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Reuter S, Lambert C, Schadt M, Imhoff AB, Centner C, Herbst E, Stöcker F, Forkel P. Effects of transcranial direct current stimulation and sensorimotor training in anterior cruciate ligament patients: a sham-controlled pilot study. SPORTVERLETZUNG SPORTSCHADEN : ORGAN DER GESELLSCHAFT FUR ORTHOPADISCH-TRAUMATOLOGISCHE SPORTMEDIZIN 2024; 38:73-78. [PMID: 38657648 DOI: 10.1055/a-2285-7159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
BACKGROUND Studies showed changes in the central nervous system in patients who sustained an anterior cruciate ligament tear. There is a lack of evidence regarding the effectiveness of transcranial direct-current stimulation in such patients. METHODS A sham-controlled randomised study. One group of patients (n = 6) underwent 6 weeks of sensorimotor training after an anterior cruciate ligament tear during transcranial direct-current stimulation. The stimulation consisted of 20 minutes (3 sessions/week; 2 weeks) of 2 mA anodal transcranial direct-current stimulation over the primary motor and premotor cortex. The second group (n = 6) received sham stimulation with 6 weeks of sensorimotor training. Centre of pressure deviations in the medio-lateral and anterior-posterior direction and centre of pressure velocity were measured. RESULTS The results demonstrated a significant effect of sensorimotor training on the centre of pressure in medio-lateral and anterior-posterior direction (p=0.025) (p=0.03) in the leg in which an anterior cruciate ligament tear occurred. The type of training did not affect the results. Post-hoc tests showed no significant effect of training in the subgroups (p≥0.115). CONCLUSION Sensorimotor training led to a decrease in sway of the centre of pressure in patients who sustained an anterior cruciate ligament tear, but the addition of anodal transcranial direct-current stimulation placed over the primary motor cortex did not potentiate the adaptive responses of the sensorimotor training.
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Affiliation(s)
- Sven Reuter
- SRH University of Applied Sciences Heidelberg: SRH Hochschule Heidelberg, Gera, GERMANY
| | - Christophe Lambert
- Deparment of Trauma and Orthopedic Surgery, University of Witten/Herdecke: Universitat Witten/Herdecke, Cologne, GERMANY
| | - Maja Schadt
- Department of Biomechanics in Sports, Technical University Munich: Technische Universitat Munchen, München, GERMANY
| | - Andreas B Imhoff
- Department for Orthopaedic Sports Medicine, Munich University of Technology: Technische Universitat Munchen, München, GERMANY
| | - Christoph Centner
- University of Freiburg im Breisgau: Albert-Ludwigs-Universitat Freiburg, Freiburg, GERMANY
| | - Elmar Herbst
- Department for Orthopaedic Sports Medicine, Technische Universität München: Technische Universitat Munchen, München, GERMANY
| | - Fabian Stöcker
- Department of Biomechanics in Sports, Technische Universität München: Technische Universitat Munchen, München, GERMANY
| | - Philipp Forkel
- Department for Orthopaedic Sports Medicine, Technische Universität München: Technische Universitat Munchen, München, GERMANY
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Hassan Z, Hadian MR, Hussain SA, Shadmehr A, Talebian S, Bagheri H, Mir SM, Arslan SA. Comparison of the Conjunct Effects of Electrical Stimulation and Whole-Body Vibration Therapy with Transcranial Direct Current Stimulation and Whole-body Vibration Therapy on Balance and Function in Children With Spastic Cerebral Palsy. Cureus 2024; 16:e61511. [PMID: 38957262 PMCID: PMC11217583 DOI: 10.7759/cureus.61511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Cerebral palsy is a neurodevelopmental condition that results in impaired movement and posture, often accompanied by disturbances in balance and functional abilities. Recent advances in neurorehabilitation, including whole-body vibration therapy (WBVT), functional electrical stimulation, and transcranial direct current stimulation, show promise in enhancing traditional interventions and fostering neuroplasticity. However, the efficacy of their conjunct effects remains largely uncharted territory and warrants further exploration. The objective of the study was to compare the conjunct effects of functional electrical stimulation (FES) and WBVT with transcranial direct current stimulation (tDCS) and WBVT on lower extremity range of motion (ROM), dynamic balance, functional mobility, isometric muscle strength and hand grip strength in children with spastic cerebral palsy. METHODS A randomized clinical trial was carried out on 42 children of both genders with spastic cerebral palsy, aged 5-15 years. The children were divided at random into three groups (14 in each group). In Group A, there were three (21.42%) males and 11 (78.57%) females, in Group B, eight (57.14%) were males and six (42.85%) were females, and in Group C, six (42.85%) children were males and eight (57.14%) were females. Group A received WBVT only, Group B received WBVT and FES, and Group C received WBVT and tDCS. The intervention was applied four times a week for four consecutive weeks. The data was collected two times before and immediately after four weeks of intervention. Lower extremity ROM was measured by a goniometer, functional mobility or dynamic balance was measured by a Time Up and Go test, isometric muscle strength was measured by a digital force gauge, and hand grip strength was assessed by a digital hand-held dynamometer. IBM SPSS Statistics for Windows, Version 27.0 (Released 2020; IBM Corp., Armonk, New York, United States) was utilized for statistical analysis. RESULTS The mean age of the children in groups A, B, and C was 12.21±2.11 years, 11.71±2.01, and 11.07±2.01 years respectively. Intergroup analysis revealed a statistically significant difference (p<0.05) in the lower extremity range of motion, and functional mobility. Hand grip strength and isometric muscle strength between three groups. Post hoc analysis revealed that WBVT with transcranial direct current stimulation combined showed the most improvement. CONCLUSION The study concluded that positive effects were seen in all three groups but tDCS with WBVT was found to be most effective in improving lower extremity ROM, functional mobility or dynamic balance, isometric muscle strength, and hand grip strength in children with spastic CP. The differences between the groups were statistically significant. The effect size was substantial enough to surpass established clinical benchmarks, indicating that the observed improvements are likely to have meaningful and beneficial impacts on patient outcomes.
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Affiliation(s)
- Zainab Hassan
- School of Rehabilitation, Tehran University of Medical Sciences, Tehran, IRN
| | - Mohammad-Reza Hadian
- Brain and Spinal Cord Injury Research Center, Institute of Neuroscience, Tehran, IRN
| | - Syed Ali Hussain
- School of Rehabilitation, Tehran University of Medical Sciences, Tehran, IRN
| | - Azadeh Shadmehr
- School of Rehabilitation, Tehran University of Medical Sciences, Tehran, IRN
| | - Saeed Talebian
- School of Rehabilitation, Tehran University of Medical Sciences, Tehran, IRN
| | - Hossein Bagheri
- School of Rehabilitation, Tehran University of Medical Sciences, Tehran, IRN
| | - S Mohsen Mir
- School of Rehabilitation, Tehran University of Medical Sciences, Tehran, IRN
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Lopes J, Miziara I, Kahani D, Parreira R, Fonseca D, Lazzari R, Cordeiro L, Naves E, Cimolin V, Galli M, Conway B, Oliveira C. Brain wave behavior in children with down syndrome following cortical neuromodulation combined with sensorimotor stimulation: observational study. Physiother Theory Pract 2024; 40:941-951. [PMID: 36384401 DOI: 10.1080/09593985.2022.2147808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 11/09/2022] [Accepted: 11/09/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Individuals with Down syndrome (DS) require more time to develop motor and/or cognitive skills. Neuromodulation is used to assist in this development. However, there is a gap in the literature on neurophysiological changes that may occur in the primary motor cortex in individuals with DS following neuromodulation. OBJECTIVE Our objective was to investigate possible neurophysiological changes in brain wave behavior of the primary motor cortex following the administration of anodal transcranial direct current stimulation combined with sensorimotor training. METHODS The study involved 12 participants with DS. EEG equipment was used to investigate brain activity. The participants received neuromodulation involving anodal tDCS for 20 minutes with a current of 1 mA combined with virtual reality (VR) training three times a week for a total of ten sessions. We analyzed EGG signals and 3D movement during a reaching movement of the dominant upper limb before and after the ten-session protocol. RESULTS Significant differences in event-related desynchronization and event-related synchronization of the alpha and beta rhythms were found throughout the evaluations. Brain mapping revealed reductions in power and frequency, demonstrating changes in the patterns of these rhythms in the cerebral cortex. Revealed reorganization of the behavior of alpha and beta waves, as demonstrated by distribution of synchronization and desynchronization of these waves among the regions of the brain. CONCLUSION The results suggest that anodal tDCS promotes the reorganization of brain impulses, redirecting these impulses to the required regions more efficiently and contributing to better motor planning.
