Transcranial Direct Current Stimulation (tDCS) at PYONG Rehabilitation Penthouse

tDCS (Transcranial Direct Current Stimulation) is a technology that delivers a weak, direct electrical current through electrodes placed on the scalp to “stimulate/modulate” brain activity. The purpose is to adjust the neuronal environment so the brain can “learn more easily.” It is therefore often used in conjunction with physical therapy, cognitive training, language practice, or other rehabilitation programs. It is suitable for those seeking to enhance recovery post-stroke, individuals with mood and sleep problems, or those with certain types of neuropathic pain.

At PYONG Rehabilitation Penthouse (Floor 11, Gaysorn Tower, near BTS Chidlom), every step of the treatment is supervised by a rehabilitation medicine physician along with a multidisciplinary team, and integrated into a personalized rehabilitation plan based on individual goals.

What is tDCS

tDCS is an electrical stimulation technology for brain disorders (Neuromodulation), using a constant current of 1–2 milliamps through electrodes placed on the head. Its key features are its high safety profile and minimal side effects, such as itching, skin irritation beneath the electrodes, or minor neurological symptoms. After tDCS, individuals can resume normal daily life.

The action of tDCS does not “force” brain function immediately, but adjusts the threshold for neuronal firing so that the brain responds better to training and rehabilitation. It is therefore commonly used as a “rehabilitative adjunct” alongside physical therapy, speech rehabilitation, cognitive and memory training, or psychological and sleep programs. tDCS differs from TMS (Transcranial Magnetic Stimulation), which uses a strong magnetic field — PYONG Rehabilitation uses both technologies as appropriate for each brain condition, with the physician assessing, selecting the stimulation site, and overseeing safety throughout the process.

tDCS is safe when used according to standard protocols and with attention to individual contraindications. (PMC (opens in a new tab))

Why tDCS should be done at PYONG Rehabilitation

• The tDCS device chosen by PYONG Rehabilitation is a model built to international standards and approved in the European Union. It comes with an application that helps track and record results, and offers 2–16 electrode channels (compared with a typical tDCS device's 2 channels), maximising precision in rehabilitation. It has also received the Translation Research Award.
• A rehabilitation medicine physician together with physiotherapists supervises every step, from assessment and electrode placement to treatment planning and follow-up.
• An integrated personalised plan pairing tDCS with physical therapy, occupational therapy, language and cognitive training, and targeted psychological or sleep programs.
• Comprehensive technology: when the physician judges it appropriate, tDCS can be used together with TMS or other techniques according to the patient's goals.
• A convenient location in central Bangkok at PYONG Rehabilitation Penthouse – Floor 11, Gaysorn Tower (BTS Chidlom), with an environment suited to continuous training.
• Clear safety standards and communication: expectations are assessed and explained fairly, with no overstated claims.

How tDCS works

The principle is the modulation of the electrical potential of the neuronal membrane in the area where the electrodes are placed. There are two types of modulation:

• Anodal tDCS helps make neurons “more likely to fire”.
• Cathodal tDCS helps “slightly reduce the likelihood of firing” of neurons.
  The overall effect is to facilitate brain plasticity (neuroplasticity) while we practise a skill or undergo physical therapy, so that the brain learns more efficiently.

Step-by-step:

1. History taking, physical and neurological examination, and setting rehabilitation goals with the physician
2. Placing the electrodes according to the target (for example, the motor cortex or the prefrontal area)
3. Setting the current (generally 1–2 milliamps) and the time (20–30 minutes per session)
4. During stimulation, what may be felt is warmth, tingling, or slight itching beneath the electrodes
5. Performing tDCS together with training (gait, hand and arm, language, cognition, or mood and sleep programs)
6. Assessing results every week and adjusting the site and parameters according to the progress of training

The general guideline for parameters (1–2 milliamps, 20–30 minutes per session, several times a week) is widely used in clinical studies. (PMC (opens in a new tab), Frontiers (opens in a new tab))

Symptoms and conditions suited to tDCS

• Motor rehabilitation after stroke (arm, hand, gait)
• Speech and language problems, or thinking and memory problems after a cerebrovascular disease
• Mood disorders such as depression or anxiety (as an adjunct to the main treatment)
• Chronic pain of neurological origin (for example chronic back pain, certain kinds of migraine)
• Insomnia or poor sleep quality
• Treatment-resistant epilepsy (in some cases, under specialist supervision)
• Long COVID with fatigue or reduced concentration (screened individually)
• Certain learning and attention difficulties in adults (assessed case by case)
• Muscle spasticity or weakness from neurological disease (as an adjunct to training)
• After brain or spinal cord injury (the site and the risk must be assessed closely)

