Transcranial Electrical Nerve Stimulation for Dementia: Difference between revisions

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== Description  ==


Although Transcutaneous electrical nerve stimulation is known for non-pharmacological pain control, some scholars showed that it might also be used for brain stimulation in person with  dementia<ref name=":0">Cameron MH, Lonergan E, Lee H. [https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004032/abstract?__cf_chl_jschl_tk__=825dbba406e2e362cb19738244ae7e0a475486a5-1581864188-0-AQ8RbL_QUahFu9b2bCRFWIkHcLgzgixv5JQTknus7P-t56OnEYoJstiRFPPBo2_YqT6WKd9PW8jnBarcvCYHvdKo7oGeGNg2jTyVpwRJH Transcutaneous electrical nerve stimulation (TENS) for dementia.] Cochrane Database of Systematic Reviews. 2003(3).</ref><ref>Schabrun SM. [https://www.researchgate.net/publication/50315174_Transcranial_direct_current_stimulation_A_place_in_the_future_of_physiotherapy Transcranial direct current stimulation: a place in the future of physiotherapy?]. Physical Therapy Reviews. 2010 Aug 1;15(4):320-6.</ref>. Application of TENS electrodes to head is called Cranial Electrical Nerve Stimulation (CES) or transcranial stimulation and it is one of the methods used to stimulate the brain of a person with dementia<ref name=":0" />. Despite a recent evidence that CES alone or combine with physical therapy improves some functional activities in person with possible cognitive impairment<ref name=":1">Yotnuengnit P, Bhidayasiri R, Donkhan R, Chaluaysrimuang J, Piravej K. [https://journals.lww.com/ajpmr/FullText/2018/01000/Effects_of_Transcranial_Direct_Current_Stimulation.2.aspx Effects of transcranial direct current stimulation plus physical therapy on gait in patients with Parkinson disease: a randomized controlled trial.] American journal of physical medicine & rehabilitation. 2018 Jan 1;97(1):7-15.</ref>, trans-cranial electrical nerve stimulation is not a common practice among  physiotherapists who are one of the experts in managing person with dementia. This paper will therefore provide information on the CES method of application to stimulate the brain of a person with dementia.<br>
== Overview ==
[[File:TDCS administration.gif|right|frameless|350x350px]]
Transcranial electrical [[Neurone|nerve]] stimulation (tES) or Cranial Electrical Nerve Stimulation, CES, is a non-invasive [[Brain Anatomy|brain]] stimulation where brain activity is excited or inhibited by application of a  low voltage constant or alternating currents to the human brain via scalp electrodes.<ref>Bestmann S, Walsh V. [https://www.sciencedirect.com/science/article/pii/S0960982217314434?via%3Dihub Transcranial electrical stimulation]. Curr Biol. 2017 Dec 4;27(23):R1258-R1262.</ref>


