Effect of Transcranial Direct Current Stimulation on Motor Recovery in Altered Conscious Patients after Traumatic Brain Injury and Cerebrovascular Accident: A Randomized Clinical Trial

Abstract Background and Purpose  Altered levels of consciousness resulting from a vascular insult to the brain can vary from confusion to coma. A disruption in the function of the brain stem reticular activating system in the brain stem or both cerebral hemispheres and thalami causes coma. This study is aimed at finding the effect of transcranial direct current stimulation (tDCS) on motor recovery in altered conscious patients after traumatic brain injury and cerebrovascular accident. Materials and Methods  A total of 100 patients admitted to the neurology and neurosurgery unit of the university hospital were screened and 40 subjects who satisfied inclusion criteria were recruited and randomly divided into two groups, group A (experimental) ( n  = 20) and group B (control)(n = 20), by computerized randomization. Written informed consent was taken from all the caregivers before recruitment. After taking the preliminary assessment, anodal tDCS is given to the motor area (C3/C4 ipsilesional), sensory area (P3/P4 ipsilesional), and left dorsolateral prefrontal cortex (F3) according to the 10/20 electroencephalogram montage for two sessions of 20 min/day for 7 consecutive days. Routine physiotherapy was also given the same as group B. Results  At baseline, there were no significant group differences in the baseline characteristics. The groups passed the normality test. The results were tested for statistical significance between the groups by Mann–Whitney U test and by one-way analysis of variance and Tukey Honest Significant Difference for post-hoc comparison; the results were statistically different with p -value less than 0.05 with a large effect size. Conclusion  We conclude, based on the results of this study, that tDCS can be effective in motor recovery in altered consciousness patients. It is noninvasive, cost-effective with minimal contraindications, and does not interfere with other modalities in the intensive care unit. Hence, it can be administered safely under the supervision of a qualified therapist.