Search Results (517)

Background/Objectives: Stroke is a sudden neurological event caused by disrupted cerebral blood flow and represents a leading cause of acquired disability worldwide. Motor impairments and spasticity are among the most prevalent sequelae, significantly limiting functional independence and quality of life. Non-invasive electrotherapy has emerged as a complementary strategy in neurorehabilitation aimed at enhancing neuroplasticity and improving motor recovery. To systematically review current evidence regarding the effectiveness of non-invasive electrotherapy modalities in the rehabilitation of motor sequelae and spasticity following stroke, and to examine their theoretical and clinical rationale. Methods: A systematic literature review was conducted in accordance with PRISMA 2020 guidelines. The protocol was prospectively registered in the Open Science Framework (OSF). A comprehensive search was performed in Pubmed, Web of Science (WoS), and Scopus for studies published up to 14 November 2023, using the terms “Electric Stimulation Therapy” and “Stroke”. The methodological quality was assessed using the PEDro scale. The levels of evidence were classified according to the Oxford Centre for Evidence-Based Medicine criteria, and the risk of bias was evaluated using the Cochrane Risk of Bias tool (RoB 2). Results: Sixteen studies were included in the review. The analyzed interventions comprised neuromuscular electrical stimulation (NMES), transcutaneous electrical nerve stimulation (TENS), functional electrical stimulation (FES), neuromuscular electrical stimulation combined with transcranial magnetic stimulation (NMES + rTMS), transcranial direct current stimulation (tDCS), and afferent electrical stimulation (AES). Overall, the methodological quality of the included studies ranged from moderate to high, with PEDro scores between 6 and 9 out of 10. According to the Oxford Centre for Evidence-Based Medicine classification, most studies corresponded to level 1b evidence, while a smaller proportion were classified as level 2b. A risk of bias assessment using the Cochrane RoB 2 tool showed that the majority of the included studies presented a low risk of bias across most domains, although some concerns were identified in the domains of randomization and measurement in a limited number of trials. Across modalities, consistency within group improvement in motor function and spasticity was reported. However, between group comparisons with conventional rehabilitation were often inconsistent and did not consistently demonstrate superiority. The variability in stimulation parameters, intervention duration, and outcome measures further limited direct comparisons across studies. Conclusions: Non-invasive electrotherapy appears to be a safe and promising adjunct to conventional stroke rehabilitation. Nevertheless, further high-quality studies are required to clarify the underlying neurophysiological mechanisms and to establish standardized treatment protocols. Full article

Background: Traumatic brain injury (TBI) and hypoxic-ischemic encephalopathy (HIE) cause significant pediatric morbidity through primary insults and secondary cascades like excitotoxicity, neuroinflammation, and impaired plasticity. Nerve growth factor (NGF) promotes neuroprotection, anti-inflammation, and repair, but delivery challenges persist. This review evaluates preclinical and clinical evidence on intranasal human recombinant NGF (hr-NGF) to enhance neurorepair in pediatric TBI and HIE patients. It aims to clarify the potential of intranasal hr-NGF as part of future multimodal approaches to enhance brain repair and improve functional recovery across the lifespan. Methods: A PRISMA-guided literature search (2000–2025) was conducted across Scopus, PubMed, and Cochrane CENTRAL using terms like “intranasal NGF”, “TBI”, “HIE”, and “pediatric”. Eligible studies involved pediatric brain injury patients receiving NGF, with outcomes via clinical scales, imaging, or EEG. Results: Preclinical models showed that intranasal NGF reduces lesion volume, inflammation, and deficits while boosting angiogenesis and cholinergic function. Clinically, one child with meningitis and five TBI cases exhibited improved consciousness, spasticity, motor scores, cognition, and brain imaging. Three HIE cases gained voluntary movements, expressivity, and perfusion. No adverse events occurred related to hr-NGF administration. Conclusions: Intranasal hr-NGF safely reactivates plasticity in pediatric brain injury, yielding motor, cognitive, and neurophysiological gains. Preliminary data support multimodal use, but randomized trials are needed to optimize protocols and confirm efficacy. Full article