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Affiliation(s)
- Jamile Lopes
- School of Medical Sciences, Santa Casa de São Paulo, 112 Doutor Cesário Street, São Paulo, SP, Brazil
| | - Isabela Miziara
- Electrical and Biomedical Engineering, Technology Institute, Federal University of Pará, Belém, PA, Brazil
| | - Danial Kahani
- Department of Bioengineering, University of Strathclyde, Glasgow, UK
| | - Rodolfo Parreira
- School of Medical Sciences, Santa Casa de São Paulo, 112 Doutor Cesário Street, São Paulo, SP, Brazil
| | - Daniela Fonseca
- Movement Analysis Lab, University Centre of Anápolis, Anápolis, Brazil
| | - Roberta Lazzari
- School of Medical Sciences, Santa Casa de São Paulo, 112 Doutor Cesário Street, São Paulo, SP, Brazil
| | - Lorraine Cordeiro
- Movement Analysis Lab, University Centre of Anápolis, Anápolis, Brazil
| | - Eduardo Naves
- Electrical Engineering Faculty, Federal University of Uberlândia, Uberlândia, Brazil
| | - Veronica Cimolin
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
- Istituto Auxologico Italiano - IRCCS, San Giuseppe Hospital, Piancavallo, Italy
| | - Manuela Galli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Bernard Conway
- Department of Bioengineering, University of Strathclyde, Glasgow, UK
| | - Claudia Oliveira
- School of Medical Sciences, Santa Casa de São Paulo, 112 Doutor Cesário Street, São Paulo, SP, Brazil
- Movement Analysis Lab, University Centre of Anápolis, Anápolis, Brazil
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Cangussu AI, Lucarini B, Melo IDF, Diniz PA, Mancini M, Viana BDM, Romano-Silva MA, Miranda DMD. Motor Effects of Intervention With Transcranial Direct Current Stimulation for Physiotherapy Treatment in Children With Cerebral Palsy: Protocol for a Randomized Clinical Trial. JMIR Res Protoc 2024; 13:e52922. [PMID: 38687586 PMCID: PMC11094605 DOI: 10.2196/52922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 12/27/2023] [Accepted: 01/20/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Children diagnosed with cerebral palsy (CP) often experience various limitations, particularly in gross motor function and activities of daily living. Transcranial direct current stimulation (tDCS) is a noninvasive brain stimulation technique that has been used to improve movement, gross motor function, and activities of daily living. OBJECTIVE This study aims to evaluate the potential additional effects of physiotherapy combined with tDCS in children with CP in comparison with physiotherapy only. METHODS This is a 2-arm randomized controlled trial that will compare the effects of tDCS as an adjunctive treatment during rehabilitation sessions to rehabilitation without tDCS. Children with CP classified by the Gross Motor Function Classification System as levels I and II will be randomly assigned to either the sham + rehabilitation group or the tDCS + rehabilitation group. The primary outcome will be the motor skills assessed using the Gross Motor Function Measure domain E scores, and the secondary outcome will be the measurement scores of the children's quality of life. The intervention will consist of a 10-day stimulation protocol with tDCS spread over 2 weeks, with stimulation or sham tDCS administered for 20 minutes at a frequency of 1 Hz, in combination with physiotherapy. Physical therapy exercises will be conducted in a circuit based on each child's baseline Gross Motor Function Measure results. The participants' changes will be evaluated and compared in both groups. Intervenient features will be tested. RESULTS Data collection is ongoing and is expected to be completed by January 2025. A homogeneous sample and clear outcomes may be a highlight of this protocol, which may allow us to understand the potential use of tDCS and for whom it should or should not be used. CONCLUSIONS A study with good evidence and clear outcomes in children with CP might open an avenue for the potential best use of neurostimulation. TRIAL REGISTRATION Brazilian Registry of Clinical Trials RBR-104h4s4y; https://tinyurl.com/47r3x2e4. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/52922.
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Affiliation(s)
- Anna Izabel Cangussu
- Faculdade de Medicina da Universidade Federal de Minas Gerais, Federal University of Minas Gerais, Belo Horizonte, Brazil
- Instituto Nacional de Ciência e Tecnologia de Medicina Molecular, Universidade Federal de Minas Gerais, Belo Horinzote, Brazil
| | - Beatriz Lucarini
- Faculdade de Medicina da Universidade Federal de Minas Gerais, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Igor de Freitas Melo
- Faculdade de Medicina da Universidade Federal de Minas Gerais, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Paula Araújo Diniz
- Faculdade de Medicina da Universidade Federal de Minas Gerais, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Marisa Mancini
- Departament of Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Bernardo de Mattos Viana
- Faculdade de Medicina da Universidade Federal de Minas Gerais, Federal University of Minas Gerais, Belo Horizonte, Brazil
- Instituto Nacional de Ciência e Tecnologia Neurotech R, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Marco Aurélio Romano-Silva
- Faculdade de Medicina da Universidade Federal de Minas Gerais, Federal University of Minas Gerais, Belo Horizonte, Brazil
- Instituto Nacional de Ciência e Tecnologia Neurotech R, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Débora Marques de Miranda
- Faculdade de Medicina da Universidade Federal de Minas Gerais, Federal University of Minas Gerais, Belo Horizonte, Brazil
- Instituto Nacional de Ciência e Tecnologia Neurotech R, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Departamento de Pediatria, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Ehsani F, Masoudi M, Hedayati R, Jaberzadeh S. Transcranial direct current stimulation over dorsolateral prefrontal cortex improves postural stability in non-specific chronic low back pain patients with high fear of pain: A randomized sham-controlled trial. Eur J Neurosci 2023; 58:3315-3329. [PMID: 37519282 DOI: 10.1111/ejn.16090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 05/14/2023] [Accepted: 06/27/2023] [Indexed: 08/01/2023]
Abstract
Deficits in postural stability in response to environmental challenges are seen in chronic low back pain (CLBP) patients with high fear of pain (HFP). Hence, it is essential to follow effective approaches to treat postural stability deficits and improve the health status of these patients. The current study aimed to compare the effects of cathodal and anodal transcranial direct current stimulation (c-tDCS and a-tDCS) over the left dorsolateral prefrontal cortex (DLPFC) on postural stability in non-specific CLBP patients with HFP. In this randomized clinical trial study, 75 patients were randomly assigned to left DLPFC a-tDCS, left DLPFC c-tDCS and sham stimulation groups (n = 25 in each group). All groups received a single-session 2 mA tDCS for 20 min, but the stimulation was slowly turned off after 30 s in the sham group. Before, immediately, 24 h and 1 week after the interventions, postural stability indices were assessed using a Biodex Balance System. A significant reduction in most indices was shown in both a-tDCS and c-tDCS groups after interventions (immediately, 24 h and 1 week follow-up) during static and dynamic postural tasks compared with the sham tDCS group (p < .01). In addition, some tests showed a significant difference between a-tDCS and c-tDCS (p < .05). The findings indicated positive effects of both a-tDCS and c-tDCS on the left DLPFC, with more efficacy of a-tDCS on postural stability in LBP patients with HFP.
