed).
3.3
3.3. Analysis
Comparison 3 Subgroup analyses for primary outcome measure: ADLs at the end of the intervention period, Outcome 3 Planned analysis: type of control intervention (sham tDCS, conventional therapy or nothing).
See this image and copyright information in PMC

Update of

References

References to studies included in this review

Ang 2012 {published and unpublished data}
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Boggio 2007a {published data only}
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Bolognini 2011 {published and unpublished data}
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Di Lazzaro 2014a {published data only}
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Fusco 2014 {published data only}
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Hesse 2011 {published data only}
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Jo 2008 {published data only}
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Kang 2008a {published and unpublished data}
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Khedr 2013 {published data only}
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Kim 2009 {published and unpublished data}
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Kim 2010 {published data only}
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Ko 2008 {published data only}
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Lee 2014 {published data only}
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Lindenberg 2010 {published data only}
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Mahmoudi 2011 {published data only}
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Nair 2011 {published data only (unpublished sought but not used)}
    1. NCT00792428. Non‐invasive brain stimulation and occupational therapy to enhance stroke recovery. ClinicalTrials.gov/show/NCT00792428 (accessed 4 March 2013).
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Park 2013 {published data only}
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Qu 2009 {published data only (unpublished sought but not used)}
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Rossi 2013 {published and unpublished data}
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Sohn 2013 {published data only}
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Sunwoo 2013 {published data only}
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Tahtis 2012 {published data only}
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Tedesco Triccas 2015b {published and unpublished data}
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Viana 2014 {published data only}
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Wang 2014 {published data only}
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Wu 2013a {published and unpublished data}
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References to studies excluded from this review