== Dementia(Major Neurocognitive disorder)  ==
Image 1: tES  administration. A subject (front) sits on a sofa relaxed, and a researcher (behind) controls the tDCS device (a). A head strap (d) for convenience and reproducibility, and also use a rubber band (e) for reducing resistance
DSM-5 detailed  on the definition and diagnosis of  neurocognitive disorders<ref name=":2">American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub; 2013 May 22.</ref>. Dementia now addressed as a major neurocognitive disorder according to DSM-5 on neurocognitive disorder, is an impairment in one or more cognitive domain with functional status impairment<ref name=":2" />, which is of concern to both patient and patient relative. A cognitive impairment without significant impact on the functional activities of the person with dementia is termed mild neurocognitive impairment. Neuropsychological and behavioural characteristics such as anxiety, depression…and sleeping disturbances are prominent feature of dementia<ref>Burke AD, Goldfarb D, Bollam P, Khokher S. [https://link.springer.com/article/10.1007/s40120-019-00148-5 Diagnosing and Treating Depression in Patients with Alzheimer’s Disease.] Neurology and therapy. 2019 Aug 1:1-26.</ref><ref>Müller-Spahn F. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181717/ Behavioral disturbances in dementia. Dialogues in clinical neuroscience]. 2003 Mar;5(1):49.</ref>. This characteristics including neurocognitive impairment might improve with trans cranial electrical nerve stimulation<ref name=":0" /><ref>Das N, Spence JS, Aslan S, Vanneste S, Mudar R, Rackley A, Quiceno M, Chapman SB. [https://www.frontiersin.org/articles/10.3389/fnins.2019.00307/full Cognitive training and transcranial direct current stimulation in mild cognitive impairment: A randomized pilot trial]. Frontiers in Neuroscience. 2019;13:307.</ref><ref name=":3">Moreno-Duarte I, Gebodh N, Schestatsky P, Guleyupoglu B, Reato D, Bikson M, Fregni F. [https://www.sciencedirect.com/science/article/pii/B9780124047044000028 Transcranial electrical stimulation: transcranial direct current stimulation (tDCS), transcranial alternating current stimulation (tACS), transcranial pulsed current stimulation (tPCS), and transcranial random noise stimulation (tRNS).] InThe stimulated brain 2014 Jan 1 (pp. 35-59). Academic Press.</ref>. Scholars affirmed that TENS might stimulate brain and improve both the cognitive impairment and the neuropsychological characteristics of the dementia<ref name=":0" />


== '''Cognitive Impairment Assessment''' ==
The tES is a promising tool in rehabilitation, based on the growing evidence that delivery of current to specific brain regions can promote desirable plastic changes<ref>Truong D, Minhas P, Nair A, Bikson M. [https://www.sciencedirect.com/science/article/pii/B9780124047044000041 Computational modeling assisted design of optimized and individualized transcranial direct current stimulation protocols.] InThe stimulated brain 2014 Jan 1 (pp. 85-115). Academic Press.Available: https://www.sciencedirect.com/science/article/pii/B9780124047044000041<nowiki/>(accessed 23.9.2021)</ref>. The tES is becoming a topic for non-pharmacological management of various cognitive related conditions and this concept is still under research for effectiveness.<ref>Reed T, Kadosh RC. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6326965/ Transcranial electrical stimulation (tES) mechanisms and its effects on cortical excitability and connectivity]. Journal of inherited metabolic disease. 2018 Nov 2;41(6):1123-30.</ref>
Evaluating the person with dementia requires standardised neuropsychological assessment tools. Among this tools, the most common one universally use is Mini Mental Status Examination<ref>[https://www.ncbi.nlm.nih.gov/pubmed/1202204 Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. Journal of psychiatric research. 1975 Nov 1;12(3):189-98.]</ref>  and for functional status, Functional Activities Questionnaire (FAQ) for older adults might be used<ref>[https://consultgeri.org/try-this/dementia/issue-d13 Mayo AM. Use of the Functional Activities Questionnaire in older adults with dementia. Try This: Best Practices in Nursing Care to Older Adults with Dementia D. 2012;13.]</ref>. More so, this tools can be used to monitor the person with major neurocognitive impairment  progress on the intervention.


