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Randomized Controlled Trial
. 2018 May;22(3):358-368.
doi: 10.1016/j.ejpn.2018.02.001. Epub 2018 Feb 11.

Transcranial direct current stimulation and constraint-induced therapy in cerebral palsy: A randomized, blinded, sham-controlled clinical trial

Bernadette Gillick  1 , Tonya Rich  2 , Samuel Nemanich  2 , Chao-Ying Chen  2 , Jeremiah Menk  3 , Bryon Mueller  4 , Mo Chen  5 , Marcie Ward  6 , Gregg Meekins  7 , Tim Feyma  6 , Linda Krach  8 , Kyle Rudser  3
Affiliations
Randomized Controlled Trial

Transcranial direct current stimulation and constraint-induced therapy in cerebral palsy: A randomized, blinded, sham-controlled clinical trial

Bernadette Gillick et al. Eur J Paediatr Neurol. 2018 May.

Abstract

We investigated the safety, feasibility, and efficacy of transcranial direct current stimulation (tDCS) combined with constraint-induced movement therapy (CIMT) in children and young adults with unilateral cerebral palsy. Twenty participants were randomized to receive active or sham tDCS. The intervention consisted of 10 consecutive weekday sessions of tDCS applied to the non-lesioned hemisphere (20 min) concurrently with CIMT (120 min). Participants, caregivers, and interventionists were blinded to group assignment. The primary safety outcome investigated adverse events. The primary behavioral outcome was the Assisting Hand Assessment. All 20 participants (mean age = 12.7 yrs, range = 7.4-21.6 years) were evaluated for the primary outcomes. No serious adverse events occurred, and the most commonly reported minor adverse events were headache and itchiness. Both groups demonstrated a significant improvement in hand function after the intervention, although no significant effect of tDCS was observed (between-group difference = -2.18, 95% CI = [-6.48, 2.12], p = 0.30). Although hand function improved overall, no significant differences between intervention groups were found. Children with preserved corticospinal tract circuitry from the lesioned hemisphere, compared to those without, showed greater improvement in hand function (mean difference = 3.04, 95% CI = [-0.64, 6.72], p = 0.099). Our study demonstrates the safety and feasibility of serial sessions of tDCS, and presents preliminary evidence for the effect of CST circuitry on outcomes following tDCS/CIMT. Future work in children with unilateral cerebral palsy should focus on the optimal dosing and consider individual brain circuitry when describing response to combined interventions.

Clinical trials registration: Clinicaltrials.govNCT 02250092.

Keywords: Constraint-induced movement therapy; Rehabilitation; Transcranial direct current stimulation; Unilateral cerebral palsy.

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Figures

Figure 1
Figure 1
CONSORT diagram and study flow.
Figure 2
Figure 2
Behavioral outcomes following tDCS+CIMT intervention. All plots show individual (dashed lines) and group mean (solid line) data. (A) AHA (n=20), (B) Grip Strength in More-affected hand (n=19), (C) Grip Strength in Less-affected hand (n=19), (D) COPM Performance (n=20), (E) COPM Satisfaction (n=20). AHA: Assisting Hand Assessment, COPM: Canadian Occupational Performance Measure.
Figure 2
Figure 2
Behavioral outcomes following tDCS+CIMT intervention. All plots show individual (dashed lines) and group mean (solid line) data. (A) AHA (n=20), (B) Grip Strength in More-affected hand (n=19), (C) Grip Strength in Less-affected hand (n=19), (D) COPM Performance (n=20), (E) COPM Satisfaction (n=20). AHA: Assisting Hand Assessment, COPM: Canadian Occupational Performance Measure.
Figure 2
Figure 2
Behavioral outcomes following tDCS+CIMT intervention. All plots show individual (dashed lines) and group mean (solid line) data. (A) AHA (n=20), (B) Grip Strength in More-affected hand (n=19), (C) Grip Strength in Less-affected hand (n=19), (D) COPM Performance (n=20), (E) COPM Satisfaction (n=20). AHA: Assisting Hand Assessment, COPM: Canadian Occupational Performance Measure.
Figure 2
Figure 2
Behavioral outcomes following tDCS+CIMT intervention. All plots show individual (dashed lines) and group mean (solid line) data. (A) AHA (n=20), (B) Grip Strength in More-affected hand (n=19), (C) Grip Strength in Less-affected hand (n=19), (D) COPM Performance (n=20), (E) COPM Satisfaction (n=20). AHA: Assisting Hand Assessment, COPM: Canadian Occupational Performance Measure.
Figure 2
Figure 2
Behavioral outcomes following tDCS+CIMT intervention. All plots show individual (dashed lines) and group mean (solid line) data. (A) AHA (n=20), (B) Grip Strength in More-affected hand (n=19), (C) Grip Strength in Less-affected hand (n=19), (D) COPM Performance (n=20), (E) COPM Satisfaction (n=20). AHA: Assisting Hand Assessment, COPM: Canadian Occupational Performance Measure.
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References

    1. Bolognini N, Vallar G, Casati C, Latif LA, El-Nazer R, Williams J, et al. Neurophysiological and behavioral effects of tDCS combined with constraint-induced movement therapy in poststroke patients. Neurorehabil Neural Repair. 2011;25(9):819–29. - PubMed
    1. Figlewski K, Blicher JU, Mortensen J, Severinsen KE, Nielsen JF, Andersen H. Transcranial Direct Current Stimulation Potentiates Improvements in Functional Ability in Patients With Chronic Stroke Receiving Constraint-Induced Movement Therapy. Stroke. 2017;48(1):229–32. - PubMed
    1. Williams JA, Pascual-Leone A, Fregni F. Interhemispheric modulation induced by cortical stimulation and motor training. Phys Ther. 2010;90(3):398–410. - PubMed
    1. Gillick BT, Krach LE, Feyma T, Rich TL, Moberg K, Thomas W, et al. Primed low-frequency repetitive transcranial magnetic stimulation and constraint-induced movement therapy in pediatric hemiparesis: a randomized controlled trial. Dev Med Child Neurol. 2014;56(1):44–52. - PMC - PubMed
    1. Nitsche MA, Paulus W. Excitability changes induced in the human motor cortex by weak transcranial direct current stimulation. J Physiol. 2000;527 Pt 3:633–9. - PMC - PubMed

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