Boggio 2007b {published data only}
    1. Boggio PS, Nunes A, Rigonatti SP, Nitsche MA, Pascual‐Leone A, Fregni F. Repeated sessions of noninvasive brain DC stimulation is associated with motor function improvement in stroke patients. Restorative Neurology and Neuroscience 2007;25(2):123‐9. - PubMed
Bradnam 2012 {published data only}
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Jayaram 2009 {published data only}
    1. Jayaram G, Stinear JW. The effects of transcranial stimulation on paretic lower limb motor excitability during walking. Journal of Clinical Neurophysiology 2009;26(4):272‐9. - PubMed
Kasashima 2012 {published data only}
    1. Kasashima Y, Fujiwara T, Matsushika Y, Tsuji T, Hase K, Ushiyama J, et al. Modulation of event‐related desynchronization during motor imagery with transcranial direct current stimulation (tDCS) in patients with chronic hemiparetic stroke. Experimental Brain Research 2012; Vol. 221, issue 3:263‐8. - PubMed
Kharchenko 2001 {published data only}
    1. Kharchenko EV. Transcranial microelectrostimulation activates fast mechanisms of brain plasticity. Doklady Biological Sciences 2001;378:217‐9. - PubMed
Kitisomprayoonkul 2012 {published data only}
    1. Kitisomprayoonkul W. Transcranial direct current stimulation improves hand sensation in acute stroke. Archives of Physical Medicine and Rehabilitation 2012;93(10):E33.
Kumar 2011 {published data only}
    1. Kumar S, Wagner CW, Frayne C, Zhu L, Selim M, Feng W, et al. Noninvasive brain stimulation may improve stroke‐related dysphagia: a pilot study. Stroke 2011;42(4):1035‐40. - PMC - PubMed
Kwon 2012 {published data only}
    1. Kwon YH, Jang SH. Onsite‐effects of dual‐hemisphere versus conventional single‐hemisphere transcranial direct current stimulation: a functional MRI study. Neural Regeneration Research 2012;7(24):1889‐94. - PMC - PubMed
Lee 2012 {published data only}
    1. Lee YS, Yang HS, Jeong CJ, Yoo YD, Jeong SH, Jeon OK, et al. The effects of transcranial direct current stimulation on functional movement performance and balance of the lower extremities. Journal of Physical Therapy Science 2012;24(12):1215‐8. [0915‐5287]
Lefebvre 2013 {published data only}
    1. Lefebvre S, Laloux P, Peeters A, Desfontaines P, Jamart J, Vandermeeren Y. Dual‐tDCS enhances online motor skill learning and long‐term retention in chronic stroke patients. Frontiers in Human Neuroscience 2013;6:343. - PMC - PubMed
    1. Lefebvre S, Thonnard JL, Laloux P, Peeters A, Jamart J, Vandermeeren Y. Single session of dual‐tDCS transiently improves precision grip and dexterity of the paretic hand after stroke. Neurorehabilitation and Neural Repair 2013 Mar 13 [Epub ahead of print]. - PubMed
    1. Vandermeeren Y, Laloux P, Jamart J, Peeters A, Thonnard J‐L, Lefebvre S. Dual hemisphere tDCS in chronic stroke patients improves 'simple' precision grip and digital dexterity of the paretic hand with a delayed time‐course. Cerebrovascular Diseases 2012;33 Suppl 2:63 (Abst 9).
Lefebvre 2015 {published data only}
    1. Lefebvre S, Dricot L, Laloux P, Gradkowski W, Desfontaines P, Evrard F, et al. Neural substrates underlying stimulation‐enhanced motor skill learning after stroke. Brain 2015;138:149‐63. [0006‐8950] - PMC - PubMed
Madhavan 2011 {published data only}
    1. Madhavan S, Weber KA, Stinear JW. Non‐invasive brain stimulation enhances fine motor control of the hemiparetic ankle: implications for rehabilitation. Experimental Brain Research 2011;209(1):9‐17. - PubMed
Manganotti 2011 {published data only}
    1. Manganotti P, Daloli V, Fiaschi A. Decrease of upper limb spasticity after transcranial direct current stimulation in patients affected by stroke. Proceedings of the 14th European Congress of Clinical Neurophysiology and the 4th International Conference on Transcranial Magnetic and Direct Current Stimulation, Rome, Italy. 2011.
Ochi 2013 {published data only}
    1. Ochi M, Saeki S, Oda T, Matsushima Y, Hachisuka K. Effects of anodal and cathodal transcranial direct current stimulation combined with robotic therapy on severely affected arms in chronic stroke patients. Journal of Rehabilitation Medicine 2013;45(2):137‐40. - PubMed
    1. Shiraishi J, Seeki S, Ochi M, Oda T, Matsushima Y, Yoshikawa K, et al. Combined robotic therapy with transcranial direct current stimulation. Cerebrovascular Diseases 2012;34 Suppl 1:132 (Abst PP‐171).
Paquette 2011 {published data only}
    1. Paquette C, Radlinska B, Sidel M, Thiel A. Reducing transcallosal inhibition with non‐invasive brain stimulation to improve post‐infarct motor disorders. Movement Disorders 2011;26 Suppl 2:S40.
Sheliakin 2006 {published data only}
    1. Sheliakin AM, Preobrazhenskaia IG, Tiul'kin ON. [Micropolarization of the brain: a noninvasive method for correction of morphological and functional disturbances in acute focal brain lesions and their consequences]. Zhurnal Nevrologii i Psikhiatrii Imeni S.S. Korsakova 2006;106(10):27‐37. - PubMed
Stagg 2012a {published data only}
    1. Stagg C. Transcranial direct current stimulation ‐ evidence for functional improvements in conjunction with brain activation changes in chronic stroke patients. Third UK Stroke Forum Conference 2008:6.
    1. Stagg CJ, Bachtiar V, O'Shea J, Allman C, Bosnell RA, Kischka U, et al. Cortical activation changes underlying stimulation‐induced behavioural gains in chronic stroke. Brain 2012;135(Pt 1):276‐84. - PMC - PubMed
Takeuchi 2012 {published data only}
    1. Takeuchi N, Tada T, Matsuo Y, Ikoma K. Low‐frequency repetitive TMS plus anodal transcranial DCS prevents transient decline in bimanual movement induced by contralesional inhibitory rTMS after stroke. Neurorehabilitation and Neural Repair 2012;26(8):988‐98. - PubMed
Zimerman 2012 {published data only}
    1. Zimerman M, Heise KF, Hoppe J, Cohen LG, Gerloff C, Hummel FC. Modulation of training by single‐session transcranial direct current stimulation to the intact motor cortex enhances motor skill acquisition of the paretic hand. Stroke 2012;43(8):2185‐91. - PMC - PubMed