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Affiliation(s)
- Fatemeh Ehsani
- Neuromuscular Rehabilitation Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Mona Masoudi
- Neuromuscular Rehabilitation Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Rozita Hedayati
- Neuromuscular Rehabilitation Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Shapour Jaberzadeh
- Non-invasive Brain Stimulation and Neuroplasticity, Department of Physiotherapy, Nursing and Health Sceinces, Monash University, Melbourne, Australia
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Collange-Grecco LA, Cosmo C, Silva ALS, Rizzutti S, Oliveira CS, Muszkat M. Effects of Dual Task Training and Transcranial Direct Current Stimulation in Children with Spastic Cerebral Palsy: A Pilot Randomized Control Trial. Dev Neurorehabil 2023; 26:279-286. [PMID: 37352444 DOI: 10.1080/17518423.2023.2228400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 05/28/2023] [Accepted: 06/19/2023] [Indexed: 06/25/2023]
Abstract
OBJECTIVE Compare the effectiveness of active and sham transcranial direct current stimulation (tDCS) during the training of a dual task in children with spastic cerebral palsy (CP). METHODS Thirty children with CP were submitted to ten sessions of either active (n = 15) or sham (n = 15) tDCS over the motor cortex for 20 minutes during the training of a dual task. Pre-intervention, post-intervention and follow-up evaluations involved measures of functional performance, intellectual performance, functional mobility and cortical excitability. RESULTS The combination of active tDCS and dual task training led to improvements in functional mobility as well as functional and intellectual performances one month after the end of the intervention. CONCLUSION The combination of active tDCS and dual task training demonstrated promising effects for children with spastic CP.
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Affiliation(s)
- Luanda André Collange-Grecco
- Center of Pediatric Neurostimulation, Sao Paulo, SP, Brazil
- Education and health in childhood and adolescence, Federal University of São Paulo, São Paulo, SP, Brazil
- Human movement analysis laboratory, University Center of Anápolis, Anápolis, GO, Brazil
| | - Camila Cosmo
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School, Brown University, Providence, RI, USA
- Center for Neurorestoration and Neurotechnology, VA Providence Healthcare System, Providence, RI, USA
| | | | - Sueli Rizzutti
- Education and health in childhood and adolescence, Federal University of São Paulo, São Paulo, SP, Brazil
| | | | - Mauro Muszkat
- Education and health in childhood and adolescence, Federal University of São Paulo, São Paulo, SP, Brazil
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Araujo MO, Tamplain P, Duarte NAC, Comodo ACM, Ferreira GOA, Queiróga A, Oliveira CS, Collange-Grecco LA. Transcranial direct current stimulation to facilitate neurofunctional rehabilitation in children with autism spectrum disorder: a protocol for a randomized, sham-controlled, double-blind clinical trial. Front Neurol 2023; 14:1196585. [PMID: 37396775 PMCID: PMC10310925 DOI: 10.3389/fneur.2023.1196585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 05/22/2023] [Indexed: 07/04/2023] Open
Abstract
Background Anodal transcranial direct current stimulation (tDCS) over the primary motor cortex and cerebellum is gaining prominence in the literature due to its potential to favor learning and motor performance. If administered during motor training, tDCS is capable of increasing the effect of training. Considering the motor impairment presented by children with Autism Spectrum Disorders (ASD), atDCS applied during motor training may contribute to the rehabilitation of these children. However, it is necessary to examine and compare the effects of atDCS over the motor cortex and the cerebellum on the motor skills of children with ASD. This information may benefit future clinical indications of tDCS for rehabilitation of children with ASD. The aim of the proposed study is to determine whether anodal tDCS over the primary motor cortex and cerebellum can enhance the effects of gait training and postural control on motor skills, mobility, functional balance, cortical excitability, cognitive aspects and behavioral aspects in children with ASD. Our hypothesis is the active tDCS combined with motor training will enhance the performance of the participants in comparison to sham tDCS. Methods and design A randomized, sham-controlled, double-blind clinical trial will be conducted involving 30 children with ASD that will be recruited to receive ten sessions of sham or ten sessions of active anodal tDCS (1 mA, 20 min) over the primary motor cortex or cerebellun combined with motor training. The participants will be assessed before as well as one, four and eight weeks after the interventions. The primary outcome will be gross and fine motor skills. The secondary outcomes will be mobility, functional balance, motor cortical excitability, cognitive aspects and behavioral aspects. Discussion Although abnormalities in gait and balance are not primary characteristics of ASD, such abnormalities compromise independence and global functioning during the execution of routine activities of childhood. If demonstrated that anodal tDCS administered over areas of the brain involved in motor control, such as the primary motor cortex and cerebellum, can enhance the effects of gait and balance training in only ten sessions in two consecutive weeks, the clinical applicability of this stimulation modality will be expanded as well as more scientifically founded.Clinical trial registration February 16, 2023 (https://ensaiosclinicos.gov.br/rg/RBR-3bskhwf).
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Affiliation(s)
- Marcela O. Araujo
- Human Movement and Rehabilitation, Post Graduate Program, Evangelic University of Goias, Anápolis, Brazil
- Children's Rehabilitation Department, Follow Kids Child Neurorehabilitation Clinic, Rio de Janeiro, Brazil
| | - Priscila Tamplain
- Department of Kinesiology, University of Texas at Arlington, Arlington, TX, United States
| | - Natália A. C. Duarte
- Human Movement and Rehabilitation, Post Graduate Program, Evangelic University of Goias, Anápolis, Brazil
| | - Andréa C. M. Comodo
- Children's Rehabilitation Department, Follow Kids Child Neurorehabilitation Clinic, Rio de Janeiro, Brazil
| | - Giselle O. A. Ferreira
- Children's Rehabilitation Department, Follow Kids Child Neurorehabilitation Clinic, Rio de Janeiro, Brazil
| | - Amanda Queiróga
- Department of Child Neurofunctional Physiotherapy, Center of Pediatric Neurostimulation, São Paulo, Brazil
| | - Claudia S. Oliveira
- Human Movement and Rehabilitation, Post Graduate Program, Evangelic University of Goias, Anápolis, Brazil
| | - Luanda A. Collange-Grecco
- Human Movement and Rehabilitation, Post Graduate Program, Evangelic University of Goias, Anápolis, Brazil
- Department of Child Neurofunctional Physiotherapy, Center of Pediatric Neurostimulation, São Paulo, Brazil
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Delatorre RG, Sutter EN, Nemanich ST, Krach LE, Meekins G, Feyma T, Gillick BT. Anodal Contralesional tDCS Enhances CST Excitability Bilaterally in an Adolescent with Hemiparetic Cerebral Palsy: A Brief Report. Dev Neurorehabil 2023; 26:216-221. [PMID: 36967533 PMCID: PMC10228174 DOI: 10.1080/17518423.2023.2193626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 01/08/2023] [Accepted: 03/17/2023] [Indexed: 04/11/2023]
Abstract
Hemiparetic cerebral palsy (HCP), weakness on one side of the body typically caused by perinatal stroke, is characterized by lifelong motor impairments related to alterations in the corticospinal tract (CST). CST reorganization could be a useful biomarker to guide applications of neuromodulatory interventions, such as transcranial direct current stimulation (tDCS), to improve the effectiveness of rehabilitation therapies. We evaluated an adolescent with HCP and CST reorganization who demonstrated persistent heightened CST excitability in both upper limbs following anodal contralesional tDCS. The results support further investigation of targeted tDCS as an adjuvant therapy to traditional neurorehabilitation for upper limb function.
