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Randomized Controlled Trial
. 2014 Aug 29;9(8):e105777.
doi: 10.1371/journal.pone.0105777. eCollection 2014.

Effect of transcranial direct-current stimulation combined with treadmill training on balance and functional performance in children with cerebral palsy: a double-blind randomized controlled trial

Natália de Almeida Carvalho Duarte  1 , Luanda André Collange Grecco  2 , Manuela Galli  3 , Felipe Fregni  4 , Cláudia Santos Oliveira  5
Affiliations
Randomized Controlled Trial

Effect of transcranial direct-current stimulation combined with treadmill training on balance and functional performance in children with cerebral palsy: a double-blind randomized controlled trial

Natália de Almeida Carvalho Duarte et al. PLoS One. .

Abstract

Background: Cerebral palsy refers to permanent, mutable motor development disorders stemming from a primary brain lesion, causing secondary musculoskeletal problems and limitations in activities of daily living. The aim of the present study was to determine the effects of gait training combined with transcranial direct-current stimulation over the primary motor cortex on balance and functional performance in children with cerebral palsy.

Methods: A double-blind randomized controlled study was carried out with 24 children aged five to 12 years with cerebral palsy randomly allocated to two intervention groups (blocks of six and stratified based on GMFCS level (levels I-II or level III).The experimental group (12 children) was submitted to treadmill training and anodal stimulation of the primary motor cortex. The control group (12 children) was submitted to treadmill training and placebo transcranial direct-current stimulation. Training was performed in five weekly sessions for 2 weeks. Evaluations consisted of stabilometric analysis as well as the administration of the Pediatric Balance Scale and Pediatric Evaluation of Disability Inventory one week before the intervention, one week after the completion of the intervention and one month after the completion of the intervention. All patients and two examiners were blinded to the allocation of the children to the different groups.

Results: The experimental group exhibited better results in comparison to the control group with regard to anteroposterior sway (eyes open and closed; p<0.05), mediolateral sway (eyes closed; p<0.05) and the Pediatric Balance Scale both one week and one month after the completion of the protocol.

Conclusion: Gait training on a treadmill combined with anodal stimulation of the primary motor cortex led to improvements in static balance and functional performance in children with cerebral palsy.

Trial registration: Ensaiosclinicos.gov.br/RBR-9B5DH7.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Flowchart of study based on Consolidated Standards of Reporting Trials.
Figure 2
Figure 2. PBS scores in both groups before and after intervention.
*statistically significant difference between groups (p<0.05).
Figure 3
Figure 3. Oscillations of center of pressure.
A) anteroposterior sway with eyes open; B) mediolateral sway with eyes open; C) anteroposterior sway with eyes closed; D) mediolateral sway with eyes closed. *Statistically significant difference between groups (p<0.05).
Figure 4
Figure 4. Self-care and mobility scores on PEDI in both groups before and after intervention.
See this image and copyright information in PMC

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