Transcranial direct current stimulation: a place in the future of physiotherapy?

Background: Cortical plasticity underlies the brain's ability to compensate and adapt after neurological and musculoskeletal injury. However, increasing evidence demonstrates that plasticity can also be maladaptive, contributing to functional impairment in a variety of conditions. Transcranial direct current stimulation (tDCS) is an emerging brain stimulation technique with the potential to alter cortical plasticity and prime the brain to enhance learning. If the potential of this technique can be harnessed, tDCS may provide a novel therapeutic approach in physiotherapy practice. Objectives: This review aims to provide an overview of the mechanisms, stimulation parameters and clinical applications of tDCS. Major findings: tDCS is an emerging and novel technique. Evidence at this early stage is promising with reductions in pain scores and improvements in motor function noted across a range of conditions. However, further research is needed before clinical efficacy and safety can be determined. Conclusions: tDCS is a powerful, non-invasive brain stimulation technique with the potential to improve outcomes in neurological and musculoskeletal conditions. Further research is needed using large sample sizes, long-term follow-up and a range of patient populations before the technique is available for clinical use. However, tDCS may be useful as a standalone therapy or as an adjunct to other physiotherapy treatments in the future.