Table 3.

Themes related to concerns for adopting transcranial direct current stimulation (tDCS) and qualitative responses.

Concern	Comment
Training/continuing education	“No formal training for clinicians that I am aware of for clinical implementation.”
Administrative approval	“Hospital administration may not approve…due to safety concerns and reimbursement issues….”
Cost	“The cost listed above is not likely to be the cost paid by patients because someone must be paid to set up and break down the equipment and apply it properly. If the SLP does this there will be less time for therapy so someone else must be employed as a tDCS tech and the cost of that person's salary will be borne by the patients.”
Safety	“Strong evidence of ‘no harm’ would be the first paper I would look for.”
Reimbursement	“…patients do not have finances (either through insurance or as private payers) to afford prolonged treatment. Most insurance plans do not cover either extended periods of time for or number of sessions.”
Efficacy	“No phase 3 trials have shown efficacy. The current evidence for tDCS in aphasia is similar to the evidence for rTMS for motor recovery a few years ago. Then the pivotal phase 3 trial of rTMS for motor recovery was stopped early for lack of efficacy. A multicenter trial is needed before charging patients for tDCS.”
tDCS treatment protocols	“What factors would inform an individualized tDCS electrode placement montage?”
Inclusion criteria	“…protocols for client selection,” “severity of aphasia prior to tDCS,” “…presence of underlying cognitive deficits”
Patient/family perceptions	“I'm concerned that patients would not be open to it because they believe it is unsafe, or because they feel it is too far ‘out there’”
Facility resources	“Maintenance of equipment considering my rural location.”

Note. Concerns included here are from free responses and describe additional concerns from Table 2. rTMS = repetitive transcranial magnetic stimulation.