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Neurological Rehabilitation

Session: Feasibility of transcranial direct current stimulation as adjuvant to neurorehabilitation. Preliminary results from an outpatient clinical program

Feasibility of Transcranial Direct Current Stimulation as Adjuvant to Neurorehabilitation. Preliminary Results from an Outpatient Clinical Program

Saturday, October 25, 2025

8:00 AM - 9:15 AM MT

Location: Original Research Theater

Primary Author(s)

Alejandra Cardenas Rojas, MD

PM&R Resident PGY3
Johns Hopkins University PM&R Program
Baltimore, Maryland

Co-Author(s)

RN

Robert W. Nickl, PhD

Research Associate
Johns Hopkins School of Medicine
Baltimore, Maryland
Meredith Drake, PT, DPT (she/her/hers)

Neurologic Physical Therapist
Johns Hopkins Hospital
Baltimore, Maryland
JH

Jaelah Hurt, Other

NIBS Rehabilitation Technician
Johns Hopkins Hospital
Baltimore, Maryland
Aara Chandrashekaran, MS, CCC-SLP

Speech Language Pathologist
Johns Hopkins Medicine
Monmouth Junction, New Jersey
DK

Daniel Krasna, MD

Assistant Professor
Johns Hopkins
Baltimore, Maryland
RS

Rajani Sebastian, PhD

Associate Professor
Johns Hopkins University
Baltimore, Maryland
NC

Ning Cao, MD

Medical Director
Johns Hopkins University School of Medicine
Baltimore, Maryland

Disclosure(s):

Alejandra Cardenas Rojas, MD: No financial relationships to disclose

Meredith Drake, PT, DPT: No financial relationships to disclose

Aara Chandrashekaran, MS, CCC-SLP: No financial relationships to disclose

Daniel Krasna, MD: No financial relationships to disclose

Rajani Sebastian, PhD: No financial relationships to disclose

Background and/or Objectives: Non-invasive brain stimulation (NIBS), including transcranial direct-current stimulation (tDCS), has shown moderate evidence of efficacy (level B) for motor rehabilitation in patients with stroke, with most studies occurring in laboratory settings. This study examines feasibility of administering tDCS as an adjuvant to physical therapy (PT) in the clinical setting.

Design: Observational, open-label study of stroke patients enrolled in the NIBS Clinical Program

Setting : Outpatient clinical setting

Participants : Twenty-six participants with chronic stroke have received tDCS as an adjuvant to PT in the NIBS Program since 2018 (average age 55 years (SD 15), 15 females, 21 White/Caucasian). Inclusion criteria were impaired mobility and ability to engage in therapy (5 times/week).

Interventions: Patients received 15 tDCS sessions combined with high-intensity evidence-based PT focused on gait and balance training (5 times/week). Sessions were approximately 60 minutes (tDCS for first 20-25 minutes, intensity 2mA). Seventeen participants (65%) received anodal stimulation to the primary motor cortex and 9 to the cerebellum (35%). Thirteen patients had an ipsilateral M1 montage (76%). Orbitofrontal cortex was the most common cathode placement (62%), followed by T12 of spine.

Main Outcome Measures: AM-PAC Mobility Outpatient Short Form, 5 Times Sit-to-stand (5TSTS), 10 Meter and 2 Minute Walk Test, and Berg Balance Scale before and after the program.

Results: Patients showed significant improvements in self-reported AMPAC mobility raw and standardized scores with mean changes of 4.8 and 3.6 respectively (p=0.001), improvement of 2 minute-walk test (delta = 36.75 ft, p=0.0002) and balance by 5.32 points (p < 0.0001). Significant time reductions in the 5TSTS (delta = -10.475s; p=0.01) and improvement of 10 meter walk test (m/s) (delta =0.06, p=0.01).

Conclusions: These preliminary data suggest that it is feasible to implement tDCS, a low-cost, non-invasive, and non-painful technique, in a clinical neurorehabiliation program. In addition, tDCS coupled with high-intensity therapy has the potential to improve gait, balance, and patient-reported outcomes.