Academic evidence on tDCS

• After stroke: many studies and updated reviews indicate that tDCS may help increase motor recovery, particularly when used together with physical or robotic rehabilitation and programs aimed at systematic repeated practice. Although results vary between studies, the overall direction of the research supports the role of tDCS as a safe “adjunctive tool”. (PMC (opens in a new tab), Lippincott Journals (opens in a new tab), PubMed (opens in a new tab))
• Mood and mental health: recent meta-analyses report that tDCS has a degree of positive effect on depression, typically applied to the prefrontal area, and should sit within a comprehensive treatment plan rather than replacing standard therapy entirely. (PMC (opens in a new tab), ScienceDirect (opens in a new tab))
• Chronic pain: pooled review-level evidence indicates that tDCS may reduce pain in the short term in some groups, such as chronic headache. The effect depends on the stimulation site, the frequency, and the type of pain. (PubMed (opens in a new tab), Brieflands (opens in a new tab))

In summary: tDCS has the potential to be an adjunctive device that increases the effectiveness of a rehabilitation program, rather than being used on its own, and its use should be adapted to the clinical context of each person receiving treatment.

How often should tDCS be done

The general practice in research is 3–5 times a week for 2–4 consecutive weeks (approximately 10–20 sessions), but the actual number depends on the goal, the condition, and the response of each individual. In patients with cerebrovascular disease we usually pair tDCS with an intensive rehabilitation program (for example hand training, gait training, or language training), to take advantage of the brain's learning. Some individuals may benefit from combining it with a full rehabilitation course. All of this is planned by a rehabilitation medicine physician, with weekly assessment so that the approach can be adjusted to suit as well as possible. (PMC (opens in a new tab))

When should results be expected

• Short term (first session – first week): a number of clients report feeling relaxed, slightly better concentration, or being able to practise a skill more “smoothly” during the training session. The common side effects are itching or tingling beneath the electrodes or a slight headache, which usually resolve on their own within a few hours.
• Long term (4–6 weeks and beyond): with continuous use alongside a suitable training program, some patients may see concrete development in movement, language, mood, sleep, or the level of pain. However, results differ between individuals and depend on the cause, the severity, co-morbidities, and the consistency of training and continued care. (PMC (opens in a new tab), ScienceDirect (opens in a new tab))

Contraindications and precautions for the procedure

tDCS is a treatment tool that is safe when carried out to standard by specialists. The adverse effects most commonly found are itching or tingling, skin irritation, redness beneath the electrodes, drowsiness, or a slight headache, which are usually only temporary.

Contraindications, and situations to avoid or approach with particular caution, include:

• Implanted electrical devices in the skull or inner ear (such as a cochlear implant or a deep brain stimulator), or metallic material in the skull near the stimulation site
• Wounds or inflammation of the skin where the electrodes are attached
• Uncontrolled seizures or epilepsy (considered case by case by a specialist physician)
• Pregnancy (safety data are limited — considered only where necessary)
• Children and adolescents should be under a specific protocol and careful consent
  Before every session, the physician takes a history, examines the patient, and screens for risk, for maximum safety. (PMC (opens in a new tab), ScienceDirect (opens in a new tab))

The cost

The fee for tDCS is approximately 5,000–7,000 baht per session (THB), with the price varying according to the package, the length of the program, and the pairing with other rehabilitation. For those entering an intensive rehabilitation program, tDCS sessions may already be included in the plan. Choosing the suitable plan of treatment requires an assessment by a physician first, in order to set the number of sessions and the goals of treatment that suit.

Frequently asked questions (FAQ)

1) How is tDCS different from TMS?

tDCS uses a weak direct current through the skin to “modulate the excitability” of neurons, while TMS uses a strong magnetic field to induce an electrical potential in the brain directly. The choice depends on the goal and the safety limitations of each individual.

2) What will I feel during the procedure?

Most people feel warmth, itching, or tingling beneath the electrodes at first, which fades within a few minutes. There is no need to fast, and normal activities can be resumed afterwards.

3) How many sessions are needed to see results?

Generally 10–20 sessions within 2–4 weeks, with the physician adjusting according to the response and the rehabilitation goals. Results differ between individuals.

4) Who should avoid tDCS?

Those with implanted electrical devices in the skull or inner ear, metal in the skull near the stimulation site, skin inflammation at the electrode site, or uncontrolled seizures (individual assessment required).

5) Can tDCS be used on its own?

On current evidence, tDCS is best suited as a “rehabilitative adjunct” alongside training or the main treatment, so as to gain the greatest benefit for the brain's learning.

Choosing a place to treat pain and conditions of the brain from a clinic cared for by a team of specialist physicians with expertise, such as PYONG Rehabilitation Clinic and PYONG Rehabilitation Penthouse, helps the patient receive effective and safe care, with modern technology, so that the patient has the chance to recover and return to a better quality of life quickly. Anyone interested can make enquiries at