== '''Cranial Electrical Nerve Stimulation (CES) intervention''' ==
* The tES  is one of the techniques used to stimulate the brain of a person with [[dementia]].<ref name=":0">Cameron MH, Lonergan E, Lee H. [https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004032/abstract?__cf_chl_jschl_tk__=825dbba406e2e362cb19738244ae7e0a475486a5-1581864188-0-AQ8RbL_QUahFu9b2bCRFWIkHcLgzgixv5JQTknus7P-t56OnEYoJstiRFPPBo2_YqT6WKd9PW8jnBarcvCYHvdKo7oGeGNg2jTyVpwRJH Transcutaneous electrical nerve stimulation (TENS) for dementia.] Cochrane Database of Systematic Reviews. 2003(3).</ref>
Using electrotherapy modalities like TENS requires assessment like skin sensation test to determine if the intervention will be appropriate. CES application requires several parameter based on the objectives to achieve in the person with dementia<ref name=":3" /> <ref>Peterchev AV, Wagner TA, Miranda PC, Nitsche MA, Paulus W, Lisanby SH, Pascual-Leone A, Bikson M. [https://www.ncbi.nlm.nih.gov/pubmed/22305345 Fundamentals of transcranial electric and magnetic stimulation dose: definition, selection, and reporting practices. Brain stimulation.] 2012 Oct 1;5(4):435-53.</ref> . ''Moreno-Duarte''<ref name=":3" /> affirmed that low level intensity transcranial electrical nerve stimulation is the major documented intensity level of CES application and there are four methods to this: transcranial direct current stimulation (tDCS), transcranial pulsed current stimulation (tPCS), transcranial alternating current stimulation(tACS) and transcranial random noise stimulation (tRNS)(see figure 1 for the summary of the parameters used)<ref name=":3" />. Although, there is still some controversial in the use of CES among person with dementia, yet there are supporting evidence that  using CES either combined with physiotherapy intervention  or not improves cognitive, physical activities and behavioural characteristics<ref name=":1" /><ref>Elsner B, Kugler J, Pohl M, Mehrholz J. [https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD009645.pub3/abstract Transcranial direct current stimulation (tDCS) for improving activities of daily living, and physical and cognitive functioning, in people after stroke]. Cochrane Database of Systematic Reviews. 2016(3).</ref>
* Recent evidence had shown that tES alone or in combination with physiotherapy improves certain functional activities in person with possible cognitive impairment<ref name=":1">Yotnuengnit P, Bhidayasiri R, Donkhan R, Chaluaysrimuang J, Piravej K. [https://journals.lww.com/ajpmr/FullText/2018/01000/Effects_of_Transcranial_Direct_Current_Stimulation.2.aspx Effects of transcranial direct current stimulation plus physical therapy on gait in patients with Parkinson disease: a randomized controlled trial.] American journal of physical medicine & rehabilitation. 2018 Jan 1;97(1):7-15.</ref>
* The tES is not a common practice among physiotherapists who are one of the experts in dementia management. Accordingly, this paper will provide information on the tES method of application to stimulate the brain of a person with dementia.


Figure 1
== Dementia (Major Neurocognitive disorder)  ==
[[File:T dementia.jpg|thumb|<ref>Moreno-Duarte I, Gebodh N, Schestatsky P, Guleyupoglu B, Reato D, Bikson M, Fregni F. Transcranial electrical stimulation: transcranial direct current stimulation (tDCS), transcranial alternating current stimulation (tACS), transcranial pulsed current stimulation (tPCS), and transcranial random noise stimulation (tRNS). InThe stimulated brain 2014 Jan 1 (pp. 35-59). Academic Press.</ref>]]
[https://physio-pedia.com/Carers_Guide_to_Dementia Dementia] is an impairment in one or more cognitive domains with impaired functional status<ref name=":2">American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub; 2013 May 22.</ref>, which is of concern to both patient and patient relative. Neuropsychological and behavioural characteristics such as anxiety, depression and sleep disturbances are prominent features of dementia.<ref>Burke AD, Goldfarb D, Bollam P, Khokher S. [https://link.springer.com/article/10.1007/s40120-019-00148-5 Diagnosing and Treating Depression in Patients with Alzheimer’s Disease.] Neurology and therapy. 2019 Aug 1:1-26.</ref><ref>Müller-Spahn F. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181717/ Behavioral disturbances in dementia. Dialogues in clinical neuroscience]. 2003 Mar;5(1):49.</ref> These symptoms, including neurocognitive dysfunction, may be enhanced by using transcranial electrical nerve stimulation.<ref name=":0" /><ref>Das N, Spence JS, Aslan S, Vanneste S, Mudar R, Rackley A, Quiceno M, Chapman SB. [https://www.frontiersin.org/articles/10.3389/fnins.2019.00307/full Cognitive training and transcranial direct current stimulation in mild cognitive impairment: A randomized pilot trial]. Frontiers in Neuroscience. 2019;13:307.</ref><ref name=":3">Moreno-Duarte I, Gebodh N, Schestatsky P, Guleyupoglu B, Reato D, Bikson M, Fregni F. [https://www.sciencedirect.com/science/article/pii/B9780124047044000028 Transcranial electrical stimulation: transcranial direct current stimulation (tDCS), transcranial alternating current stimulation (tACS), transcranial pulsed current stimulation (tPCS), and transcranial random noise stimulation (tRNS).] InThe stimulated brain 2014 Jan 1 (pp. 35-59). Academic Press.</ref>.
== Mechanism of Transcranial electrical nerve stimulation  ==
Non-Invasive brain stimulation (transcranial electrical nerve stimulation ) main modalities are of different type and in this write up direct and alternating current type of trans-cranial electrical nerve stimulation mechanism will be discussed.<ref>Yavari F, Jamil A, Samani MM, Vidor LP, Nitsche MA. [https://www.sciencedirect.com/science/article/abs/pii/S0149763417300921?via%3Dihub Basic and functional effects of transcranial electrical stimulation (tES)—an introduction]. Neuroscience & Biobehavioral Reviews. 2018 Feb 1;85:81-92.</ref>