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Affiliation(s)
| | - Ellen N. Sutter
- Waisman Center, University of Wisconsin-Madison, Madison, USA
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Samuel T. Nemanich
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, USA
- Department of Occupational Therapy, Marquette University, Milwaukee, WI, USA
| | - Linda E. Krach
- Department of Neurology, Gillette Children’s Specialty Healthcare, Saint Paul, MN, USA
| | - Gregg Meekins
- Department of Neurology, University of Minnesota, Minneapolis, MN, USA
| | - Timothy Feyma
- Department of Neurology, Gillette Children’s Specialty Healthcare, Saint Paul, MN, USA
| | - Bernadette T. Gillick
- Waisman Center, University of Wisconsin-Madison, Madison, USA
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, USA
- Department of Pediatrics, University of Wisconsin-Madison, Madison, WI, USA
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9
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Nemanich ST, Lench DH, Sutter EN, Kowalski JL, Francis SM, Meekins GD, Krach LE, Feyma T, Gillick BT. Safety and feasibility of transcranial direct current stimulation stratified by corticospinal organization in children with hemiparesis. Eur J Paediatr Neurol 2023; 43:27-35. [PMID: 36878110 PMCID: PMC10117060 DOI: 10.1016/j.ejpn.2023.01.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/13/2023] [Accepted: 01/25/2023] [Indexed: 03/04/2023]
Abstract
Children with hemiparesis (CWH) due to stroke early in life face lifelong impairments in motor function. Transcranial direct current stimulation (tDCS) may be a safe and feasible adjuvant therapy to augment rehabilitation. Given the variability in outcomes following tDCS, tailored protocols of tDCS are required. We evaluated the safety, feasibility, and preliminary effects of a single session of targeted anodal tDCS based on individual corticospinal tract organization on corticospinal excitability. Fourteen CWH (age = 13.8 ± 3.63) were stratified into two corticospinal organization subgroups based on transcranial magnetic stimulation (TMS)-confirmed motor evoked potentials (MEP): ipsilesional MEP presence (MEPIL+) or absence (MEPIL-). Subgroups were randomized to real anodal or sham tDCS (1.5 mA, 20 min) applied to the ipsilesional (MEPIL + group) or contralesional (MEPIL- group) hemisphere combined with hand training. Safety was assessed with questionnaires and motor function evaluation, and corticospinal excitability was assessed at baseline and every 15 min for 1 h after tDCS. No serious adverse events occurred and anticipated minor side effects were reported and were self-limiting. Six of 14 participants had consistent ipsilesional MEPs (MEPIL + group). Paretic hand MEP amplitude increased in 5/8 participants who received real anodal tDCS to either the ipsilesional or contralesional hemisphere (+80% change). Application of tDCS based on individual corticospinal organization was safe and feasible with expected effects on excitability, indicating the potential for tailored tDCS protocols for CWH. Additional research involving expanded experimental designs is needed to confirm these effects and to determine if this approach can be translated into a clinically relevant intervention.
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Affiliation(s)
- Samuel T Nemanich
- Department of Occupational Therapy, Marquette University, 1700 West Wells St., Room 140, Milwaukee, WI, 53201, USA.
| | - Daniel H Lench
- Department of Neurology, Medical University of South Carolina, 208B Rutledge Avenue, Charleston, SC, 29425, USA
| | - Ellen N Sutter
- Department of Rehabilitation Medicine, University of Minnesota, 420 Delaware St SE, MMC 388, Minneapolis, MN, 55455, USA
| | - Jesse L Kowalski
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, 79/96 13th Street, Charlestown, MA, United States
| | - Sunday M Francis
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, 2312 S. 6th St.Floor 2, Suite F-275, Minneapolis, MN, 55454, USA
| | - Gregg D Meekins
- Department of Neurology, University of Minnesota, 420 Delaware St SE, MMC 295, Minneapolis, MN, 55455, USA
| | - Linda E Krach
- Department of Rehabilitation Medicine, University of Minnesota, 420 Delaware St SE, MMC 388, Minneapolis, MN, 55455, USA; Rehabilitation Medicine, Gillette Children's Specialty Healthcare, 200 University Ave E, St Paul, MN, 55101, USA
| | - Tim Feyma
- Neurology, Gillette Children's Specialty Healthcare, 200 University Ave E, St Paul, MN, 55101, USA
| | - Bernadette T Gillick
- Department of Rehabilitation Medicine, University of Minnesota, 420 Delaware St SE, MMC 388, Minneapolis, MN, 55455, USA; Department of Pediatrics, University of Wisconsin-Madison, 1500 Highland Avenue, Madison, WI, 53705, USA
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10
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Effect of Transcranial Direct Current Stimulation versus Virtual Reality on Gait for Children with Bilateral Spastic Cerebral Palsy: A Randomized Clinical Trial. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020222. [PMID: 36832351 PMCID: PMC9955548 DOI: 10.3390/children10020222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/20/2023] [Accepted: 01/22/2023] [Indexed: 02/03/2023]
Abstract
Impaired gait is a common sequela in bilateral spastic cerebral palsy. We compared the effects of two novel research interventions-transcranial direct current stimulation and virtual reality-on spatiotemporal and kinetic gait impairments in children with bilateral spastic CP. Forty participants were randomized to receive either transcranial direct current stimulation or virtual reality training. Both groups received standard-of-care gait therapy during the assigned intervention and for the subsequent 10 weeks afterward. Spatiotemporal and kinetic gait parameters were evaluated at three different times: (i) before starting the intervention, (ii) after two weeks of intervention, and (iii) 10 weeks after intervention completion. Both groups exhibited higher velocity and cadence, as well as longer stance time, step length, and stride length after intervention (p < 0.001). Only the transcranial direct current stimulation group exhibited increased maximum force and maximum peak pressure after intervention (p's ≤ 0.001), with continued improvements in spatiotemporal parameters at follow-up. The transcranial direct current stimulation group had higher gait velocities, stride length, and step length at follow-up compared to the virtual reality group (p ≤ 0.02). These findings suggest that transcranial direct current stimulation has a broader and longer-lasting effect on gait than virtual reality training for children with bilateral spastic cerebral palsy.
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11
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Hilderley AJ, Wright FV, Taylor MJ, Chen JL, Fehlings D. Functional Neuroplasticity and Motor Skill Change Following Gross Motor Interventions for Children With Diplegic Cerebral Palsy. Neurorehabil Neural Repair 2023; 37:16-26. [PMID: 36524254 PMCID: PMC9896542 DOI: 10.1177/15459683221143503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Gross motor intervention designs for children with diplegic cerebral palsy (DCP) require an improved understanding of the children's potential for neuroplasticity. OBJECTIVE To identify relations between functional neuroplasticity and motor skill changes following gross motor interventions for children with DCP. METHODS There were 17 participants with DCP (ages 8-16 years; 6 females; Gross Motor Function Classification System Level I [n = 9] and II [n = 8]). Each completed a 6-week gross motor intervention program that was directed toward achievement of individualized motor/physical activity goals. Outcomes were assessed pre/post and 4 to 6 months post-intervention (follow-up). An active ankle dorsiflexion task was completed during functional magnetic resonance imaging. The ratio of motor cortical activation volume in each hemisphere was calculated using a laterality index. The Challenge was the primary gross motor skill measure. Change over time and relations among outcomes were evaluated. RESULTS Challenge scores improved post-intervention (4.57% points [SD 4.45], P = .004) and were maintained at follow-up (0.75% [SD 6.57], P = 1.000). The laterality index for dominant ankle dorsiflexion increased (P = .033), while non-dominant change was variable (P = .534). Contralateral activation (laterality index ≥+0.75) was most common for both ankles. Challenge improvements correlated with increased ipsilateral activity (negative laterality index) during non-dominant dorsiflexion (r = -.56, P = .045). Smaller activation volume during non-dominant dorsiflexion predicted continued gross motor gains at follow-up (R2 = .30, P = .040). CONCLUSIONS Motor cortical activation during non-dominant ankle dorsiflexion is a modest indicator of the potential for gross motor skill change. Further investigation of patterns of neuroplastic change will improve our understanding of effects. CLINICALTRIALS.GOV REGISTRY NCT02584491 and NCT02754128.
