Effects of bihemispheric transcranial direct current stimulation on motor recovery in subacute stroke patients: a double-blind, randomized sham-controlled trial.
Shih-Pin Hsu, Chia-Feng Lu, Bing-Fong Lin and 8 others
PMID 36849990WHAT IT FOUND
Adding bihemispheric tDCS to task-oriented training helped subacute stroke patients recover upper limb function better than sham.
This benefit persisted at three months and appeared even in patients with severe damage to the motor pathways.
Key findings
01Patients receiving real tDCS showed significantly greater improvement in upper limb motor function scores than the sham group both immediately after the two-week intervention and at the three-month follow-up.
02In the subgroup of patients with no measurable motor evoked potentials (indicating compromised corticospinal tract integrity), real tDCS did not improve scores immediately but led to significantly better long-term recovery at three months compared to sham.
03Real tDCS was associated with a higher probability of patients achieving the minimal clinically important difference in their upper limb scores, with 100% of the real group classified as responders at three months versus 50% of the sham group.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The study had a small sample size (27 participants), which limits the generalizability of the findings and the statistical power for subgroup analyses. Patients with very mild or very severe upper limb impairment were excluded, so the results apply only to those with moderate deficits. The electrode placement was based on standard anatomical landmarks (C3/C4) rather than individualized brain imaging, which may not be optimal for all patients, particularly those with altered cortical anatomy. While the primary outcome was robust, the secondary outcome (Action Research Arm Test) showed a difference that did not persist at three months, possibly due to floor or ceiling effects in the test.
Declared interests
The study was funded by the Ministry of Science and Technology, Taipei Veterans General Hospital, and National Yang Ming Chiao Tung University. The authors declared no conflicts of interest.
The easy way to misread this
Do not assume this intervention works for all stroke patients or at all stages. The benefit was specific to the subacute phase (2-4 weeks post-stroke) and moderate impairment levels. Additionally, in patients with the most severe motor pathway damage, the benefit was delayed and not seen immediately after the intervention period.