== Resources ==  
* Transcranial alternating current stimulation, tACS, delivers an alternated sinusoidal current at a specific frequency. In tACS, specific sine-wave stimulation waveforms interact with endogenous brain oscillations to alter neuronal plasticity for desired outcome.<ref name=":5">Elyamany O, Leicht G, Herrmann CS, Mulert C. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7867505/ Transcranial alternating current stimulation (tACS): from basic mechanisms towards first applications in psychiatry]. European Archives of Psychiatry and Clinical Neuroscience. 2020 Nov 19:1-22.</ref>
* Transcranial direct current stimulation, tDCS. The tDCS is believed to alter neuronal excitability by excitatory or inhibitory action and consequently modulating synaptic plasticity (long term potentiation or long term depression)<ref name=":5" />.
 
 
Aside the direct and alternating current type of trans-cranial electrical nerve stimulation, It is important to highlight on some of the other existing forms of the non-invasive brain stimulation, which include:
# [[Transcranial magnetic stimulation (TMS)]] - an electromagnet placed on the scalp generates magnetic field pulses that can activate axons and cause them to fire action potentials. For repetitive transcranial magnetic stimulation, it uses repeated application of TMS pulses for modulating brain activity.
# Repetitive transcranial magnetic stimulation, rTMS.<ref>Fertonani A, Miniussi C. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5405830/ Transcranial electrical stimulation: what we know and do not know about mechanisms]. The Neuroscientist. 2017 Apr;23(2):109-23.</ref> - which uses repeated application of TMS pulses for modulating brain activity.
 
== Cognitive Impairment Assessment ==
Evaluating a person with dementia requires neuropsychological assessment tools. Among these tools, the most common universally used is  [[Mini-Mental State Examination|Mini Mental State Examination(MMSE)]]<ref>Folstein MF, Folstein SE, McHugh PR. “[https://www.ncbi.nlm.nih.gov/pubmed/1202204 Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician.] Journal of psychiatric research. 1975 Nov 1;12(3):189-98.</ref>  and for functional status, Functional Activities Questionnaire (FAQ) for older adults might be used<ref>Mayo AM. [https://consultgeri.org/try-this/dementia/issue-d13 Use of the Functional Activities Questionnaire in older adults with dementia.] Try This: Best Practices in Nursing Care to Older Adults with Dementia D. 2012;13.</ref>. And these assessment tools, the MMSE and FAQ can as well used tools to monitor the progress of the intervention of a person with major neurocognitive impairment.
{{#ev:youtube|ryqlaTgGgPM}}  {{#ev:youtube|CleyjjD4kUw}}
== TES in Physiotherapy Practice for Brain Stimulation ==
Promising findings suggest that tDCS may be a useful standalone treatment or a helpful complement to other physiotherapy treatments in managing chronic pain and neurological conditions. 
 
