Transcranial Direct Current Stimulation to Augment Motor Imagery Training: A Systematic Review

Motor imagery training (MIT) is a widely used technique for motor learning and recovery. To optimize training outcomes, researchers have explored the integration of MIT with complementary approaches. One such approach is transcranial direct current stimulation (tDCS), which also shows promise as a method to enhance motor performance and neuroplasticity. This systematic review aimed to synthesize the current evidence on the synergistic effects of MIT combined with tDCS, with a specific focus on behavioral outcomes. Heterogeneous methods across 16 studies with 432 participants in total, including both healthy and clinical populations, yielded mixed results. Nonetheless, the potential of anodal tDCS applied over the primary motor cortex to augment the beneficial effects of MIT for motor performance in healthy participants is suggested by the current literature. The benefits of combining tDCS with MIT in brain-computer interface (BCI) protocols with stroke patients were less clear, which may relate to population differences, timing of stimulation, or the similarity between outcome measures and trained tasks. Overall, small samples and heterogeneous methods limit interpretation of the findings of combined intervention studies, and further research should aim to measure both behavioral and neurophysiological outcomes in larger samples as well as examining longer-term synergistic effects.