Transcranial direct current stimulation (tDCS), a non-invasive brain modulation tool, has gained popularity due to the portability, ease-of-use, and low cost. A majority of stroke recovery studies using tDCS have been focused on the chronic stage of recovery, as this time frame is relatively easy to conduct clinical trials and measure efficacy. However, studies during the chronic stage likely miss a window of opportunity where dynamic brain plasticity is occurring, the acute and subacute stages after stroke. The recent article by Bornheim et al. [1] investigated the effects of tDCS applied during the first month post-stroke on functional recovery in a small, single-center, randomized, triple-blinded shamcontrolled trial. Fifty patients were randomized to receive anodal tDCS (intervention) or sham tDCS (control) for 20 minutes per day, 5 days per week over 4 weeks starting 48 hours post-stroke onset. After the morning stimulation session, all subjects received targeted rehabilitation therapy to address their deficits for a total of 2 hours per day, 5 days per week in the inpatient rehabilitation setting. Outcomes were assessed longitudinally and included measures for motor impairment (Upper and Lower Extremity section of Fugl Meyer Test [FM]), sensation (somatosensory section of the FM Test and Semmes Weinstein Monofilament Test [SWMT]), motor function (Wolf Motor Function Test [WMFT]), disability (Barthel Index [BI]), anxiety and depression (Hospital Anxiety and Depression Scale [HADS]), and quality of life (Stroke Impact Scale [SIS]). Per-protocol analysis showed statistically significant “time by treatment” effect in almost all the outcomes measures, proving that the seamless integration of tDCS into daily rehabilitation in the inpatient rehabilitation setting can lead to significant improvements in a number of key aspects of stroke recovery. Significant improvements were observed at pre to post intervention time points between the treatment groups in the assessments formotor impairment (FM), upper extremity function (WMFT), and anxiety and depression (HADS) but not in sensation, disability (BI) or quality of life (SIS). As motor impairment reduced and function improved, there appeared to be an associated improvement in depression status (HADS), which is consistent with the FLAME study [2]. The sustained benefits seen in this trial are likely attributable to the prolonged application of tDCS for 20 sessions with a total of 400 minutes of brain stimulation time starting as early as 48 hours post-stroke,which is substantially longer than the majority of tDCS studies except for one [3]. While the outcome measures assessing motor impairment are encouraging, functional independence measured by the BI and quality of life measuredby the SISprovideabetterestimateof clinicallymeaningful treatment effect. The authors cite a study by Lin et al. [4] to conclude

中文翻译：

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将 tDCS 整合到常规住院康复实践中以促进中风后康复

经颅直流电刺激 (tDCS) 是一种非侵入性大脑调制工具，因其便携性、易用性和低成本而广受欢迎。大多数使用 tDCS 的中风恢复研究都集中在恢复的慢性阶段，因为这个时间框架相对容易进行临床试验和衡量疗效。然而，慢性阶段的研究可能错过了发生动态大脑可塑性的机会之窗，即中风后的急性和亚急性阶段。Bornheim 等人最近的文章。[1] 在一项小型、单中心、随机、三盲假对照试验中研究了在中风后第一个月应用 tD​​CS 对功能恢复的影响。50 名患者随机接受阳极 tDCS（干预）或假 tDCS（对照），每天 20 分钟，从中风发作后 48 小时开始，每周 5 天，持续 4 周。在早上的刺激课程之后，所有受试者都接受了针对性的康复治疗，以解决他们在住院康复环境中每天总共 2 小时、每周 5 天的缺陷。纵向评估结果，包括运动障碍（Fugl Meyer 测试 [FM] 的上肢和下肢部分）、感觉（FM 测试的体感部分和 Semmes Weinstein 单丝测试 [SWMT]）、运动功能（Wolf 运动功能测试）的测量[WMFT])、残疾（Barthel 指数 [BI]）、焦虑和抑郁（医院焦虑和抑郁量表 [HADS]）和生活质量（中风影响量表 [SIS]）。符合方案的分析在几乎所有的结果测量中都显示出统计学上显着的“治疗时间”效应，证明将 tDCS 无缝集成到住院康复环境中的日常康复中可以显着改善中风康复的许多关键方面。在治疗组之间的干预前后时间点，在运动障碍 (FM)、上肢功能 (WMFT) 和焦虑和抑郁 (HADS) 的评估中观察到显着改善，但在感觉、残疾 (BI) 或质量生活（SIS）。随着运动障碍的减轻和功能的改善，抑郁状态 (HADS) 似乎有所改善，这与 FLAME 研究一致 [2]。在该试验中看到的持续益处可能归因于 tDCS 的长期应用 20 个疗程，总共 400 分钟的脑刺激时间早在中风后 48 小时就开始了，这比大多数 tDCS 研究要长得多，除了为一 [3]。虽然评估运动障碍的结果指标令人鼓舞，但由 BI 衡量的功能独立性和由 SIS 衡量的生活质量提供了对临床有意义的治疗效果的最佳估计。作者引用了 Lin 等人的一项研究。[4] 总结 BI 衡量的功能独立性和 SIS 衡量的生活质量提供了临床上有意义的治疗效果的最佳估计。作者引用了 Lin 等人的一项研究。[4] 总结 BI 衡量的功能独立性和 SIS 衡量的生活质量提供了临床上有意义的治疗效果的最佳估计。作者引用了 Lin 等人的一项研究。[4] 总结