However,  
 
* There are only a small number of heterogeneous studies.
* There is a need of further studies that will contribute to the current studies evidence in terms of tDCS parameters, long-term follow-up and different pathological populations. This will aid in determining tDCS clinical efficacy.
* It is of importance to note that while there are evidences pointing to potential benefits of tDCS for dementia population it's clinical application in physiotherapy practice still needs to be extensively studied.<ref name=":4">Schabrun SM. [https://www.researchgate.net/publication/50315174_Transcranial_direct_current_stimulation_A_place_in_the_future_of_physiotherapy Transcranial direct current stimulation: a place in the future of physiotherapy?]. Physical Therapy Reviews. 2010 Aug 1;15(4):320-6.</ref>
 
 
tDCS in stroke rehabilitation:
 
* In a randomised controlled trial conducted by Pires and colleagues, it was concluded that five tDCS sessions are sufficient to augment the effect of standard physiotherapy on upper limb function recovery in chronic post-stroke patients, and ten sessions resulted in greater gains <ref>Pires R, Baltar A, Sanchez MP, Antonino GB, Brito R, Berenguer-Rocha M, Monte-Silva K. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9859554/ Do Higher Transcranial Direct Current Stimulation Doses Lead to Greater Gains in Upper Limb Motor Function in Post-Stroke Patients?]. International Journal of Environmental Research and Public Health. 2023 Jan;20(2):1279.</ref>.
* In the study conducted by Garrido and colleagues, they concluded that combining modified [https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&cad=rja&uact=8&ved=2ahUKEwjopeHE6NX9AhXg-jgGHanJB-MQFnoECAwQAQ&url=https%3A%2F%2Fwww.physio-pedia.com%2FConstraint-Induced_Movement_Therapy_(CIMT)&usg=AOvVaw0BpPhccFKsJyqkJe34aYVo CIMT] with bihemispheric tDCS in patients hospitalised with acute to subacute stroke allows us to maximise the motor and functional recovery of the paretic upper limb in the early stages and independence in ADL, maintaining the effects over time <ref>Garrido M, Álvarez E, Acevedo F, Moyano Á, Castillo N, Ch GC. [https://www.sciencedirect.com/science/article/pii/S1935861X2200256X?via%3Dihub Early transcranial direct current stimulation with modified constraint-induced movement therapy for motor and functional upper limb recovery in hospitalized patients with stroke: A randomized, multicentre, double-blind, clinical trial]. Brain Stimulation. 2023 Jan 1;16(1):40-7.</ref>.
* In chronic stroke patients with severe hemiparesis of the upper limb, it was found that combined tDCS and [https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&cad=rja&uact=8&ved=2ahUKEwjwiLyT6dX9AhWqxTgGHdFZCq8QFnoECAsQAQ&url=https%3A%2F%2Fwww.physio-pedia.com%2FVirtual_Reality_for_Individuals_Affected_by_Stroke&usg=AOvVaw0crz7rfkE3YSIPxvEuKCH4 virtual reality-based] paradigm provided not only greater but also clinically meaningful improvement in the motor function (and similar sensory effects) in comparison to conventional physical therapy <ref>Llorens R, Fuentes MA, Borrego A, Latorre J, Alcañiz M, Colomer C, Noé E. [https://jneuroengrehab.biomedcentral.com/articles/10.1186/s12984-021-00896-2 Effectiveness of a combined transcranial direct current stimulation and virtual reality-based intervention on upper limb function in chronic individuals post-stroke with persistent severe hemiparesis: a randomized controlled trial]. Journal of NeuroEngineering and Rehabilitation. 2021 Dec;18:1-3.</ref>.
* Current findings suggest that tDCS combined with Robotic Therapy (RT) does not improve upper limb function, strength, spasticity, functional independence or velocity of movement after stroke <ref>Comino-Suárez N, Moreno JC, Gómez-Soriano J, Megía-García Á, Serrano-Muñoz D, Taylor J, Alcobendas-Maestro M, Gil-Agudo Á, Del-Ama AJ, Avendaño-Coy J. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8474736/ Transcranial direct current stimulation combined with robotic therapy for upper and lower limb function after stroke: a systematic review and meta-analysis of randomized control trials]. Journal of NeuroEngineering and Rehabilitation. 2021 Dec;18(1):1-6.</ref>. However, tDCS may enhance the effects of RT alone for lower limb function. tDCS parameters and the stage or type of stroke injury could be crucial factors that determine the effectiveness of this therapy.


