Journal CME, February 2023: Transcranial direct current stimulation for upper extremity spasticity rehabilitation in stroke survivors: A systematic review of randomized controlled trials-Journal CME, February 2023: Transcranial direct current stimulation for upper extremity spasticity rehabilitation in stroke

Journal CME, February 2023: Transcranial direct current stimulation for upper extremity spasticity rehabilitation in stroke

Back to course

Pdf Summary

This systematic review evaluates the effects of transcranial direct current stimulation (tDCS) on upper extremity spasticity in stroke survivors by analyzing randomized controlled trials (RCTs). Seven studies with 320 participants were included after screening databases like PubMed, SCOPUS, and others. Participants primarily had ischemic strokes and included a mix of acute, subacute, and chronic stroke patients.<br /><br />The studies showed mixed results regarding tDCS effectiveness. While five studies that combined tDCS with traditional interventions like functional electrical stimulation (FES) or virtual reality (VR) noted significant reductions in spasticity, the two studies that used tDCS alone found no significant improvements. The optimal parameters for tDCS use (current intensity, electrode size, application duration) remained unclear due to the heterogeneity among study protocols.<br /><br />Common tDCS setups included applying cathodal stimulation over the contralesional primary motor cortex (M1) to decrease excitability in the non-lesioned hemisphere and anodal stimulation over the ipsilesional M1 to enhance excitability in the lesioned hemisphere. Studies combining tDCS with other therapies showed promising reductions in spasticity, suggesting that tDCS might be more effective as a complementary treatment rather than a standalone intervention.<br /><br />Adverse effects were minimal, with only minor issues such as itching reported, demonstrating that tDCS is well-tolerated. However, due to small sample sizes in some studies and varying methodologies, the evidence is limited and warrants further research with larger sample sizes and long-term follow-up to establish definitive conclusions.<br /><br />Overall, while tDCS holds potential for managing spasticity in stroke patients, particularly when used in conjunction with other therapies, more high-quality studies are needed to determine the most effective treatment protocols and long-term benefits.

Keywords

transcranial direct current stimulation

tDCS

upper extremity spasticity

stroke survivors

randomized controlled trials

functional electrical stimulation

virtual reality

cathodal stimulation

anodal stimulation

spasticity management