{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T22:28:26Z","timestamp":1791239306958,"version":"4.1.0"},"reference-count":85,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2025,9,23]],"date-time":"2025-09-23T00:00:00Z","timestamp":1758585600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004809","name":"Finep\u2014The Funding Authority for Studies and Projects (FINEP)","doi-asserted-by":"publisher","award":["1748\/22"],"award-info":[{"award-number":["1748\/22"]}],"id":[{"id":"10.13039\/501100004809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Amyotrophic Lateral Sclerosis (ALS) is a progressive and fatal neurodegenerative disease characterized by motor neuron loss, muscle weakness, and respiratory dysfunction, often culminating in ventilatory failure. Evidence suggests that High-Definition Transcranial Direct Current Stimulation (HD-tDCS) may modulate motor cortical excitability and potentially influence motor and respiratory function in ALS. This study aims to evaluate the effects of home-based HD-tDCS applied over the primary diaphragmatic motor cortex on respiratory parameters and disease progression in individuals with ALS. Methods: This is a multicenter, randomized, controlled clinical trial. Eligible participants (aged 18\u201380, both sexes, diagnosed with ALS) will be randomized into an active HD-tDCS group (gTDCS) or a sham group (gSham). The intervention consists of 30 min daily HD-tDCS sessions (3 mA) applied for two weeks (5 days\/week), using a 4 \u00d7 1 ring configuration targeting the diaphragmatic motor cortex. Sham stimulation includes an identical setup but only delivers ramp currents (30 s) with a minimal ongoing current (0.1 mA). Results: Pre-, intra-, and post-intervention evaluations will include measures of cortical excitability, cerebral and tissue perfusion, surface electromyography, respiratory and pulmonary function, fatigue, sleep quality, pain, motor performance, dyspnea, quality of life, and adverse effects. All procedures will be conducted at participants\u2019 homes with appropriate safety monitoring. Conclusions: This study will investigate the effects of HD-tDCS on respiratory and motor function in ALS and explore the feasibility of a home-based neuromodulation intervention. The outcomes may provide insight into non-pharmacological strategies for respiratory management in ALS.<\/jats:p>","DOI":"10.3390\/jcm14196701","type":"journal-article","created":{"date-parts":[[2025,9,23]],"date-time":"2025-09-23T10:27:53Z","timestamp":1758623273000},"page":"6701","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["High-Definition Transcranial Direct Current Stimulation (HD-tDCS) Therapy in Amyotrophic Lateral Sclerosis: Study Protocol for a Multicenter Randomized Controlled Clinical Trial"],"prefix":"10.3390","volume":"14","author":[{"given":"Edna Karla","family":"Ferreira Laurentino","sequence":"first","affiliation":[{"name":"PneumoCardioVascular Lab\/HUOL, Departamento de Fisioterapia, Hospital Universit\u00e1rio Onofre Lopes, Universidade Federal do Rio Grande do Norte, Natal 59010-090, Rio Grande do Norte, Brazil"},{"name":"Laborat\u00f3rio de Inova\u00e7\u00e3o Tecnol\u00f3gica em Reabilita\u00e7\u00e3o, Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte, Natal 59012-300, Rio Grande do Norte, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7804-7517","authenticated-orcid":false,"given":"Vinicius Zacarias","family":"Maldaner da Silva","sequence":"additional","affiliation":[{"name":"Ceil\u00e2ndia Sul\u2014Campus Universit\u00e1rio, Universidade de Bras\u00edlia, Centro Metropolitano, Ceil\u00e2ndia 72220-275, Distrito Federal, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wesley Ribeiro","family":"Costa Meneses","sequence":"additional","affiliation":[{"name":"PneumoCardioVascular Lab\/HUOL, Departamento de Fisioterapia, Hospital Universit\u00e1rio Onofre Lopes, Universidade Federal do Rio Grande do Norte, Natal 59010-090, Rio Grande do Norte, Brazil"},{"name":"Laborat\u00f3rio de Inova\u00e7\u00e3o Tecnol\u00f3gica em Reabilita\u00e7\u00e3o, Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte, Natal 59012-300, Rio Grande do Norte, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lariza Maria","family":"da Costa","sequence":"additional","affiliation":[{"name":"PneumoCardioVascular Lab\/HUOL, Departamento de Fisioterapia, Hospital Universit\u00e1rio Onofre Lopes, Universidade Federal do Rio Grande do Norte, Natal 59010-090, Rio Grande do Norte, Brazil"},{"name":"Laborat\u00f3rio de Inova\u00e7\u00e3o Tecnol\u00f3gica em Reabilita\u00e7\u00e3o, Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte, Natal 59012-300, Rio Grande do Norte, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5784-275X","authenticated-orcid":false,"given":"Matias","family":"Otto-Ya\u00f1ez","sequence":"additional","affiliation":[{"name":"Escuela de Kinesiologia, Universidad Autonoma de Chile, Santiago 7501012, Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Vera-Uribe","sequence":"additional","affiliation":[{"name":"Departamento de Kinesiolog\u00eda, Facultad de Medicina, Universidad de Chile, Santiago 8380453, Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7974-4333","authenticated-orcid":false,"given":"Rodrigo","family":"Torres-Castro","sequence":"additional","affiliation":[{"name":"Departamento de Kinesiolog\u00eda, Facultad de Medicina, Universidad de Chile, Santiago 8380453, Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruna Ribeiro","family":"Carneiro de Sousa","sequence":"additional","affiliation":[{"name":"Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte, Natal 59078-900, Rio Grande do Norte, 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