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Transcranial direct current stimulation results for upper limb spasticity after stroke remain inconclusiveTrial data shows mixed results for stroke recovery treatments

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Key Takeaway
Note that evidence for tDCS in reducing upper limb spasticity after stroke is currently inconclusive due to heterogeneity.

This systematic review of randomized controlled trials evaluated the efficacy of transcranial direct current stimulation (tDCS), primarily anodal stimulation of the primary motor cortex, for managing upper limb spasticity in patients following a stroke. The review included 9 publications to assess clinical outcomes.

The authors reported that a clear beneficial effect on upper limb spasticity was observed in only 3 out of 9 studies. Due to significant heterogeneity in treatment parameters, including duration, current intensity, and the number of sessions, the overall evidence is currently considered inconclusive regarding the effectiveness of tDCS for this condition.

Clinical application is limited by a lack of standardized protocols and inconsistent results across trials. The authors note that the certainty of evidence is low because of these inconsistencies and varying treatment parameters. Clinicians should exercise caution when interpreting the utility of tDCS for spasticity management until more standardized data is available.

How this fits prior evidence

This systematic review addresses a gap in non-pharmacological interventions for stroke recovery, specifically regarding upper limb spasticity. While other modalities like BCI-mediated rehabilitation have been shown to improve motor function and MBI scores after stroke, the evidence for tDCS remains inconclusive due to heterogeneous treatment parameters.

Living with muscle stiffness, known as spasticity, after a stroke can make moving an arm or hand very difficult. Some experts have looked into using transcranial direct current stimulation (tDCS). This is a method that uses a mild electrical current to target the brain's motor cortex to help improve movement.

Researchers reviewed nine different studies to see if this treatment actually helps patients with upper limb spasticity. The results were not consistent across the board. While three of the nine studies showed a clear benefit for patients, the other six did not show a clear improvement or had inconsistent results.

Because each study used different settings, such as different current strengths and session lengths, it is hard to say if the treatment works reliably. The evidence is currently considered inconclusive. Because of these inconsistencies, doctors do not yet have a standard way to use this method for stroke recovery.

What this means for you:
Current evidence is inconclusive on whether electrical brain stimulation helps reduce muscle stiffness after stroke.

Common questions

What is transcranial direct current stimulation?

Transcranial direct current stimulation (tDCS) is a method that uses a mild electrical current to target the primary motor cortex. This part of the brain controls movement. It is being studied as a way to help patients who experience muscle stiffness, or spasticity, in their arms after having a stroke.

Does this treatment work for everyone after a stroke?

The evidence is not clear yet. Out of nine studies reviewed, only three showed a clear benefit for upper limb spasticity. Because the study results were inconsistent and used different settings like different current intensities, it is currently considered inconclusive whether this treatment works reliably.

Why are the results not more consistent?

The results are hard to judge because the studies were very different from one another. They used different durations, different amounts of electricity, and different numbers of sessions. Because there is no standard protocol yet, it is difficult to say exactly how effective the treatment is for stroke patients.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedAug 2026
View Original Abstract ↓
IntroductionSpasticity is a common motor disorder that develops after stroke, negatively impacting motor control and functional capacity. Non-pharmacological methods, including transcranial direct current stimulation (tDCS), are increasingly used in its treatment; however, the optimal stimulation protocol remains unclear. Therefore, the aim of this study was to conduct a systematic review of the literature regarding the efficacy of tDCS in treating upper limb spasticity in post-stroke patients.MethodsA systematic review of randomized controlled trials was conducted in accordance with the PRISMA guidelines. PubMed, Scopus, PEDro, Cochrane CENTRAL, ScienceDirect, Web of Science, and Google Scholar were searched using the following keywords and their combinations: transcranial direct current stimulation, stroke, muscle spasticity and upper limb. The eligibility criteria were defined according to the PICOTS framework. The risk of bias in the included studies was assessed using the Cochrane Risk of Bias 2 tool. The review was registered in PROSPERO (CRD420261363944).ResultsOf the 2,797 records identified, nine publications met the eligibility criteria and were included in the analysis. These studies differed in terms of participant characteristics. In most cases, the intervention involved anodal stimulation of the primary motor cortex; however, the treatment parameters, including stimulation duration, current intensity, and number of sessions, were heterogeneous. A clear beneficial effect of tDCS on upper limb spasticity in patients after stroke was observed in three articles.DiscussionThe available evidence regarding the effectiveness of tDCS in reducing upper limb spasticity after stroke remains inconclusive. Further high-quality studies using standardized research protocols are required.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420261363944, PROSPERO; registration number CRD420261363944.
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