Advances in Transcranial Direct Current Stimulation for Poststroke Balance Recovery: Current Evidence, State-of-the-Art Mapping, and Future Directions

Balance impairments are frequent after stroke, increasing fall risk and reducing quality of life. Transcranial direct current stimulation (tDCS) is a widely investigated noninvasive neuromodulatory technique; however, its effectiveness for balance improvement and motor recovery remains under debate.

This mapping review aimed to synthesize the current literature on tDCS for poststroke balance, addressing two key questions: 1) Which stimulation protocols are most frequently applied? and (2) which physical therapy approaches are commonly combined with tDCS?

A systematic search was conducted across major data bases from inception to December 2025 using tailored keywords. References were managed in EndNote (Web), and data were extracted with a standardized form. VOSviewer was used for keyword cooccurrence and citation network analyses.

Six studies met the inclusion criteria. The Cz region emerged as the most frequently reported target site, with anodal stimulation intensities ranging between 1 and 2 mA across studies. Protocols ranged from single-session interventions to four-week programs. In two studies, tDCS was combined with treadmill gait training. Keyword mapping revealed five main clusters, highlighting links among stroke, tDCS, physical therapy, and neuroplasticity. The most recurrent terms referred to participant characteristics, intervention strategies, and functional recovery outcomes.

Current literature suggests that tDCS may enhance poststroke balance. Systematic reviews most often highlight Cz placement with intensities around 1 to 2 mA, whereas individual trials report heterogeneous protocols. Further high-quality trials are warranted to establish standardized protocols and optimize clinical translation.

The registration number for the study is CRD420251177329.