Combining transcranial direct current stimulation and computerized cognitive training for post-stroke cognitive recovery: Study protocol for a randomized controlled trial with optimized temporal intervention sequences

This trial will systematically evaluate the optimal timing strategies for combining tDCS and CCT in PSCI. The hypothesized mechanisms are: (1) synchronous stimulation enhancing cognitive processing efficiency through immediate synaptic changes, (2) pre-training stimulation promoting plasticity via long-term potentiation-like modifications, and (3) post-training stimulation consolidating training effects by modulating neuronal synchrony. High-sensitivity cerebral oxygenation parameters will be used to assess microcirculatory improvements, linking physiological changes to cognitive recovery. However, ceiling effects and test biases will potentially limit the accuracy of long-term results, while sample size and lack of stratification based on brain lesion characteristics may introduce heterogeneity. Future studies will need to incorporate multimodal neuroimaging for stratified analysis and should develop personalized interventions based on lesion severity, disease stage, and timing to address therapeutic challenges and advance precision rehabilitation. Trial registration: ChiCTR2500102565.[Chinese Clinical Trial Registry (ChiCTR), https://www.chictr.org.cn/] [Registered on May 16, 2025].