Transcranial Direct Current Stimulation (tDCS) is an emerging non-invasive brain stimulation technology that uses low electrical current to modulate brain activity. Over the past decade, tDCS has shown potential in enhancing motor recovery and cognitive rehabilitation, especially in neurological conditions like stroke, Parkinson’s disease, and traumatic brain injury. Despite its expanding use in global research and clinical settings, its adoption in Indian physiotherapy practice remains limited and underexplored. A recent study was conducted to investigate Indian physiotherapists’ awareness, attitudes, and use of tDCS in clinical practice.
The cross-sectional study surveyed 148 licensed physiotherapists from across India through an online questionnaire. Respondents included professionals from diverse specialties and work settings, including government hospitals, private clinics, teaching institutions, and rehabilitation centers. Most participants were aged around 30, with a majority holding bachelor's or master’s degrees in physiotherapy, while a smaller group held PhDs. Notably, 67% of the respondents specialized in neurorehabilitation, which is the primary area where tDCS is applied.
The survey results revealed that while many physiotherapists (about 57%) were familiar with tDCS in theory, only a small proportion (around 20%) had ever used it in their practice. On a 9-point knowledge scale, the average score was just 3.2, indicating a generally low level of understanding about tDCS mechanisms, contraindications, and clinical protocols. For instance, only a minority were aware that tDCS could not be used as a diagnostic tool or that it required careful patient selection due to risks in epilepsy or fainting disorders. Moreover, many were unaware of basic stimulation parameters such as the differences between anodal and cathodal stimulation, which are crucial for clinical efficacy.
Despite this knowledge gap, the overall attitude toward tDCS was largely positive. Nearly 68% of physiotherapists agreed that tDCS could improve motor outcomes in patients with neurological disorders. Many also expressed willingness to attend workshops or receive additional training in the technique. A significant number also advocated for its inclusion in formal physiotherapy education. However, concerns around device safety, lack of standardized training, and the absence of institutional support remain common.
The study also found that factors such as higher educational qualifications (particularly PhD holders) and international training experiences were associated with significantly better knowledge scores. Those who attended more workshops or had direct experience with neurological cases especially stroke patients were more likely to be aware of tDCS and open to using it. However, major barriers preventing clinical adoption included lack of access to devices (reported by 39% of respondents), insufficient training (44%), and regulatory or safety concerns (24%).
In conclusion, while tDCS holds significant promise in neurorehabilitation, its application in Indian physiotherapy remains at a nascent stage. Physiotherapists are open to integrating tDCS into their clinical toolkit but require structured education, hands-on workshops, and improved institutional support. As India modernizes its rehabilitation services through initiatives like Ayushman Bharat and the National Digital Health Mission, integrating innovative neuromodulation techniques like tDCS could dramatically improve patient outcomes provided the profession receives adequate support and training.
This study highlights the urgent need for curriculum reform, awareness campaigns, and practical training to bridge the knowledge-practice gap and unlock the full potential of tDCS in Indian physiotherapy.
More:
1. Transcranial Direct Current Stimulation (tDCS): Introduction, Working Principle, Indication, Contraindications, Benifits, FAQs.