== References  ==
== References  ==


<references />
<references />
[[Category:Older People/Geriatrics]]
[[Category:Electrophysical]]
[[Category:Electrophysical]]
[[Category:Neurological - Interventions]]
[[Category:Interventions]]
[[Category:Technology]]

Latest revision as of 20:10, 3 March 2024

Original Editor - Tolulope Adeniji

Top Contributors - Tolulope Adeniji, Kim Jackson, Lucinda hampton, Candace Goh, Pacifique Dusabeyezu, Rishika Babburu and Angeliki Chorti

Overview[edit | edit source]

TDCS administration.gif

Transcranial electrical nerve stimulation (tES) or Cranial Electrical Nerve Stimulation, CES, is a non-invasive brain stimulation where brain activity is excited or inhibited by application of a low voltage constant or alternating currents to the human brain via scalp electrodes.[1]

Image 1: tES administration. A subject (front) sits on a sofa relaxed, and a researcher (behind) controls the tDCS device (a). A head strap (d) for convenience and reproducibility, and also use a rubber band (e) for reducing resistance

The tES is a promising tool in rehabilitation, based on the growing evidence that delivery of current to specific brain regions can promote desirable plastic changes[2]. The tES is becoming a topic for non-pharmacological management of various cognitive related conditions and this concept is still under research for effectiveness.[3]

  • The tES is one of the techniques used to stimulate the brain of a person with dementia.[4]
  • Recent evidence had shown that tES alone or in combination with physiotherapy improves certain functional activities in person with possible cognitive impairment[5]
  • The tES is not a common practice among physiotherapists who are one of the experts in dementia management. Accordingly, this paper will provide information on the tES method of application to stimulate the brain of a person with dementia.

Dementia (Major Neurocognitive disorder)[edit | edit source]

Dementia is an impairment in one or more cognitive domains with impaired functional status[6], which is of concern to both patient and patient relative. Neuropsychological and behavioural characteristics such as anxiety, depression and sleep disturbances are prominent features of dementia.[7][8] These symptoms, including neurocognitive dysfunction, may be enhanced by using transcranial electrical nerve stimulation.[4][9][10].

Mechanism of Transcranial electrical nerve stimulation[edit | edit source]

Non-Invasive brain stimulation (transcranial electrical nerve stimulation ) main modalities are of different type and in this write up direct and alternating current type of trans-cranial electrical nerve stimulation mechanism will be discussed.[11]

  • Transcranial alternating current stimulation, tACS, delivers an alternated sinusoidal current at a specific frequency. In tACS, specific sine-wave stimulation waveforms interact with endogenous brain oscillations to alter neuronal plasticity for desired outcome.[12]
  • Transcranial direct current stimulation, tDCS. The tDCS is believed to alter neuronal excitability by excitatory or inhibitory action and consequently modulating synaptic plasticity (long term potentiation or long term depression)[12].