References to studies awaiting assessment

Brem 2010 {published data only}
    1. Brem AK, Speight I, Jaencke L. Impact of tDCS on motor function in acute stroke. 6th World Congress of Neurorehabilitation 2010:123‐7.
Miller 2013 {published data only}
    1. Miller J, Marquez J, Vliet P, Lagopoulos J, Parsons M. Transcranial Direct Current Stimulation: A randomised controlled trial to investigate the effects on upper limb function in chronic stroke. International Journal of Stroke 2013:22.
Park 2014 {published data only}
    1. Park E, Kwon TG, Chang WH, Kim YH. Non‐invasive brain stimulation for motor function of chronic stroke patients. International Stroke Conference Poster Abstracts. 2014. [0039‐2499]

References to ongoing studies

ACTRN12613000109707 {published and unpublished data}
    1. ACTRN12613000109707. Standard upper limb therapy treatment with or without non‐invasive brain stimulation to assist recovery after stroke. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=1261... (accessed 5 March 2013).
Chelette 2012 {published data only}
    1. Chelette K, Carrico C, Nichols L, Sawaki L. Optimizing transcranial direct current stimulation for motor recovery from severe post‐stroke hemiparesis: early results from an ongoing clinical trial. Archives of Physical Medicine and Rehabilitation 2012;93(10):E20. [0003‐9993]
ChiCTR‐TRC‐11001398 {published data only}
    1. ChiCTR‐TRC‐11001398. Effect of transcranial direct current stimulation on recovery of upper‐limb function after stroke. http://apps.who.int/trialsearch/Trial.aspx?TrialID=ChiCTR‐TRC‐11001398 (accessed 4 March 2013).
ChiCTR‐TRC‐11001490 {published data only}
    1. ChiCTR‐TRC‐11001490. Using transcranial direct current stimulation to treat ataxia and balance impairment after stroke. apps.who.int/trialsearch/Trial.aspx?TrialID=ChiCTR‐TRC‐11001490 (accessed 4 March 2013).
NCT00542256 {published data only}
    1. NCT00542256. tDCS and physical therapy in stroke. http://clinicaltrials.gov/ct2/show/NCT00542256?term=tDCS+and+physical+th... (accessed 4 March 2013).
NCT00783913 {published data only}
    1. NCT00783913. Using transcranial direct current stimulation (tDCS) to enhance the benefit of movement training in stoke patients. http://ClinicalTrials.gov/show/NCT00783913 (accessed 4 March 2013).
NCT00853866 {published data only}
    1. NCT00853866. Enhancement of motor function with reboxetine and transcranial direct current stimulation (STIMBOX). http://clinicaltrials.gov/ct2/show/NCT00853866 (accessed 4 March 2013).
NCT00909714 {published data only}
    1. NCT00909714. Neuroregeneration enhanced by transcranial direct current stimulation (TDCS) in stroke. http://ClinicalTrials.gov/show/NCT00909714 (accessed 4 March 2013).
NCT01007136 {published data only}
    1. Hodics T, Cohen L, Upreti B, Alex A, Kowalske K, Hart J, et al. Enrollment in early brain stimulation arm motor recovery studies is limited primarily by stimulation‐unrelated exclusions including ethnic and racial characteristics. Stroke 2012;43(2):(Abst 2439).
    1. Hodics T, Hidler J, Xu B, Kowalske K, Hart J, Briggs R, et al. Transcranial direct current stimulation (tDCS) enhanced stroke recovery and cortical reorganization. In: International Stroke Conference; San Antonio, Texas; February 23‐26, 2010. [CENTRAL: CN‐00747781]
    1. Hodics T, Upreti B, Alex A, Xu B, Hidler J, Kowalske K, et al. Transcranial direct current stimulation (tDCS) enhanced stroke recovery and cortical reorganization ‐ an ongoing clinical trial. European Journal of Neurology 2011;18(Suppl 2):127.
    1. Hodics TM, Dromerick AW, Pezullo JC, Xu B, Hidler J, Hart J, et al. Transcranial direct current stimulation (tDCS) enhanced stroke recovery and cortical reorganization. Proceedings of the International Stroke Conference. Los Angeles, USA, 2012:(Abst CT P25).