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Affiliation(s)
- Alicia J. Hilderley
- Bloorview Research Institute, Holland
Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - F. Virginia Wright
- Bloorview Research Institute, Holland
Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada,Department of Physical Therapy,
University of Toronto, Toronto, ON, Canada
| | - Margot J. Taylor
- Diagnostic Imaging, The Hospital for
Sick Children, Toronto, ON, Canada,Department of Medical Imaging,
University of Toronto, Toronto, ON, Canada,Department of Psychology, University of
Toronto, Toronto, ON, Canada
| | - Joyce L. Chen
- Faculty of Kinesiology and Physical
Education, University of Toronto, Toronto, ON, Canada,Hurvitz Brain Sciences Program,
Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, Toronto,
ON, Canada
| | - Darcy Fehlings
- Bloorview Research Institute, Holland
Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada,Department of Paediatrics, Faculty of
Medicine, University of Toronto, Toronto, ON, Canada,Darcy Fehlings, Holland Bloorview Kids
Rehabilitation Hospital, 150 Kilgour Road, Toronto, ON M4G 1R8, Canada.
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12
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Dumont AJL, Cimolin V, Parreira RB, Armbrust D, Fonseca DRP, Fonseca AL, Cordeiro L, Franco RC, Duarte NAC, Galli M, Oliveira CS. Effects of Transcranial Direct Current Stimulation Combined with Treadmill Training on Kinematics and Spatiotemporal Gait Variables in Stroke Survivors: A Randomized, Triple-Blind, Sham-Controlled Study. Brain Sci 2022; 13:brainsci13010011. [PMID: 36671993 PMCID: PMC9856811 DOI: 10.3390/brainsci13010011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/08/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022] Open
Abstract
The present study assessed the effects of anodal transcranial direct current stimulation (tDCS) combined with treadmill training on spatiotemporal and kinematic variables in stroke survivors using gait speed as the primary outcome. A randomized, sham-controlled, triple-blind, study was conducted involving 28 patients with hemiparesis allocated to two groups. The experimental group was submitted to treadmill training combined with anodal tDCS over the primary motor cortex (M1) of the damaged hemisphere. The control group was submitted to treadmill training combined with sham tDCS. Stimulation was administered (2 mA, 20 min) five times a week for two weeks during treadmill training. No significant differences (p > 0.05) in spatiotemporal variables were found in the intra-group and inter-group analyses. However, the experimental group demonstrated improvements in kinematic variables of the knee and ankle (p < 0.05) and these results were maintained one month after the end of the intervention. The inter-group analysis revealed significant differences (p < 0.05) with regard to the pelvis, hip and knee. Anodal tDCS over M1 of the damaged hemisphere combined with treadmill training did not affect spatiotemporal variables, but promoted improvements in kinematic variables of the pelvis, hip, knee and ankle and results were maintained one month after treatment.
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Affiliation(s)
| | - Veronica Cimolin
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milan, Italy
- Istituto Auxologico Italiano, IRCCS, S. Giuseppe Hospital, 28824 Piancavallo, Italy
| | - Rodolfo Borges Parreira
- Health Sciences Program, Santa Casa School of Medical Sciences of São Paulo, St. Jaguaribe 155, São Paulo 01224-001, Brazil
| | - Danilo Armbrust
- Health Sciences Program, Santa Casa School of Medical Sciences of São Paulo, St. Jaguaribe 155, São Paulo 01224-001, Brazil
| | - Daniela Rosana Pedro Fonseca
- Human Movement and Rehabilitation, Post-Graduate Program Medical School, Evangelic University of Goiás—UniEVANGÉLICA, Anápolis 75083-515, Brazil
| | - Adriano Luís Fonseca
- Human Movement and Rehabilitation, Post-Graduate Program Medical School, Evangelic University of Goiás—UniEVANGÉLICA, Anápolis 75083-515, Brazil
| | - Lorraine Cordeiro
- Human Movement and Rehabilitation, Post-Graduate Program Medical School, Evangelic University of Goiás—UniEVANGÉLICA, Anápolis 75083-515, Brazil
| | - Renata Calhes Franco
- Departamento de Fisioterapia, University Center of Americas, Campus Consolação, Street Augusta 1508, São Paulo 01304-001, Brazil
| | - Natália Almeida Carvalho Duarte
- Human Movement and Rehabilitation, Post-Graduate Program Medical School, Evangelic University of Goiás—UniEVANGÉLICA, Anápolis 75083-515, Brazil
| | - Manuela Galli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milan, Italy
| | - Cláudia Santos Oliveira
- Human Movement and Rehabilitation, Post-Graduate Program Medical School, Evangelic University of Goiás—UniEVANGÉLICA, Anápolis 75083-515, Brazil
- Correspondence: ; Tel.: +55-(62)-3310-6600
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13
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Simpson EA, Saiote C, Sutter E, Lench DH, Ikonomidou C, Villegas MA, Gillick BT. Remotely monitored transcranial direct current stimulation in pediatric cerebral palsy: open label trial protocol. BMC Pediatr 2022; 22:566. [PMID: 36175848 PMCID: PMC9521558 DOI: 10.1186/s12887-022-03612-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 09/14/2022] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Pediatric applications of non-invasive brain stimulation using transcranial direct current stimulation (tDCS) have demonstrated its safety with few adverse events reported. Remotely monitored tDCS, as an adjuvant intervention to rehabilitation, may improve quality of life for children with cerebral palsy (CP) through motor function improvements, reduced treatment costs, and increased access to tDCS therapies. Our group previously evaluated the feasibility of a remotely monitored mock tDCS setup in which families and children successfully demonstrated the ability to follow tDCS instructional guidance. METHODS AND DESIGN Here, we designed a protocol to investigate the feasibility, safety, and tolerability of at-home active transcranial direct current stimulation in children with CP with synchronous supervision from laboratory investigators. Ten participants will be recruited to participate in the study for 5 consecutive days with the following sessions: tDCS setup practice on day 1, sham tDCS on day 2, and active tDCS on days 3-5. Sham stimulation will consist of an initial 30-second ramp up to 1.5 mA stimulation followed by a 30-second ramp down. Active stimulation will be delivered at 1.0 - 1.5 mA for 20 minutes and adjusted based on child tolerance. Feasibility will be evaluated via photographs of montage setup and the quality of stimulation delivery. Safety and tolerability will be assessed through an adverse events survey, the Box and Blocks Test (BBT) motor assessment, and a setup ease/comfort survey. DISCUSSION We expect synchronous supervision of at-home teleneuromodulation to be tolerable and safe with increasing stimulation quality over repeated sessions when following a tDCS setup previously determined to be feasible. The findings will provide opportunity for larger clinical trials exploring efficacy and illuminate the potential of remotely monitored tDCS in combination with rehabilitation interventions as a means of pediatric neurorehabilitation. This will demonstrate the value of greater accessibility of non-invasive brain stimulation interventions and ultimately offer the potential to improve care and quality of life for children and families with CP. TRIAL REGISTRATION October 8, 2021( https://clinicaltrials.gov/ct2/show/NCT05071586 ).
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Affiliation(s)
- Emma A Simpson
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Avenue Room 491, Madison, Wisconsin, 53706, USA
| | - Catarina Saiote
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Avenue Room 491, Madison, Wisconsin, 53706, USA
| | - Ellen Sutter
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Avenue Room 491, Madison, Wisconsin, 53706, USA
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Daniel H Lench
- Department of Neurology, Medical University of South Carolina, Charleston, South Carolina, USA
| | | | - Melissa A Villegas
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Avenue Room 491, Madison, Wisconsin, 53706, USA
- University of Wisconsin-Madison Pediatrics, Madison, Wisconsin, USA
| | - Bernadette T Gillick
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Avenue Room 491, Madison, Wisconsin, 53706, USA.