Aside the direct and alternating current type of trans-cranial electrical nerve stimulation, It is important to highlight on some of the other existing forms of the non-invasive brain stimulation, which include:

  1. Transcranial magnetic stimulation (TMS) - an electromagnet placed on the scalp generates magnetic field pulses that can activate axons and cause them to fire action potentials. For repetitive transcranial magnetic stimulation, it uses repeated application of TMS pulses for modulating brain activity.
  2. Repetitive transcranial magnetic stimulation, rTMS.[13] - which uses repeated application of TMS pulses for modulating brain activity.

Cognitive Impairment Assessment[edit | edit source]

Evaluating a person with dementia requires neuropsychological assessment tools. Among these tools, the most common universally used is Mini Mental State Examination(MMSE)[14] and for functional status, Functional Activities Questionnaire (FAQ) for older adults might be used[15]. And these assessment tools, the MMSE and FAQ can as well used tools to monitor the progress of the intervention of a person with major neurocognitive impairment.

TES in Physiotherapy Practice for Brain Stimulation[edit | edit source]

Promising findings suggest that tDCS may be a useful standalone treatment or a helpful complement to other physiotherapy treatments in managing chronic pain and neurological conditions.

However,

  • There are only a small number of heterogeneous studies.
  • There is a need of further studies that will contribute to the current studies evidence in terms of tDCS parameters, long-term follow-up and different pathological populations. This will aid in determining tDCS clinical efficacy.
  • It is of importance to note that while there are evidences pointing to potential benefits of tDCS for dementia population it's clinical application in physiotherapy practice still needs to be extensively studied.[16]


tDCS in stroke rehabilitation:

  • In a randomised controlled trial conducted by Pires and colleagues, it was concluded that five tDCS sessions are sufficient to augment the effect of standard physiotherapy on upper limb function recovery in chronic post-stroke patients, and ten sessions resulted in greater gains [17].
  • In the study conducted by Garrido and colleagues, they concluded that combining modified CIMT with bihemispheric tDCS in patients hospitalised with acute to subacute stroke allows us to maximise the motor and functional recovery of the paretic upper limb in the early stages and independence in ADL, maintaining the effects over time [18].
  • In chronic stroke patients with severe hemiparesis of the upper limb, it was found that combined tDCS and virtual reality-based paradigm provided not only greater but also clinically meaningful improvement in the motor function (and similar sensory effects) in comparison to conventional physical therapy [19].
  • Current findings suggest that tDCS combined with Robotic Therapy (RT) does not improve upper limb function, strength, spasticity, functional independence or velocity of movement after stroke [20]. However, tDCS may enhance the effects of RT alone for lower limb function. tDCS parameters and the stage or type of stroke injury could be crucial factors that determine the effectiveness of this therapy.

References[edit | edit source]