    1. NCT01007136. Transcranial direct current stimulation (tDCS)‐enhanced stroke recovery. http://ClinicalTrials.gov/show/NCT01007136 (accessed 4 March 2013).
NCT01014897 {published data only}
    1. NCT01014897. Transcranial direct current stimulation (tDCS) in chronic stroke recovery. http://ClinicalTrials.gov/show/NCT01014897 (accessed 4 March 2013).
NCT01127789 {published data only}
    1. NCT01127789. The use of transcranial direct current stimulation (tDCS) to study implicit motor learning on patients with brain injury [Withdrawn]. http://ClinicalTrials.gov/show/NCT01127789 (accessed 4 March 2013).
NCT01143649 {published data only}
    1. NCT01143649. Use of transcranial direct current stimulation (tDCS) coupled with constraint induced movement therapy in stroke patients. http://ClinicalTrials.gov/show/NCT01143649 (accessed 4 March 2013).
NCT01169181 {published data only}
    1. NCT01169181. AMES + brain stimulation: treatment for profound plegia in stroke. https://clinicaltrials.gov/show/NCT01169181 (accessed 7 September 2015).
NCT01201629 {published data only}
    1. NCT01201629. Transcranial direct current stimulation (tDCS). http://ClinicalTrials.gov/show/NCT01201629 (accessed 4 March 2013).
NCT01207336 {published data only}
    1. NCT01207336. Combined tDCS + PNS after acute stroke. http://clinicaltrials.gov/show/NCT01207336 (accessed 4 March 2013).
NCT01356654 {published data only}
    1. NCT01356654. Transcranial direct current stimulation in stroke rehabilitation. http://ClinicalTrials.gov/show/NCT01356654 (accessed 4 March 2013).
NCT01414582 {published data only}
    1. NCT01414582. Transcranial stimulation and motor training in stroke rehabilitation. http://ClinicalTrials.gov/show/NCT01414582 (accessed 4 March 2013).
NCT01500564 {published data only}
    1. Kandel M, Beis JM, Ganis V, Prestini M, Paysant J, Jacquin‐Courtois S. Transcranial direct current stimulation associated with physical therapy after stroke: feasability of a prospective, randomised, double blinded, sham controlled study. Annals of Physical and Rehabilitation Medicine 2011;54:e234.
    1. NCT01500564. Functional interest of non invasive brain stimulation during physiotherapy at a subacute phase post stroke (anodal protocol): ReSTIM. http://ClinicalTrials.gov/show/NCT01500564 (accessed 4 March 2013).
NCT01503073 {published data only}
    1. NCT01503073. Noninvasive brain stimulation for stroke. http://ClinicalTrials.gov/show/NCT01503073 (accessed 4 March 2012).
NCT01519843 {published data only}
    1. NCT01519843. Post stroke motor learning. http://ClinicalTrials.gov/show/NCT01519843 (accessed 4 March 2013).
NCT01539096 {published data only}
    1. NCT01539096. Brain stimulation‐aided stroke rehabilitation: neural mechanisms of recovery. http://ClinicalTrials.gov/show/NCT01539096 (accessed 4 March 2013).
    1. Plow EB, Cunningham DA, Beall E, Jones S, Wyant A, Bonnett C, et al. Effectiveness and neural mechanisms associated with tDCS delivered to premotor cortex in stroke rehabilitation: Study protocol for a randomized controlled trial. Trials 2013;14(1):331. - PMC - PubMed
NCT01544699 {published data only}
    1. NCT01544699. Impact of non‐invasive brain stimulation on motor recuperation. http://ClinicalTrials.gov/show/NCT01544699 (accessed 4 March 2013).
NCT01574989 {published data only}
    1. NCT01574989. Effects of rTMS and tDCS on motor function in stroke. http://ClinicalTrials.gov/show/NCT01574989 (accessed 4 March 2013).
NCT01644929 {published data only}
