The Role of Telehealth to Assist In-Home tDCS: Opportunities, Promising Results and Acceptability

Abstract

Transcranial direct current stimulation (tDCS) has shown great promise as a neuromodulatory intervention capable of improving behavioral outcomes in a range of neurological and psychiatric populations. Evidence indicates that the neuromodulatory effect of stimulation may be cumulative, with greater improvements in behavior observed following multiple treatment sessions. However, the requirement to attend clinical or research departments for multiple treatment sessions may present a barrier for many people, particularly those with greater disability or living remotely. The portability of tDCS suggests that in-home stimulation may become an avenue for further investigation. However, safe and effective use of tDCS by a participant within their home requires a form of monitoring. This review discusses how telehealth may provide real-time visual monitoring to ensure correct tDCS set-up and adherence to stimulation protocols, manage technical issues and monitor adverse events. The combination of telehealth to supplement in-home tDCS use has potential to transform the way tDCS is delivered.

A randomized controlled pilot trial of a smoking cessation intervention for US women living with HIV: telephone-based video call vs voice call

“…Telemedicine, including counseling, has grown rapidly for various health conditions that include depression, cancer, and diabetes, and also provides genetic counseling. 26 – 30 Clinicians are generally satisfied with the telemedicine experience and there seems to be no difference in treatment outcomes between telemedicine and an office visit. 31 – 34 Until a few years ago, telemedicine had been delivered with sophisticated teleconferencing equipment.…”

Ambient Intelligence Environment for Home Cognitive Telerehabilitation

“…A fundamental factor of rehabilitation technology research is knowing how therapists or end users react to new technology proposals [ 43 , 44 ]. It is important that the design and development of telerehabilitation systems consider user-centered approaches [ 45 ], especially to find out if the proposed system fits the needs and preferences of the end user, as well as the context in which it can be implemented [ 9 , 46 ].…”

Strategies to implement and monitor in-home transcranial electrical stimulation in neurological and psychiatric patient populations: a systematic review

“…This would require participants to attend frequent treatment sessions applied over a number of days, months or years. Given that many participants who are likely to benefit from stimulation are those with higher levels of motor or cognitive impairment, the requirement to travel regularly for treatment may present a barrier, limiting potential clinical utility or ability to recruit suitable research participants [25]. In addition, regular daily treatments would also hinder those who travel from remote destinations to receive this potentially beneficial neuromodulation.…”

“…This opportunity may allow for stimulation to be delivered in a participant’s home, which could represent the mode of delivery for future clinical applications. However, it may be unreasonable to expect that a participant would be capable of managing delivery of tES alone and would likely require some form of training and/or monitoring [25]. Although tES is considered relatively safe [26], stimulation should be delivered within established guidelines to avoid adverse events [27].…”

“…Inappropriate delivery of stimulation could result in neural damage, detrimental behavioural effects, irritation, burns or lesions of the skin [28–33]. Therefore, in order to deliver stimulation safely to the appropriate cortical region, it is likely that in-home stimulation may require some form of monitoring [25].…”