Background/Objectives: Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common neurodevelopmental disorders in childhood and it tends to remain during adulthood. It not only affects cognitive abilities and behavior but also often presents emotional disturbances and alterations in the perceived quality of life. These symptoms are primarily related to dysfunctions in the ventromedial and dorsolateral prefrontal network. The main objective was to evaluate the feasibility and explore the initial outcomes of an integrated protocol combining neuropsychological treatment and transcranial direct current stimulation (tDCS). Methods: This study presents a single-case experimental A-B design of a 21-year-old woman, diagnosed with predominantly inattentive ADHD, treated at the University Psychology Clinic of Loyola Andalucía University. The treatment was carried out twice a week for 5 weeks (10 sessions in total), with 20 min of anodal tDCS at F3 and cathodal tDCS at F4 (2 mA), while digital neurorehabilitation exercises and psychotherapeutic support were provided. Results: An overall significant improvement was observed in cognitive functions (p = 0.008), with clinically significant gains in cognitive flexibility, visual working memory, and planning. Mixed results were found in inhibition, with improvement in interference control but no change in response inhibition. No significant changes were observed in sustained attention, auditory working memory, or processing speed. In terms of emotional state, an overall improvement was noted (p = 0.046), particularly in depression symptoms and perceived quality of life related to physical and psychological health. However, no significant changes were observed in anxiety symptoms or in areas related to the environment and social relationships. These findings reflect pilot-level evidence of clinical change within a feasibility framework. Conclusions: The combined treatment was found to be safe and feasible, showing promising preliminary improvements in cognitive and emotional domains. As a single-case study, these results serve as hypothesis-generating evidence for future controlled trials. Full article

Background: Chronic pain is a prevalent and disabling condition that affects physical health but also cognitive domains. Executive functions, including inhibitory control, cognitive flexibility, and working memory, essentials for self-regulation, treatment adherence, and coping with symptoms, are particularly compromised. Physiotherapy interventions, traditionally aimed at physical outcomes, may also influence executive functions; however, their impact remains unclear. Objective: This review aimed to synthesize current evidence regarding the effects of physiotherapy-related interventions on executive function in adults with chronic pain. Methods: The review followed the Cochrane Handbook and Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines, and the protocol was registered in PROSPERO (CRD42024611800). A comprehensive search was performed. Randomized controlled trials (RCTs) included adults with chronic pain (≥3 months) whose executive function outcomes were evaluated after physiotherapy-based interventions. Results: Out of 12,391 records, 10 randomized controlled trials were included. Populations primarily had fibromyalgia, chronic low back pain, and chronic musculoskeletal pain. Interventions encompassed transcranial direct current stimulation (tDCS), transcranial magnetic stimulation (rTMS), neurofeedback, structured exercise, and multimodal physical-cognitive-mindfulness training. Intervention durations ranged from one session to 16 weeks. Executive function was assessed with diverse neuropsychological tests. tDCS improved attention, inhibitory control, cognitive flexibility, and working memory. Exercise interventions showed benefits in working memory and inhibitory control. Conclusions: Preliminary evidence suggests that physiotherapy interventions, particularly anodal tDCS and structured exercise, may improve executive functions in individuals with chronic pain. Future trials should incorporate long-term follow-up. Integrating cognitive targets into physiotherapy may enhance the multidimensional management of chronic pain. Full article

Background: Non-invasive brain stimulation (NIBS) is increasingly used as an adjunctive option in late-life depression (≥60 years), a condition frequently complicated by multimorbidity and incomplete response to standard treatments. Comparative real-world evidence between repetitive Transcranial Magnetic Stimulation (rTMS) and transcranial Direct Current Stimulation (tDCS), particularly including functional outcomes, remains limited. Methods: We conducted a retrospective, naturalistic comparative study of 104 depressed inpatients (≥60 years), either unipolar or bipolar, treated with rTMS (n = 48) or tDCS (n = 56) as part of routine care. Depression severity was assessed with the 21-item Hamilton Depression Rating Scale (HDRS21) at baseline, 2 weeks, and 1 month; response was defined as ≥50% HDRS21 score reduction and remission as HDRS21 < 7 at 1 month. Global Assessment of Functioning (GAF) was assessed at admission and discharge (baseline and 1 month). Longitudinal changes were examined using covariate-adjusted mixed-effects models; categorical outcomes were compared using χ² tests. Propensity score matching was applied as an additional approach to reduce confounding due to the observational design. Results: At 1 month, response and remission rates were significantly higher in the rTMS group than in the tDCS group (87.5% vs. 55.4%, p < 0.001; 62.5% vs. 41.1%, p = 0.047, respectively). rTMS showed greater HDRS21 score reductions at 2 weeks and 1 month (Time × Treatment, p < 0.001). GAF scores significantly improved over time in both groups (Time effect, p < 0.001) without between-technique differences (Time × Treatment, p = 0.56), and GAF scores did not differ by response/remission status. Conclusions: In this cohort of inpatients aged ≥ 60 years with depressive episodes, rTMS was associated with greater short-term reductions in HDRS21 scores compared with tDCS, whereas both modalities showed comparable improvements in GAF from admission to discharge. Full article

