Combined Transcranial Direct Current Stimulation and Functional Electrical Stimulation for Upper Limbs in Individuals with Stroke: A Systematic Review
Background: Transcranial direct current stimulation (tDCS) and functional electrical stimulation (FES) are established interventions to enhance upper limb motor function (ULMF) in people with stroke (PwS). However, evidence supporting their combined use remains limited and inconsistent. This systema...
Saved in:
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2025-06-01
|
| Series: | Neurology International |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2035-8377/17/6/89 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849705920491159552 |
|---|---|
| author | Alfredo Lerín-Calvo Juan José Fernández-Pérez Raúl Ferrer-Peña Aitor Martín-Odriozola |
| author_facet | Alfredo Lerín-Calvo Juan José Fernández-Pérez Raúl Ferrer-Peña Aitor Martín-Odriozola |
| author_sort | Alfredo Lerín-Calvo |
| collection | DOAJ |
| description | Background: Transcranial direct current stimulation (tDCS) and functional electrical stimulation (FES) are established interventions to enhance upper limb motor function (ULMF) in people with stroke (PwS). However, evidence supporting their combined use remains limited and inconsistent. This systematic review aims to evaluate the effectiveness of combined tDCS and FES for improving ULMF, activity, and participation in PwS. Methods: A systematic search was conducted across MEDLINE, CINAHL, SPORTDiscus, CENTRAL, SCOPUS, and Web of Science from inception to December 2024. Randomized and controlled clinical trials (RCTs) involving adults (≥18 years) with acute, subacute, or chronic stroke undergoing combined tDCS and FES interventions were included. Methodological quality was assessed with the PEDro scale, and risk of bias was evaluated using the Cochrane RoB2 tool. A qualitative synthesis was performed employing a five-level evidence grading system. Results: Five RCTs involving 148 participants (mean age range: 50.6–61.2 years; 26% female) were included. Stroke chronicity ranged from 7.6 days to 27.5 months post-onset. Four studies reported significant ULMF improvements with the combined intervention. However, activity and participation outcomes were inconsistently assessed, and results remained inconclusive. Methodological quality varied, with one study rated as excellent, two as good, one as fair, and one as poor. The risk of bias was rated high or with concerns in four out of five studies. Conclusions: Based on qualitative synthesis, moderate-level evidence supports the combined use of tDCS and FES for improving ULMF in PwS. However, high variability in protocols, small sample sizes, and the increased risk of bias in most studies limit the strength of these conclusions. Standardized protocols and larger high-quality RCTs are needed to confirm the effectiveness of this combined intervention. |
| format | Article |
| id | doaj-art-a06c210bdeb24cc9b538c262fa001491 |
| institution | DOAJ |
| issn | 2035-8377 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Neurology International |
| spelling | doaj-art-a06c210bdeb24cc9b538c262fa0014912025-08-20T03:16:21ZengMDPI AGNeurology International2035-83772025-06-011768910.3390/neurolint17060089Combined Transcranial Direct Current Stimulation and Functional Electrical Stimulation for Upper Limbs in Individuals with Stroke: A Systematic ReviewAlfredo Lerín-Calvo0Juan José Fernández-Pérez1Raúl Ferrer-Peña2Aitor Martín-Odriozola3Grupo de Investigación en Neurociencias Aplicadas a la Rehabilitación (GINARE), 28923 Alcorcón, SpainGrupo de Investigación en Neurociencias Aplicadas a la Rehabilitación (GINARE), 28923 Alcorcón, SpainDepartamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, 28023 Madrid, SpainFesia Technology, 20009 Donostia-San Sebastián, SpainBackground: Transcranial direct current stimulation (tDCS) and functional electrical stimulation (FES) are established interventions to enhance upper limb motor function (ULMF) in people with stroke (PwS). However, evidence supporting their combined use remains limited and inconsistent. This systematic review aims to evaluate the effectiveness of combined tDCS and FES for improving ULMF, activity, and participation in PwS. Methods: A systematic search was conducted across MEDLINE, CINAHL, SPORTDiscus, CENTRAL, SCOPUS, and Web of Science from inception to December 2024. Randomized and controlled clinical trials (RCTs) involving adults (≥18 years) with acute, subacute, or chronic stroke undergoing combined tDCS and FES interventions were included. Methodological quality was assessed with the PEDro scale, and risk of bias was evaluated using the Cochrane RoB2 tool. A qualitative synthesis was performed employing a five-level evidence grading system. Results: Five RCTs involving 148 participants (mean age range: 50.6–61.2 years; 26% female) were included. Stroke chronicity ranged from 7.6 days to 27.5 months post-onset. Four studies reported significant ULMF improvements with the combined intervention. However, activity and participation outcomes were inconsistently assessed, and results remained inconclusive. Methodological quality varied, with one study rated as excellent, two as good, one as fair, and one as poor. The risk of bias was rated high or with concerns in four out of five studies. Conclusions: Based on qualitative synthesis, moderate-level evidence supports the combined use of tDCS and FES for improving ULMF in PwS. However, high variability in protocols, small sample sizes, and the increased risk of bias in most studies limit the strength of these conclusions. Standardized protocols and larger high-quality RCTs are needed to confirm the effectiveness of this combined intervention.https://www.mdpi.com/2035-8377/17/6/89tDCSfunctional electrical stimulationstrokeneuromodulationneurorehabilitationmotor recovery |
| spellingShingle | Alfredo Lerín-Calvo Juan José Fernández-Pérez Raúl Ferrer-Peña Aitor Martín-Odriozola Combined Transcranial Direct Current Stimulation and Functional Electrical Stimulation for Upper Limbs in Individuals with Stroke: A Systematic Review Neurology International tDCS functional electrical stimulation stroke neuromodulation neurorehabilitation motor recovery |
| title | Combined Transcranial Direct Current Stimulation and Functional Electrical Stimulation for Upper Limbs in Individuals with Stroke: A Systematic Review |
| title_full | Combined Transcranial Direct Current Stimulation and Functional Electrical Stimulation for Upper Limbs in Individuals with Stroke: A Systematic Review |
| title_fullStr | Combined Transcranial Direct Current Stimulation and Functional Electrical Stimulation for Upper Limbs in Individuals with Stroke: A Systematic Review |
| title_full_unstemmed | Combined Transcranial Direct Current Stimulation and Functional Electrical Stimulation for Upper Limbs in Individuals with Stroke: A Systematic Review |
| title_short | Combined Transcranial Direct Current Stimulation and Functional Electrical Stimulation for Upper Limbs in Individuals with Stroke: A Systematic Review |
| title_sort | combined transcranial direct current stimulation and functional electrical stimulation for upper limbs in individuals with stroke a systematic review |
| topic | tDCS functional electrical stimulation stroke neuromodulation neurorehabilitation motor recovery |
| url | https://www.mdpi.com/2035-8377/17/6/89 |
| work_keys_str_mv | AT alfredolerincalvo combinedtranscranialdirectcurrentstimulationandfunctionalelectricalstimulationforupperlimbsinindividualswithstrokeasystematicreview AT juanjosefernandezperez combinedtranscranialdirectcurrentstimulationandfunctionalelectricalstimulationforupperlimbsinindividualswithstrokeasystematicreview AT raulferrerpena combinedtranscranialdirectcurrentstimulationandfunctionalelectricalstimulationforupperlimbsinindividualswithstrokeasystematicreview AT aitormartinodriozola combinedtranscranialdirectcurrentstimulationandfunctionalelectricalstimulationforupperlimbsinindividualswithstrokeasystematicreview |