Effects of Non-Invasive Electrical Stimulation, Transcranial Direct Current Stimulation, and Physical Exercises in Stroke Patients – Systematic review

Background: Stroke ranked third in terms related to mortality and impairment worldwide and second common reason of death (11.6%).It greatly affects people quality of life and mobility.For faster recovery different rehabilitation approaches used like Transcranial Direct Current Stimulation (tDCS) device, a small intensity of electrical current is produced that can stimulate specific areas of the brain which are affected due to stroke.The tDCS device can be effective in improving motor skills and aiding in the recovery process after a stroke.Physical exercise is also crucial for stroke rehabilitation.But when we used these approaches together in rehabilitation of stroke patients it enhance recovery effectively.Objective: The objective of this systematic review is to evaluate the effects of non-invasive transcranial direct current stimulation (tDCS) and physical exercises on the rehabilitation outcomes of stroke patients.Methodology: This systematic review followed the guidelines of PRISMA.Used several online search engine known as PubMed, Cochrane Library, Google scholar to search eligible data availability.PICO framework used as screening criteria tool.Data relevant to study was extracted using self-developed data table based on previous literature.The Studies on stroke patients from subacute to chronic conditions with age limit 20 to 80 years, using tDCS device as an intervention and physical exercises were included in this review.Studies before 2019, Grey or unreported, not using tDCS device and non-English studies were excluded.Studies on stroke used tDCS and physical exercises were included in this review.Studies which conducted before the year 2019 and Non-English studies were excluded.Results: In this systematic review 35 studies were included with 1242 subjects after fulfill the requirements.In which 30 studies revealed significant improvement in stroke patients used noninvasive electrical stimulation tDCS and physical exercises with p value <0.05 but only 5 studies showed no significant improvement after using tDCS.Conclusion: This systematic review suggests that non-invasive electrical stimulation tDCS and physical exercises are effective for stroke patients.However in comparison to physical exercise alone, tDCS and Physical exercises showed more improvement.