- University of Wisconsin-Madison Pediatrics, Madison, Wisconsin, USA.
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14
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He W, Huang Y, He L, Liu L, Zeng P, Qiu H, Wang X, Zhou H, Chen Z, Xu Y, Zhao J, Wang W, Tang H, Xu K. Safety and effects of transcranial direct current stimulation on hand function in preschool children with hemiplegic cerebral palsy: A pilot study. Front Behav Neurosci 2022; 16:925122. [PMID: 36160682 PMCID: PMC9500382 DOI: 10.3389/fnbeh.2022.925122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 08/16/2022] [Indexed: 11/13/2022] Open
Abstract
Transcranial direct current stimulation (tDCS) has shown a promising prospect in improving function and spasticity in school-aged children with cerebral palsy, but little is known in preschool children. The aim of this study was to explore the safety and effects of tDCS on hand function in preschool children (aged 3–6 years) with hemiplegic cerebral palsy (HCP). We designed a crossover, single-blind, sham-controlled study in 30 preschool children with HCP, who were recruited to receive one session of sham and one session of active anodal tDCS (1.5 mA, 20 min) on the primary motor cortex of the affected hemisphere, with a 24-h interval between the two sessions. Questionnaire was completed by each participant and their attendants immediately, 90 min, and 24 h after each session to monitor common adverse events of tDCS, such as skin irritation, skin erythema, burning sensation, headache, dizziness, etc. Box and Block Test, Selective Control of the Upper Extremity Scale, Modified Ashworth Scale, and Melbourne Assessment 2 were conducted at baseline, immediately, and 90 min after each session. No severe adverse event occurred during the study and only a few of them felt transient and slight discomfort. Results also showed that all participants performed better at Box and Block Test of the hemiplegic hand immediately after a single anodal tDCS (P < 0.05) and this improvement lasted at least 90 min and more than 24 h. However, there was no significant improvement in Selective Control of the Upper Extremity Scale of both hands, Box and Block Test of the non-hemiplegic hand, Modified Ashworth Scale, and Melbourne Assessment 2 of the hemiplegic upper limb (P > 0.05). Shortly, this study supported the safety and effects of a single anodal tDCS on improving the manual dexterity of the hemiplegic hand for preschool children with HCP. Further researches with larger samples about the optimal dose and treatment cycle of tDCS for preschool children with HCP are warranted. This study gained the approval of ethics committee of the organization and was registered at chictr.org (ChiCTR2000031141).
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Affiliation(s)
- Wenjie He
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Yuan Huang
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
- School of Medicine, South China University of Technology, Guangzhou, China
| | - Lu He
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Liru Liu
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Peishan Zeng
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Huiying Qiu
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Xiaoyue Wang
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Hongyu Zhou
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Zhaofang Chen
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Yi Xu
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Jingyi Zhao
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Wenda Wang
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Hongmei Tang
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
- Hongmei Tang
| | - Kaishou Xu
- Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
- *Correspondence: Kaishou Xu
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15
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Furtado MAS, Ayupe KMA, Christovão IS, Sousa Junior RR, Rosenbaum P, Camargos ACR, Leite HR. Physical therapy in children with cerebral palsy in Brazil: a scoping review. Dev Med Child Neurol 2022; 64:550-560. [PMID: 34601719 DOI: 10.1111/dmcn.15067] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 08/30/2021] [Accepted: 09/01/2021] [Indexed: 02/06/2023]
Abstract
AIM To identify and assess published studies concerning physical therapy in Brazilian children and adolescents with cerebral palsy (CP) using the International Classification of Functioning, Disability and Health (ICF) framework. METHOD Articles in English and Portuguese published until October 2020, with no date restrictions, were searched in several different databases. Study characteristics, journal metrics, sample characteristics, and ICF domains explored intervention components and outcomes were extracted. Studies were classified according to the Oxford Centre for Evidence-Based Medicine hierarchy levels to characterize the evidence. RESULTS Ninety-four studies were included. Spastic CP with fewer limitations in gross motor abilities was the most reported; 67% of the studies had low levels of evidence and were published in journals without an impact factor. The three most frequent interventions were neurodevelopmental treatment, suit therapy, and transcranial direct current stimulation. Intervention components explored body functions and structures (73.4%), activity (59.6%), environment (2.1%). They did not explore participation (0%). The outcomes investigated addressed activity (79.8%), body functions and structures (67.0%), and participation (1.1%), but not environment (0%). INTERPRETATION Studies of physical therapy for Brazilian children and adolescents with CP focused on reducing impairments and activity limitations. Studies with higher levels of evidence and an expanded focus on participation and environmental factors are necessary.
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Affiliation(s)
- Michelle A S Furtado
- Graduate Program in Rehabilitation and Functional Performance, Physical Therapy Department, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil.,Graduate Program in Rehabilitation Sciences, School of Physical Education, Physiotherapy and Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Kênnea M A Ayupe
- Physical Therapy Department, Universidade de Brasília, Brasília, Brazil
| | - Isabella S Christovão
- Graduate Program in Rehabilitation Sciences, School of Physical Education, Physiotherapy and Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Ricardo R Sousa Junior
- Graduate Program in Rehabilitation Sciences, School of Physical Education, Physiotherapy and Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Peter Rosenbaum
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada
| | - Ana C R Camargos
- Graduate Program in Rehabilitation Sciences, School of Physical Education, Physiotherapy and Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Hércules R Leite
- Graduate Program in Rehabilitation and Functional Performance, Physical Therapy Department, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil.,Graduate Program in Rehabilitation Sciences, School of Physical Education, Physiotherapy and Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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16
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Furtado MAS, Ayupe KMA, Christovão IS, Sousa Júnior RR, Rosenbaum P, Camargos ACR, Leite HR. Fisioterapia em crianças com paralisia cerebral no Brasil: uma revisão de escopo. Dev Med Child Neurol 2022; 64:e2-e12. [PMID: 34689323 DOI: 10.1111/dmcn.15094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/01/2021] [Indexed: 11/26/2022]
Abstract
OBJETIVO Identificar e avaliar os estudos publicados sobre fisioterapia em crianças e adolescentes brasileiros com paralisia cerebral (PC), usando o modelo da Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF). MÉTODO: Artigos em inglês e português publicados até outubro de 2020, sem restrição de data, foram pesquisados em diferentes bases bibliográficas. Foram extraídos dados sobre as características do estudo, métricas do periódico, características da amostra, domínios da CIF explorados a partir dos componentes e desfechos das intervenções. Para caracterizar as evidências, os estudos foram classificados de acordo com os níveis de evidência do Centro de Medicina Baseada em Evidência de Oxford. RESULTADOS Noventa e quatro estudos foram incluídos. Crianças com PC espástica e com menores limitações nas habilidades motoras grossas foram as mais reportadas; 67% dos estudos apresentaram baixos níveis de evidência e foram publicados em periódicos sem fator de impacto. As três intervenções mais frequentes foram o conceito neuroevolutivo Bobath/terapia do neurodesenvolvimento, a terapia com vestes e a estimulação transcraniana por corrente contínua. Os componentes das intervenções exploraram estruturas e funções do corpo (73,4%), atividade (59,6%) e ambiente (2,1%). Entretanto não exploraram a participação (0%). Os desfechos investigados abordaram atividade (79,8%), estruturas e funções do corpo (67,0%), participação (1%) e ambiente (0%). INTERPRETAÇÃO: Os estudos de intervenções fisioterapêuticas para crianças e adolescentes brasileiros com PC, apresentam maior foco em minimizar deficiências em estruturas e funções do corpo e limitações de atividades. São necessários mais estudos, com melhor nível de evidência e foco ampliado para a participação e os fatores ambientais.
