Transcranial direct current stimulation: a place in the future of physiotherapy?
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Background: Cortical plasticity underlies the brain's ability to compensate and adapt after neurological and musculoskeletal injury. However, increasing evidence demonstrates that plasticity can also be maladaptive, contributing to functional impairment in a variety of conditions. Transcranial direct current stimulation (tDCS) is an emerging brain stimulation technique with the potential to alter cortical plasticity and prime the brain to enhance learning. If the potential of this technique can be harnessed, tDCS may provide a novel therapeutic approach in physiotherapy practice. Objectives: This review aims to provide an overview of the mechanisms, stimulation parameters and clinical applications of tDCS. Major findings: tDCS is an emerging and novel technique. Evidence at this early stage is promising with reductions in pain scores and improvements in motor function noted across a range of conditions. However, further research is needed before clinical efficacy and safety can be determined. Conclusions: tDCS is a powerful, non-invasive brain stimulation technique with the potential to improve outcomes in neurological and musculoskeletal conditions. Further research is needed using large sample sizes, long-term follow-up and a range of patient populations before the technique is available for clinical use. However, tDCS may be useful as a standalone therapy or as an adjunct to other physiotherapy treatments in the future.Keywords:
Transcranial Direct Current Stimulation
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Neurorehabilitation
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Neuromodulation
Transcranial Direct Current Stimulation
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A treatment for depression, chronic pain, cravings, and more?this is the emerging field of transcranial direct current stimulation (tDCS). In tDCS, transcranial means through the skull, and direct current is a weak stimulation current delivered to the brain using noninvasive electrodes placed on the scalp [Figure 1(a)].
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Transcranial direct current stimulation (tDCS) is a non-invasive neuromodulation technique proposed as an alternative or complementary treatment for several neuropsychiatric diseases. The biological effects of tDCS are not fully understood, which is in part explained due to the difficulty in obtaining human brain tissue. This protocol describes a tDCS mouse model that uses a chronically implanted electrode allowing the study of the long-lasting biological effects of tDCS. In this experimental model, tDCS changes the cortical gene expression and offers a prominent contribution to the understanding of the rationale for its therapeutic use.
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Transcranial direct current stimulation (tDCS) is a neuromodulation technique, which noninvasively alters cortical excitability via weak polarizing currents between two electrodes placed on the scalp. Since it is comparably easy to handle, cheap to use and relatively well tolerated, tDCS has gained increasing interest in recent years. Based on well-known behavioral effects, a number of clinical studies have been performed in populations including patients with major depressive disorder followed by schizophrenia and substance use disorders, in sum with heterogeneous results with respect to efficacy. Nevertheless, the potential of tDCS must not be underestimated since it could be further improved by systematically investigating the various stimulation parameters to eventually increase clinical efficacy. The present article briefly explains the underlying physiology of tDCS, summarizes typical stimulation protocols and then reviews clinical efficacy for various psychiatric disorders as well as prevalent adverse effects. Future developments include combined and more complex interactions of tDCS with pharmacological or psychotherapeutic interventions. In particular, using computational models to individualize stimulation protocols, considering state dependency and applying closed-loop technologies will pave the way for tDCS-based personalized interventions as well as the development of home treatment settings promoting the role of tDCS as an effective treatment option for patients with mental health problems.
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Purpose of review Transcranial direct current stimulation (tDCS) is a noninvasive method of brain stimulation that has been increasingly tested for the treatment of neuropsychiatric disorders. It has useful characteristics, such as low cost, ease of use, reliable sham methodology, and relatively powerful effects on cortical excitability. Because of its potential to modulate cortical excitability noninvasively, tDCS has been tested for the treatment of depression for several decades. Therefore, we reviewed evidence on the use of tDCS for major depression examining evidence from past and recent tDCS studies. We also briefly compared tDCS with other techniques of neuromodulation, namely deep brain stimulation, vagal nerve stimulation, and transcranial magnetic stimulation; and suggest future directions for the use of tDCS in major depression. Recent findings Results from past clinical trials testing direct current stimulation as a therapeutic tool had mixed methodology and showed heterogeneous results. Recent studies on tDCS and depression using novel approaches, such as different parameters of stimulation, have improved its neuromodulatory effect thus resulting in larger clinical effects. In fact, two recent small trials have shown that tDCS is associated with significant clinical gains. Summary On the basis of these findings there is still not enough evidence to support tDCS as a therapeutic modality for depression. However, findings to date encourage further studies in this area that should explore novel parameters of stimulation. In fact, it appears that current methods of tDCS might not be fully optimized and, in fact, (1) individualized parameters of stimulation, (2) longer stimulation sessions, and (3) methods to focalize tDCS might be useful strategies to provide greater clinical benefits.
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