Background: Placebo effects are well documented in Parkinson’s disease (PD) clinical trials and represent a major methodological challenge in interpreting neuromodulation studies. Although sham stimulation has been associated with clinical improvement, the magnitude, durability, and outcome specificity of placebo-related effects across non-invasive neuromodulation trials remain incompletely characterized. Methods: This systematic review and meta-analysis followed PRISMA guidelines and was registered in PROSPERO (CRD1272381). PubMed/MEDLINE, Embase, Web of Science, and the Cochrane Library were searched from inception through September 2025. Randomized, sham-controlled trials of non-invasive neuromodulation in adults with PD were included. Results: Seventeen randomized sham-controlled trials (n = 654 participants) involving repetitive transcranial magnetic stimulation and transcranial direct current stimulation were included. Sham stimulation was associated with small but statistically significant improvements in UPDRS Part III (motor examination) at post-intervention and follow-up, whereas no significant placebo-related improvement was observed for UPDRS Total score. Placebo effects were modest and did not increase over time. In contrast, active neuromodulation produced larger and more durable improvements in both UPDRS Total and Part III, with statistically significant effects maintained at follow-up. Conclusions: Placebo effects contribute to short-term clinical improvement in non-invasive neuromodulation trials for PD, particularly for motor examination outcomes, but do not fully account for the sustained benefits observed with active stimulation. Placebo responsiveness is outcome- and time-dependent, underscoring the importance of rigorous trial design, including careful outcome selection, assessment timing, expectancy management, and comparator structures, to accurately estimate neuromodulation efficacy and support clinical translation. Full article

Background: Interoception has been proposed as a key mechanism underlying impulsive behaviours, including maladaptive eating. However, the brain mechanisms supporting the interaction between interoception and impulsivity across different reward types remain unclear. This study investigated whether modulating the right insula and the dorsal anterior cingulate cortex (dACC) using high-definition transcranial direct current stimulation (HD-tDCS) could affect interoceptive accuracy and impulsive decision-making. Methods: Model-based HD-tDCS montages were defined to target the right insula and dACC. Two behavioural paradigms were administered: (i) the heartbeat detection task (HBD) to assess interoceptive accuracy and (ii) two versions of the delay discounting (DD) task with food and monetary rewards to measure impulsivity. Heart rate variability (HRV) was recorded as an index of autonomic activity. HD-tDCS was delivered online during the HBD, while DD tasks were completed offline. Twenty-four participants took part in four sessions in a within-subject design: baseline DD tasks, anodal HD-tDCS targeting the insula, dACC, or sham stimulation. Results: Stimulation of both the insula and dACC reduced participants’ ability to detect synchronous heartbeat while improving accuracy in exteroceptive trials. Discounting rates significantly increased following insula stimulation. Moreover, HD-tDCS effects on DD performance varied depending on reward type. Conclusions: These findings suggest differential contributions of the dACC and insula in interoceptive and exteroceptive processing and support the effect of HD-tDCS combined with interoceptive tasks to modulate impulsive decision-making. Reward-specific effects highlight the importance of stimulus type when designing interventions for impulsive eating behaviours. Full article