    1. NCT01644929. Rehabilitation combined with bihemispheric transcranial direct current stimulation in subacute ischemic stroke (RECOMBINE). http://ClinicalTrials.gov/show/NCT01644929 (accessed 4 March 2013).
NCT01726673 {published data only}
    1. NCT01726673. Robots paired with tDCS in stroke recovery. http://ClinicalTrials.gov/show/NCT01726673 (accessed 4 March 2012).
NCT01807637 {published data only}
    1. NCT01807637. Transcranial direct current stimulation for improving gait training in stroke. https://clinicaltrials.gov/show/NCT01807637 (accessed 7 September 2015).
NCT01828398 {published data only}
    1. NCT01828398. tDCS and robotic therapy in stroke. https://clinicaltrials.gov/show/NCT01828398 (accessed 7 September 2015).
NCT01879787 {published data only}
    1. NCT01879787. Effects of tDCS combined with mCIMT or mental practice in poststroke patients. https://clinicaltrials.gov/show/NCT01879787 (accessed 7 September 2015).
NCT01883843 {published data only}
    1. NCT01883843. Efficacy of TOCT and (tDCS) for gait improvement in patients with chronic stroke. https://clinicaltrials.gov/show/NCT01883843 (accessed 7 September 2015).
NCT01897025 {published data only}
    1. NCT01897025. Combined transcranial direct current stimulation and motor imagery‐based robotic arm training for stroke rehabilitation. https://clinicaltrials.gov/show/NCT01897025 (accessed 7 September 2015).
NCT01945515 {published data only}
    1. NCT01945515. Robotic‐assisted gait training combined with transcranial direct current stimulation to maximize gait recovery after stroke. https://clinicaltrials.gov/show/NCT01945515 (accessed 7 September 2015).
NCT01969097 {published data only}
    1. NCT01969097. Efficacy basics of bihemispheric motorcortex stimulation after stroke. https://clinicaltrials.gov/show/NCT01969097 (accessed 7 September 2015).
NCT01983319 {published data only}
    1. NCT01983319. Transcranial direct current stimulation combined with constraint induced movement therapy and role of GABA activity in stroke recovery. https://clinicaltrials.gov/show/NCT01983319 (accessed 7 September 2015).
NCT02031107 {published data only}
    1. NCT02031107. Randomized trial of transcranial theta‐burst stimulation and transcranial direct current stimulation. https://clinicaltrials.gov/show/NCT02031107 (accessed 7 September 2015).
NCT02080286 {published data only}
    1. NCT02080286. Transcranial stimulation (tDCS) and prism adaptation in spatial neglect rehabilitation. https://clinicaltrials.gov/show/NCT02080286 (accessed 7 September 2015).
NCT02109796 {published data only}
    1. NCT02109796. Effects of tDCS on quadriceps strength after stroke. https://clinicaltrials.gov/show/NCT02109796 (accessed 7 September 2015).
NCT02156635 {published data only}
    1. NCT02156635. Stroke treatment associate to rehabilitation therapy and transcranial DC stimulation. https://clinicaltrials.gov/show/NCT02156635 (accessed 7 September 2015).
NCT02166619 {published data only}
    1. NCT02166619. tDCS in poststroke on upper limb rehabilitation. https://clinicaltrials.gov/show/NCT02166619 (accessed 7 September 2015).
NCT02209922 {published data only}
    1. NCT02209922. The effects of tDCS combined with balance training on postural control and spasticity in chronic stroke patients. https://clinicaltrials.gov/show/NCT02209922 (accessed 7 September 2015).
NCT02210403 {published data only}
    1. NCT02210403. The influence of tDCS on the arm and hand function in stroke patients. https://clinicaltrials.gov/show/NCT02210403 (accessed 7 September 2015).
NCT02213640 {published data only}
    1. NCT02213640. Potentiation of the effects of prismatic adaptation by transcranial direct current stimulation (tDCS): evaluation of functional interest in negligence rehabilitation. https://clinicaltrials.gov/show/NCT02213640 (accessed 7 September 2015).
