Comparing the effect of virtual reality and transcranial direct current stimulation on fear of falling, balance, and walking ability in stroke: A randomized controlled trial protocol

Abstract

Fear of falling is a prevalent and disabling problem after stroke, contributing to reduced activity, impaired balance, and increased fall risk. Recent studies indicate that virtual reality (VR)–based interventions and transcranial direct current stimulation (tDCS) applied during exercise therapy may help reduce fear of falling in individuals with neurological disorders. This single‑center, assessor‑blinded randomized controlled trial aims to compare the effects of VR‑based gait training with tDCS combined with gait training on fear of falling in patients with subacute stroke. Participants will be randomly allocated to either the VR or tDCS group, while all also receive conventional physiotherapy. Outcomes will be assessed at baseline and after ten treatment sessions by a blinded assessor. The primary outcome is fear of falling, measured using the Falls Efficacy Scale‑International (FES‑I). Secondary outcomes include balance, assessed by the Mini‑BESTest and Biodex Balance System, as well as walking ability, assessed by the 10‑Meter Walk Test. It is hypothesized that VR‑based gait training will result in a greater reduction in fear of falling than tDCS combined with gait training.