This study investigated the acute effects of anodal transcranial direct current stimulation (a-tDCS) applied over the dorsolateral prefrontal cortex (DLPFC) and primary motor cortex (M1) on neuromuscular performance during a velocity-based back squat exercise. Fifteen recreationally trained men participated in a randomized, double-blind, crossover design, completing three experimental conditions (SHAM, DLPFC, and M1 stimulation) consisting of 20 min of 2 mA a-tDCS followed by a squat protocol performed to a 15% velocity loss threshold. Total repetitions, repetitions per set, mean concentric velocity, and rating of perceived exertion (RPE) were recorded. No significant differences between stimulation conditions were observed for any outcome variable. However, two individuals showed reversed responses, consistent with previously reported inter-individual variability in response to tDCS. Given the high inter-individual variability in response to a-tDCS, we additionally performed a post hoc sensitivity analysis based on response direction relative to SHAM. This analysis indicated that a-tDCS over M1 and DLPFC resulted in a significantly greater total number of repetitions compared with SHAM, whereas repetitions per set, mean velocity, and RPE were not different between conditions. Accordingly, a systematic and individualized approach may be needed to address inter-individual variability in response to tDCS to optimize its effect on fatigue tolerance. Full article

Background/Objectives: Transcranial direct current stimulation (tDCS) is increasingly used by athletes, yet sport-performance-enhancement findings are mixed and often small, with outcomes depending on stimulation target, timing, and task demands. Aim: This scoping review mapped and synthesized the soccer-specific trial evidence to identify (i) which tDCS targets and application schedules have been tested in soccer players, (ii) which soccer-relevant outcomes show the most consistent immediate (minutes–hours) or training-mediated benefits, and (iii) where evidence gaps persist. Methods: We conducted a scoping review of clinical trials in footballers, following review best-practice guidance (PRISMA-informed) and a preregistered protocol. Searches (August 2025) spanned PubMed/MEDLINE, ResearchGate, Google Scholar, and Cochrane, using combinations of “football/soccer” and “tDCS/transcranial direct current stimulation,” with inclusion restricted to trials from 2008–2025. Dual independent screening was applied. Of 47 records identified, 21 studies met the criteria. Across these, the total N was 593 (predominantly male adolescents/young adults; wide range of levels). Results: Prefrontal protocols—most commonly left-dominant dorsolateral prefrontal cortex (DLPFC) (+F3/−F4, ~2 mA, ~20 min)—most consistently improved post-match recovery status/well-being (e.g., fatigue, sleep quality, muscle soreness, stress, mood), and when repeated and/or paired with practice, shortened decision times and promoted more efficient visual search. Effects on classic executive tests were inconsistent, and bilateral anodal DLPFC under fatigue increased risk-tolerant choices. Motor-cortex targeting (C3/C4/Cz) rarely changed rapid force–power performance after a single session—e.g., multiple well-controlled trials found no immediate CMJ gains—but when paired with multi-week training (core/lumbar stability, plyometrics, HIIT, sling), it augmented strength, jump height, sprint/agility, aerobic capacity, and task-relevant EMG. Autonomic markers (exercise HR, early HR recovery) showed time-dependent normalization without specific tDCS effects in single-session, randomized designs. In contrast, a season-long applied program that added prefrontal stimulation to standard recovery reported significantly reduced creatine kinase. Across studies, protocols and masking were athlete-friendly and rigorous (~2 mA for ~20 min; robust sham/blinding), with only mild, transient sensations reported and no serious adverse events. Conclusions: In soccer players, tDCS shows a qualified pattern of benefits that follows a specificity model: prefrontal stimulation can support post-match recovery status/well-being and decision efficiency, while M1-centered stimulation is most effective when coupled with structured training to bias neuromuscular adaptation. Effects are generally modest and heterogeneous; practitioners should treat tDCS as an adjunct, not a stand-alone enhancer, and align montage × task × timing while monitoring individual responses. Full article

Background/Objectives: People with Parkinson’s disease (PwPD) exhibit impairments in postural responses to perturbations, increasing their risk of falls. While transcranial direct current stimulation (tDCS) has been shown to enhance postural responses in PwPD, its effects considering history of falls remain unclear. Thus, we aimed to analyse the effect of tDCS on postural responses after external perturbation in PwPD with and without a history of falls. Methods: Twenty-two PwPD were distributed into two groups—faller (n = 12) and non-faller (n = 10)—based on their history of falls over the 12 months preceding the experiment. A 20 min anodal tDCS was applied to the primary motor cortex (M1) under two conditions (2 mA and sham), performed on two different visits (at least 2 weeks apart) with a randomised order. Seven trials with temporally unpredictable external perturbation (i.e., backward translation of the support base) were performed after tDCS. Electromyographic (i.e., medial gastrocnemius (MG) onset latency, magnitude of muscle activation of MG and tibialis anterior (TA), and MG/TA coactivation index) and centre of pressure (CoP) parameters (i.e., range of CoP, peak of CoP velocity, and recovery time) were analysed to assess postural response. A two-way ANOVA (Group × Stimulation Condition) was performed. Results: Both groups had shorter recovery time (determined by CoP) and MG onset latency in the active vs. sham condition. Conclusions: The results of our pilot study suggest that a single 20 min tDCS session (2 mA) applied over M1 enhances postural responses similarly in PwPD with and without a history of falls in the past year. Full article