NCT02254616 {published data only}
    1. NCT02254616. Hybrid approach to mirror therapy and transcranial direct current stimulation for stroke recovery. https://clinicaltrials.gov/show/NCT02254616 (accessed 7 September 2015).
NCT02292251 {published data only}
    1. NCT02292251. Study to enhance motor acute recovery with intensive training after stroke. https://clinicaltrials.gov/show/NCT02292251 (accessed 7 September 2015).
NCT02308852 {published data only}
    1. NCT02308852. Improving bi‐manual activities in stroke patients with application of neuro‐stimulation. https://clinicaltrials.gov/show/NCT02308852 (accessed 7 September 2015).
NCT02325427 {published data only}
    1. NCT02325427. Changes in brain activity associated with upper limb motor recovery. https://clinicaltrials.gov/show/NCT02325427 (accessed 7 September 2015).
NCT02389608 {published data only}
    1. NCT02389608. The immediate effect of electrical stimulation transcranial direct current (tDCS) associated with the use of FES, in muscle activity of the tibialis anterior muscle, balance and plantar pressure distribution of individuals with hemiparesis due to stroke. https://clinicaltrials.gov/show/NCT02389608 (accessed 7 September 2015).
NCT02393651 {published data only}
    1. NCT02393651. Late LTP‐like plasticity effects of tDCS in subacute stroke patients. https://clinicaltrials.gov/show/NCT01807637 (accessed 7 September 2015).
NCT02399540 {published data only}
    1. NCT02399540. Late LTP‐like plasticity effects of tDCS in chronic stroke patients. https://clinicaltrials.gov/show/NCT02399540 (accessed 7 September 2015).
NCT02401724 {published data only}
    1. NCT02401724. NonInvasive brain stimulation in stroke patients. https://clinicaltrials.gov/show/NCT02401724 (accessed 7 September 2015).
NCT02416791 {published data only}
    1. NCT02416791. Robotic therapy and transcranial direct current stimulation in patients with stroke. https://clinicaltrials.gov/show/NCT02416791 (accessed 7 September 2015).
NCT02422173 {published data only}
    1. NCT02422173. Transcranial direct current stimulation on the risk of falls and lower limb function for acute stroke. https://clinicaltrials.gov/show/NCT02422173 (accessed 7 September 2015).
NCT02455427 {published data only}
    1. NCT02455427. Safety of transcranial direct current stimulation in the subacute phase after stroke. https://clinicaltrials.gov/show/NCT02455427 (accessed 7 September 2015).
NTR3315 {published data only}
    1. NTR3315. The effect of non invasive brain stimulation on lower limb motor skill acquisition. http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=3315 (accessed 4 March 2013).
Paquette 2013 {published data only}
    1. Paquette C, Riegel M, Anglade C, Fung J, Thiel A. Early inhibitory non‐invasive brain stimulation of the unaffected hemisphere combined improves motor outcome in acute stroke. Cerebrovascular Diseases 2013;35:147‐8. [1015‐9770]
Sattler 2012 {published data only}
    1. Sattler V, Acket B, Gerdelat‐Mas A, Raposo N, Albucher JF, Thalamas C, et al. Effect of repeated sessions of combined anodal tDCS and peripheral nerve stimulation on motor performance in acute stroke: a behavioural and electrophysiological study [Effet sur la recuperation motrice post‐AVC, en phase aigue, de sessions repetees de tDCS anodale du cortex moteur primaire couplee a une stimulation electrique peripherique repetitive]. Annals of Physical and Rehabilitation Medicine 2012;55:e3 + e5‐e6. [1877‐0657]

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References to other published versions of this review

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