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However, it lacks an objective measure that can indicate the effect of HD-tDCS on alteration of brain activity. Quantitative electroencephalography (qEEG) has shown promising results as an indicator of post-stroke functional recovery. Therefore, this study aims to determine whether qEEG metrics could serve as quantitative measures to assess alteration in brain activity induced by HD-tDCS. Resting state EEG was collected from stroke participants before and after (1) anodal HD-tDCS of the lesioned hemisphere, (2) cathodal stimulation of the non-lesioned hemisphere, and (3) sham. The average power spectrum was calculated using the Fast Fourier Transform for frequency bands alpha, beta, delta, and theta. In addition, delta-alpha ratio (DAR), Delta-alpha-beta-theta ratio (DTABR), and directional brain symmetry index (BSI) were also evaluated. We found that both anodal and cathodal stimulation significantly decreased the DAR and BSI over various frequency bands, which are associated with reduced motor impairments and improved nerve conduction velocity from the brain to muscles. This result indicates that qEEG metrics DAR and BSI could be quantitative indicators to assess alteration of brain activity induced by HD-tDCS in stroke rehabilitation. This would allow future development of EEG-based neurofeedback system to guide and evaluate the effect of HD-tDCS on improving movement-related brain function in stroke.<\/jats:p>","DOI":"10.1177\/09226028251347427","type":"journal-article","created":{"date-parts":[[2025,6,16]],"date-time":"2025-06-16T04:35:47Z","timestamp":1750048547000},"page":"209-221","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Quantitative EEG Metrics for Determining HD-tDCS Induced Alteration of Brain Activity in Stroke Rehabilitation"],"prefix":"10.1177","volume":"42","author":[{"given":"Jordan N","family":"Williamson","sequence":"first","affiliation":[{"name":"Department of Bioengineering, Grainger College of Engineering, University of Illinois Urbana-Champaign, Urbana, IL"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shirley A","family":"James","sequence":"additional","affiliation":[{"name":"University of Oklahoma Health Sciences Center, Hudson College of Public Health, Oklahoma City, OK, USA"},{"name":"Department of Physical Therapy, Witchita State University, Wichita, KS, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-7726-967X","authenticated-orcid":false,"given":"Beni","family":"Mulyana","sequence":"additional","affiliation":[{"name":"Department of Bioengineering, Grainger College of Engineering, University of Illinois Urbana-Champaign, Urbana, IL"},{"name":"Carle Foundation Hospital, Stephenson Family Clinical Research Institute, Clinical Imaging Research Center, Urbana, IL, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-8681-2922","authenticated-orcid":false,"given":"Sally","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Bioengineering, Grainger College of Engineering, University of Illinois Urbana-Champaign, Urbana, IL"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dorothy","family":"He","sequence":"additional","affiliation":[{"name":"University of Oklahoma Health Sciences Center, College of Medicine, Oklahoma City, OK, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sheng","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, UT Health Huston McGovern Medical School, Houston, TX, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0307-5828","authenticated-orcid":false,"given":"Evgeny V","family":"Sidorov","sequence":"additional","affiliation":[{"name":"Department of Neurology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2442-3713","authenticated-orcid":false,"given":"Yuan","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Bioengineering, Grainger College of Engineering, University of Illinois Urbana-Champaign, Urbana, IL"},{"name":"Carle Foundation Hospital, Stephenson Family Clinical Research Institute, Clinical Imaging Research Center, Urbana, IL, USA"},{"name":"University of Illinois Urbana-Champaign, Beckman Institute for Advanced Science and Technology, Urbana, IL, USA"},{"name":"Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2025,6,16]]},"reference":[{"issue":"1","key":"e_1_3_3_2_1","first-page":"8276136","article-title":"Brain symmetry index in healthy and stroke patients for assessment and prognosis","volume":"2017","author":"Agius Anastasi A.","year":"2017","unstructured":"Agius Anastasi A., Falzon O., Camilleri K., Vella M., Muscat R. 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