Background: Transcranial Direct Current Stimulation (tDCS) has shown potential in improving negative symptoms (NS) and Cognitive Impairment Associated with Schizophrenia (CIAS). However, heterogeneity in stimulation protocols and sample characteristics limit definitive conclusions regarding tDCS effectiveness in schizophrenia. Given the detrimental effects of cigarette smoking, particularly on cognition, this study explored the role of cigarette smoking as a modifiable individual factor potentially contributing to methodological heterogeneity by evaluating tDCS effects on NS and CIAS in Smoker (SM) and Non-Smoker (NoSM) patients. Methods: Post hoc analyses of a double-blind RCT were performed on 50 patients, randomized to 2 mA active or sham-tDCS (15 weekday sessions) with bilateral bipolar-nonbalanced prefrontal placement. The sample was divided according to the smoking status, consisting of 28 SM and 22 NoSM. Separate one-way analyses of covariance (ANCOVA) were performed within each subgroup to assess changes over time between treatment conditions. Clinical outcomes included Positive and Negative Symptoms Scale (PANSS), Brief Assessment of Cognition in Schizophrenia (BACS), Clinical Global Impression (CGI) and Calgary Depression Scale for Schizophrenia (CDSS) total scores. Results: SM exhibited baseline lower cognitive scores in verbal memory, motor speed and working memory domains. NS improved in both SM and NoSM with large effect size. Significant improvement in CIAS, specifically in working memory and verbal fluency, were found exclusively in NoSM. Conclusions: Cigarette smoking appeared to limit tDCS effectiveness in improving CIAS but not NS in schizophrenia. We suggested that the neurotoxic milieu linked to chronic exposure to neurotoxins of cigarette smoking could be responsible for these effects, counterbalancing the neuroprotective effects of tDCS. Further studies are warranted to replicate these findings. Full article

Background/Objectives: This study examined the effects of a computerized naming intervention combined with either cerebellar anodal transcranial direct-current stimulation (A-tDCS) or sham (S-tDCS) on noun and verb naming in Cantonese-speaking persons with chronic stroke-related aphasia (PWA). Methods: A double-blind, randomized, crossover, sham-controlled clinical trial was conducted with six Cantonese-speaking PWA following stroke. Participants received a 60 min computerized naming intervention incorporating audio–visual speech perception cues over five consecutive days, paired with concurrent 20 min of either 2 mA cerebellar A-tDCS or S-tDCS. Generalized linear mixed-effects models (GLMM) and linear mixed-effects models (LME) were used to evaluate naming accuracy and reaction time (RT). Individual variability was further explored through single-case analyses of naming accuracy changes across conditions and grammatical categories. Results: The GLMM showed a significant three-way interaction of condition, grammatical category, and time (p < 0.05). Specifically, the intervention paired with S-tDCS significantly improved verb naming, whereas A-tDCS did not induce significant improvements at the group level, effectively showing significantly smaller gains regarding verb naming compared to S-tDCS. Overall, RT decreased post-treatment across groups, but no significant differences emerged by the tDCS condition. The results support the promising efficacy of the Cantonese computerized audio–visual noun and verb naming therapy. Single-case analyses revealed high inter-individual variability in response to neuromodulation effects on naming and behavioral treatment outcomes. Conclusions: This study contributes to the emerging literature on cerebellar neuromodulation in post-stroke aphasia and underscores the need for larger trials examining grammar-specific (particularly verb-related) effects and polarity-dependent outcomes. It also highlights the value of developing personalized neuromodulation protocols to optimize the efficacy of behavioral language interventions in people with aphasia. Full article