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Affiliation(s)
- Michelle A S Furtado
- Programa de Pós-graduação em Reabilitação e Desempenho Funcional, Departamento de Fisioterapia, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Minas Gerais, Brasil.,Programa de Pós-graduação em Ciências da Reabilitação, Escola de Educação Física, Fisioterapia e Terapia Ocupacional, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brasil
| | - Kênnea M A Ayupe
- Faculdade de Ceilância, Colegiado de Fisioterapia, Universidade de Brasília (UnB), Brasília, Distrito Federal, Brasil
| | - Isabella S Christovão
- Programa de Pós-graduação em Ciências da Reabilitação, Escola de Educação Física, Fisioterapia e Terapia Ocupacional, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brasil
| | - Ricardo R Sousa Júnior
- Programa de Pós-graduação em Ciências da Reabilitação, Escola de Educação Física, Fisioterapia e Terapia Ocupacional, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brasil
| | - Peter Rosenbaum
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada
| | - Ana C R Camargos
- Programa de Pós-graduação em Ciências da Reabilitação, Escola de Educação Física, Fisioterapia e Terapia Ocupacional, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brasil
| | - Hércules R Leite
- Programa de Pós-graduação em Reabilitação e Desempenho Funcional, Departamento de Fisioterapia, Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM), Diamantina, Minas Gerais, Brasil.,Programa de Pós-graduação em Ciências da Reabilitação, Escola de Educação Física, Fisioterapia e Terapia Ocupacional, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brasil
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17
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Hadoush H, Almasri NA, Alnuman N. The Effect of Bilateral Anodal Transcranial Direct Current Stimulation versus Treadmill Training on Brain Activities, Gait Functions, Level of Participation and Enjoyment of Children with Cerebral Palsy: A Randomized Controlled Trial Protocol. Dev Neurorehabil 2022; 25:73-79. [PMID: 33775198 DOI: 10.1080/17518423.2021.1905730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Cerebral palsy (CP) possesses bilateral sensory-motor cortical excitability alterations. In past studies, researchers have applied unilateral anodal transcranial direct stimulation (tDCS) with inconsistent findings. OBJECTIVE Examining the effects of treadmill training with either unilateral or bilateral anodal tDCS stimulation on brain activities, gait, and body functions of children with CP. DESIGN Randomized-clinical-trial. PARTICIPANTS Eighty children with CP will be allocated into: treadmill/bilateral-tDCS, treadmill/unilateral-tDCS, treadmill/sham-tDCS, and treadmill groups. Additional 20 neurotypical children will be recruited for comparison. INTERVENTION Planned intervention will implement ten-sessions of treadmill training (50% of maximum-ground speed) either with unilateral-tDCS over left sensory-motor, or bilateral-tDCS over left/right sensory-motor areas. Brain activities, gait, body functions, and participation will be assessed at pre-intervention, post-intervention, and at one-month follow-up. RESULT AND DISCUSSION This study would contribute to extant findings on the use of tDCS stimulation in children with CP and to our understanding of the appropriateness of the planned outcome measures.
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Affiliation(s)
- Hikmat Hadoush
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences at Jordan University of Science and Technology, Irbid, Jordan
| | - Nihad A Almasri
- Department of Physiotherapy, School of Rehabilitation Sciences, University of Jordan, Amman, Jordan
| | - Nasim Alnuman
- Department of Biomedical Engineering, School of Applied Medical Sciences, German-Jordan University, Jordan
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18
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Salazar Fajardo JC, Kim R, Gao C, Hong J, Yang J, Wang D, Yoon B. The Effects of tDCS with NDT on the Improvement of Motor Development in Cerebral Palsy. J Mot Behav 2021; 54:480-489. [PMID: 34913842 DOI: 10.1080/00222895.2021.2016572] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
We investigated the effects of transcranial direct current stimulation (tDCS) over the primary motor cortex (M1) with neurodevelopmental treatment (NDT) on the improvement of motor development and reduction of spasticity in children with cerebral palsy (CP). Twenty-four children with CP were allocated to two groups: the tDCS + NDT group and the only NDT group, done 3 times per week for 5 weeks. The Gross Motor Function Measurement (GMFM-88) and Box and Block Test (BBT) were used to assess changes in motor development, and the Modified Ashworth Scale (MAS) was used to evaluate changes in spasticity. All measurements were carried out at 3 time points: baseline, post-intervention, and 1 month follow-up. We found improvements in the GMFM-88 total scores and in each individual GMFM-88 dimension scores, favoring the tDCS + NDT group over the only NDT group. The BBT scores improved only in the tDCS + NDT group. In addition, the MAS scores reduced in the hemibody with significant motor impairment only in the tDCS + NDT group. The present findings suggest that tDCS combined with NDT can be considered a promising intervention for children with CP, as it can enhance motor development and reduce spasticity in this population.
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Affiliation(s)
- Jhosedyn Carolaym Salazar Fajardo
- Major of Rehabilitation Science, Graduate School, Korea University, Seoul, Korea.,Department of Health Sciences, Graduate School, Korea University, Seoul, Korea
| | - RockHyun Kim
- Major of Rehabilitation Science, Graduate School, Korea University, Seoul, Korea.,Department of Health Sciences, Graduate School, Korea University, Seoul, Korea
| | - Chang Gao
- Department of Health Sciences, Graduate School, Korea University, Seoul, Korea.,BK21FOUR R&E Center for Learning Health Systems, Korea University, Seoul, Korea
| | - JiYeon Hong
- Purme Foundation, NEXON Children's Rehabilitation Hospital, Seoul, Korea
| | - JinKyu Yang
- Purme Foundation, NEXON Children's Rehabilitation Hospital, Seoul, Korea
| | | | - BumChul Yoon
- Major of Rehabilitation Science, Graduate School, Korea University, Seoul, Korea.,Department of Health Sciences, Graduate School, Korea University, Seoul, Korea.,BK21FOUR R&E Center for Learning Health Systems, Korea University, Seoul, Korea
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19
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Hornáček K, Kujawa J, Varela Donoso E, Dincer F, Ilieva E, Takáč P, Petronic Markovic I, Votava J, Vetra A, Nikolic D, Christodoulou N, Zampolini M, Kiekens C. Evidence Based Position Paper on Physical and Rehabilitation Medicine professional practice for persons with cerebral palsy. Eur J Phys Rehabil Med 2021; 57:1020-1035. [PMID: 33861040 DOI: 10.23736/s1973-9087.21.06983-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Cerebral palsy (CP) is a group of the most common developmental disorders affecting movement and posture of the body, causing activity limitations and participation restrictions. The motor disorders of persons with CP are often accompanied by disturbances of sensation, cognition, communication and perception. The symptoms of CP are very diverse and persons with CP are usually presented with a mixed type of symptoms. The non-progressive disturbances can be attributed to disorders that were developed during pregnancy, birth and/or infant stage. AIM The aim of this study was to improve Physical and Rehabilitation Medicine physician´s professional practice for persons with cerebral palsy in order to improve their functionality, social and community integration, and to reduce activity limitations and/or participation restrictions. MATERIAL AND METHODS A systematic review of the literature including an eighteen-year period and consensus procedure by means of a Delphi process was performed and involved the delegates of all European countries represented in the Union of European Medical Specialists Physical and Rehabilitation Medicine (UEMS PRM) Section. RESULTS As the result of a Consensus Delphi procedure process 74 recommendations are presented together with the systematic literature review. CONCLUSIONS The PRM physician´s role for persons with cerebral palsy is to lead and coordinate the multiprofessional team, working in an interdisciplinary way. They should propose and manage the complex but individual PRM programme developed in conjunction with other health professionals, medical specialists and importantly in agreement with the patient, their family and care giver. This should be, according to the specific medical diagnosis to improve patients´ health, functioning, social and education status, considering all impairments, comorbidities and complications, activity limitations and participation restrictions.