  1. ↑ Bestmann S, Walsh V. Transcranial electrical stimulation. Curr Biol. 2017 Dec 4;27(23):R1258-R1262.
  2. ↑ Truong D, Minhas P, Nair A, Bikson M. Computational modeling assisted design of optimized and individualized transcranial direct current stimulation protocols. InThe stimulated brain 2014 Jan 1 (pp. 85-115). Academic Press.Available: https://www.sciencedirect.com/science/article/pii/B9780124047044000041(accessed 23.9.2021)
  3. ↑ Reed T, Kadosh RC. Transcranial electrical stimulation (tES) mechanisms and its effects on cortical excitability and connectivity. Journal of inherited metabolic disease. 2018 Nov 2;41(6):1123-30.
  4. ↑ 4.0 4.1 Cameron MH, Lonergan E, Lee H. Transcutaneous electrical nerve stimulation (TENS) for dementia. Cochrane Database of Systematic Reviews. 2003(3).
  5. ↑ Yotnuengnit P, Bhidayasiri R, Donkhan R, Chaluaysrimuang J, Piravej K. Effects of transcranial direct current stimulation plus physical therapy on gait in patients with Parkinson disease: a randomized controlled trial. American journal of physical medicine & rehabilitation. 2018 Jan 1;97(1):7-15.
  6. ↑ American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub; 2013 May 22.
  7. ↑ Burke AD, Goldfarb D, Bollam P, Khokher S. Diagnosing and Treating Depression in Patients with Alzheimer’s Disease. Neurology and therapy. 2019 Aug 1:1-26.
  8. ↑ Müller-Spahn F. Behavioral disturbances in dementia. Dialogues in clinical neuroscience. 2003 Mar;5(1):49.
  9. ↑ Das N, Spence JS, Aslan S, Vanneste S, Mudar R, Rackley A, Quiceno M, Chapman SB. Cognitive training and transcranial direct current stimulation in mild cognitive impairment: A randomized pilot trial. Frontiers in Neuroscience. 2019;13:307.
  10. ↑ Moreno-Duarte I, Gebodh N, Schestatsky P, Guleyupoglu B, Reato D, Bikson M, Fregni F. Transcranial electrical stimulation: transcranial direct current stimulation (tDCS), transcranial alternating current stimulation (tACS), transcranial pulsed current stimulation (tPCS), and transcranial random noise stimulation (tRNS). InThe stimulated brain 2014 Jan 1 (pp. 35-59). Academic Press.
  11. ↑ Yavari F, Jamil A, Samani MM, Vidor LP, Nitsche MA. Basic and functional effects of transcranial electrical stimulation (tES)—an introduction. Neuroscience & Biobehavioral Reviews. 2018 Feb 1;85:81-92.
  12. ↑ 12.0 12.1 Elyamany O, Leicht G, Herrmann CS, Mulert C. Transcranial alternating current stimulation (tACS): from basic mechanisms towards first applications in psychiatry. European Archives of Psychiatry and Clinical Neuroscience. 2020 Nov 19:1-22.
  13. ↑ Fertonani A, Miniussi C. Transcranial electrical stimulation: what we know and do not know about mechanisms. The Neuroscientist. 2017 Apr;23(2):109-23.
  14. ↑ Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. Journal of psychiatric research. 1975 Nov 1;12(3):189-98.
  15. ↑ Mayo AM. Use of the Functional Activities Questionnaire in older adults with dementia. Try This: Best Practices in Nursing Care to Older Adults with Dementia D. 2012;13.
  16. ↑ Schabrun SM. Transcranial direct current stimulation: a place in the future of physiotherapy?. Physical Therapy Reviews. 2010 Aug 1;15(4):320-6.
  17. ↑ Pires R, Baltar A, Sanchez MP, Antonino GB, Brito R, Berenguer-Rocha M, Monte-Silva K. Do Higher Transcranial Direct Current Stimulation Doses Lead to Greater Gains in Upper Limb Motor Function in Post-Stroke Patients?. International Journal of Environmental Research and Public Health. 2023 Jan;20(2):1279.
  18. ↑ Garrido M, Álvarez E, Acevedo F, Moyano Á, Castillo N, Ch GC. Early transcranial direct current stimulation with modified constraint-induced movement therapy for motor and functional upper limb recovery in hospitalized patients with stroke: A randomized, multicentre, double-blind, clinical trial. Brain Stimulation. 2023 Jan 1;16(1):40-7.
  19. ↑ Llorens R, Fuentes MA, Borrego A, Latorre J, Alcañiz M, Colomer C, Noé E. Effectiveness of a combined transcranial direct current stimulation and virtual reality-based intervention on upper limb function in chronic individuals post-stroke with persistent severe hemiparesis: a randomized controlled trial. Journal of NeuroEngineering and Rehabilitation. 2021 Dec;18:1-3.
  20. ↑ Comino-Suárez N, Moreno JC, Gómez-Soriano J, Megía-García Á, Serrano-Muñoz D, Taylor J, Alcobendas-Maestro M, Gil-Agudo Á, Del-Ama AJ, Avendaño-Coy J. Transcranial direct current stimulation combined with robotic therapy for upper and lower limb function after stroke: a systematic review and meta-analysis of randomized control trials. Journal of NeuroEngineering and Rehabilitation. 2021 Dec;18(1):1-6.
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