Background: Transcranial Direct Current Stimulation (tDCS) in conjunction with behavioural language therapy in PPA has previously been modified for variation at the group level, but not at the individual level. This pilot study used individualised tDCS targeting by identifying regions of peak atrophy in the language system. Methods: Six PPA participants (four semantic and two non-fluent variant) were randomly allocated to receive tDCS or sham stimulation. The target electrode was selected for each based on their region of peak atrophy. Participants received naming therapy, individually calibrated according to baseline naming performance. Three sets of therapy were delivered in conjunction with tDCS (1 mA) or sham stimulation within participants’ homes. The study was not powered to demonstrate efficacy but to show proof-of-concept for an individualised, home-based tDCS targeting method. Results: All participants successfully completed the protocol. In one participant the region of peak atrophy differed from that predicted by clinical syndrome. Significant gains were observed at an individual level for treated items in both groups (2/3 tDCS and 2/3 Sham). No significant changes in untreated items were observed at an individual level. Significant naming improvement in untreated items was not observed for the tDCS group and was seen at one time point only for the Sham group. Conclusions: We have demonstrated the feasibility of a novel method for selecting neurostimulation targets for PPA at the individual level. A larger study would be required to determine the long-term therapeutic efficacy of this method. Full article

Background/Objectives: Despite the high prevalence (around 4.1–37.2%) and highly debilitating adverse impact, there has been inconclusive evidence regarding the efficacy of treatment for tinnitus management, especially for those patients with tinnitus who do not have a specific or treatable origin. The aim of this updated network meta-analysis (NMA) was to estimate the efficacy and safety of the different non-invasive brain stimulation (NIBS) interventions in tinnitus management in patients with chronic tinnitus without a specific or treatable origin. Methods: This NMA included randomized controlled trials (RCTs) of NIBS interventions in patients with chronic tinnitus. The current NMA was conducted using the frequentist model. The primary outcome was a change in tinnitus severity after the NIBS intervention. Results: We identified 45 eligible RCTs with a total of 2042 participants. The results of the current NMA showed that both excitatory and inhibitory NIBS interventions exerted significant effects on tinnitus severity, quality of life, or response rate. While several protocols showed a signal, the top-ranked intervention was preliminary and derived from a single, small study. All the NIBS interventions had fair acceptability compared to the controls. Conclusions: This NMA highlighted that both excitatory and inhibitory NIBS interventions exerted significant effects on tinnitus severity, quality of life, and/or response rate. Future well-designed RCTs with electroencephalogram applications are needed for replication over the proclamation of efficacy. Full article

Background/Objectives: Falls are a major cause of injury in older adults, closely related to declines in muscle strength, balance control, and sensory integration. Although exercise-based fall prevention programs are well supported, evidence on combining such programs with cerebellar transcranial direct-current stimulation (c-tDCS) remains limited. This study investigated the effects of c-tDCS applied before a modified Otago Exercise Program (OEP) on lower-extremity strength, balance, and fall efficacy in older adults. Methods: In this randomized controlled study, twenty-six community-dwelling older adults (median age [IQR]: experimental, 74.00 [10] years; control, 71.00 [10] years) were randomly assigned to either a c-tDCS + exercise group (n = 13) or a sham + exercise group (n = 13). The intervention was administered twice weekly for four weeks. The experimental group received 15 min of c-tDCS followed by 30 min of OEP-based exercise; the control group received sham stimulation under identical conditions. The outcome measures included the Five Times Sit to Stand Test (FTSST), Timed Up and Go (TUG), Balancia-based static balance (velocity average), and Falls Efficacy Scale—Korea (FES-K). Assessments were performed pre- and post-intervention. Results: The experimental group demonstrated significantly greater improvements than the control group (p < 0.05) in the Five Times Sit to Stand Test (r = 0.44) and Timed Up and Go test (r = 0.56). No significant changes were observed in static balance or fall efficacy in either group (p > 0.05). Conclusions: The combined use of c-tDCS and an OEP-based fall prevention exercise program effectively improved lower-extremity strength and dynamic balance in older adults. However, short-term intervention did not influence static balance or fall efficacy. Further studies using longer intervention periods and larger samples are warranted to verify these findings and clarify the mechanisms underlying c-tDCS-enhanced motor performance. Full article