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Affiliation(s)
- Karol Hornáček
- Department of Physical and Rehabilitation Medicine, Faculty of Medicine, Slovak Medical University, Bratislava, Slovakia
| | - Jolanta Kujawa
- Department of Physical and Rehabilitation Medicine, Medical University of Lodz, Lodz, Poland
| | - Enrique Varela Donoso
- Physical and Rehabilitation Medicine Department, Complutense University of School of Medicine, Madrid, Spain
| | - Fitnat Dincer
- Department of Physical and Rehabilitation Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Elena Ilieva
- Department of Physical and Rehabilitation Medicine, Medical Faculty, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Peter Takáč
- Department of Physical and Rehabilitation Medicine, L. Pasteur University Hospital, Faculty of Medicine, Pavol Jozef Šafárik University, Košice, Slovak Republic -
| | - Ivana Petronic Markovic
- Department of Physical and Rehabilitation Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Jiří Votava
- Faculty of Health Studies, University of J. E. Purkyně, Ústí nad Labem, Czech Republic
| | - Anita Vetra
- Rehabilitation Department, Riga Stradins University, Riga, Latvia
| | - Dejan Nikolic
- Department of Physical and Rehabilitation Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Mauro Zampolini
- Department of Rehabilitation, Foligno Hospital, USL Umbria 2, Perugia, Italy
| | - Carlotte Kiekens
- Spinal Unit, Montecatone Rehabilitation Institute, Imola Bologna, Italy
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20
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Liu Z, Dong S, Zhong S, Huang F, Zhang C, Zhou Y, Deng H. The effect of combined transcranial pulsed current stimulation and transcutaneous electrical nerve stimulation on lower limb spasticity in children with spastic cerebral palsy: a randomized and controlled clinical study. BMC Pediatr 2021; 21:141. [PMID: 33761932 PMCID: PMC7989146 DOI: 10.1186/s12887-021-02615-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 03/17/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND In the current study, we applied a combination of non-invasive neuromodulation modalities concurrently with multiple stimulating electrodes. Specifically, we used transcranial pulsed current stimulation (tPCS) and transcutaneous electrical nerve stimulation (TENS) as a novel strategy for improving lower limb spasticity in children with spastic cerebral palsy (SCP) categorized on levels III-V of the Gross Motor Function Classification System (GMFCS) with minimal side effects. METHODS Sixty-three SCP children aged 2-12 years, who were classified on levels III-V of the GMFCS were randomly assigned to one of two groups, resulting in 32 children in the experimental group and 31 children in the control group. The experimental group underwent a combination therapy of tPCS (400 Hz, 1 mA cerebello-cerebral stimulation) and TENS (400 Hz, max 10 mA) for 30 min, followed by 30 min of physiotherapy five times per week for 12 weeks. The control group underwent physiotherapy only 30 mins per day five times per week for 12 weeks. In total, all groups underwent 60 treatment sessions. The primary outcome measures were the Modified Ashworth Scale (MAS) and Modified Tardieu Scale (MTS). Evaluations were performed 3 days before and after treatment. RESULTS We found a significant improvement in MAS and MTS scores of the lower limbs in the experimental group compared to the control group in the hip adductors (Left: p = 0.002; Right: p = 0.002), hamstrings (Left: p = 0.001; Right: p < 0.001, and gastrocnemius (Left: p = 0.001; Right: p = 0.000). Moreover, MTS scores of R1, R2 and R2-R1 in left and right hip adduction, knee joint, and ankle joint all showed significant improvements (p ≤ 0.05). Analysis of MAS and MTS scores compared to baseline scores showed significant improvements in the experimental group but declines in the control group. CONCLUSION These results are among the first to demonstrate that a combination of tPCS and TENS can significantly improve lower limb spasticity in SCP children classified on GMFCS levels III-V with minimal side effects, presenting a novel strategy for addressing spasticity challenges in children with severe SCP. TRIAL REGISTRATION ChiCTR.org, ChiCTR1800020283, Registration: 22 December 2018 (URL: http://www.chictr.org.cn/showproj.aspx?proj=33953 ).
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Affiliation(s)
- Zhenhuan Liu
- Department of Pediatric Rehabilitation, Nanhai Maternity and Children's Hospital Affiliated to Guangzhou University of Traditional Chinese Medicine, Foshan, Guangdong Province, China.
| | - Shangsheng Dong
- Department of Pediatric Rehabilitation, Jiangmen Maternity and Child Health Care Hospital, Jiangmen, Guangdong Province, China
| | - Sandra Zhong
- Guangzhou Yirui Charitable Foundation, Guangzhou, Guangdong Province, China
| | - Fang Huang
- Department of Pediatric Rehabilitation, Guangzhou City Social Welfare Institute Rehabilitation Hospital, Guangzhou, Guangdong Province, China
| | - Chuntao Zhang
- Department of Pediatric Rehabilitation, Nanhai Maternity and Children's Hospital Affiliated to Guangzhou University of Traditional Chinese Medicine, Foshan, Guangdong Province, China
| | - Yuan Zhou
- Department of Pediatric Rehabilitation, Nanhai Maternity and Children's Hospital Affiliated to Guangzhou University of Traditional Chinese Medicine, Foshan, Guangdong Province, China
| | - Haorong Deng
- Department of Pediatric Rehabilitation, Guangzhou City Social Welfare Institute Rehabilitation Hospital, Guangzhou, Guangdong Province, China
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21
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Azevedo CC, Trevizol AP, Gomes JS, Akiba H, Franco RR, Simurro PB, Ianni RM, Grigolon RB, Blumberger DM, Dias AM. Transcranial Direct Current Stimulation for Prader-Willi Syndrome. J ECT 2021; 37:58-63. [PMID: 33009217 DOI: 10.1097/yct.0000000000000722] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Given the limited therapeutic options for Prader-Willi syndrome (PWS), we conducted an open-label clinical trial to evaluate the effects of transcranial direct current stimulation (tDCS) for hyperphagia, food craving, and aberrant behaviors on this population. METHODS Twelve subjects with PWS (11-35 years old) were included. The subjects underwent 10 daily 20-minute sessions of tDCS in 2 weeks. The anode was positioned over the left dorsolateral prefrontal cortex, and the cathode over the contralateral region. RESULTS We observed amelioration of hyperphagic and food craving symptoms (P < 0.05), as well as amelioration of behavioral symptoms measured with the Aberrant Behavior Checklist (P < 0.05). DISCUSSION To our knowledge, this is the first proof-of-concept trial to report the positive effects of increasing excitability of the left dorsolateral prefrontal cortex, using tDCS, for the behavioral, hyperphagia, and food craving symptoms in PWS, which is a low-cost, well-studied, safe alternative for brain stimulation.
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Affiliation(s)
- Caroline C Azevedo
- From the Interdisciplinary Laboratory of Clinical Neroscience, Federal University of São Paulo, São Paulo, Brazil
| | | | - July S Gomes
- From the Interdisciplinary Laboratory of Clinical Neroscience, Federal University of São Paulo, São Paulo, Brazil
| | - Henrique Akiba
- From the Interdisciplinary Laboratory of Clinical Neroscience, Federal University of São Paulo, São Paulo, Brazil
| | - Ruth R Franco
- Division of Pediatric Endocrinology, Children's Hospital, University of São Paulo Medical School
| | - Paula B Simurro
- From the Interdisciplinary Laboratory of Clinical Neroscience, Federal University of São Paulo, São Paulo, Brazil
| | - Renata M Ianni
- From the Interdisciplinary Laboratory of Clinical Neroscience, Federal University of São Paulo, São Paulo, Brazil
| | - Ruth B Grigolon
- From the Interdisciplinary Laboratory of Clinical Neroscience, Federal University of São Paulo, São Paulo, Brazil
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O'Leary GH, Jenkins DD, Coker-Bolt P, George MS, Kautz S, Bikson M, Gillick BT, Badran BW. From adults to pediatrics: A review noninvasive brain stimulation (NIBS) to facilitate recovery from brain injury. PROGRESS IN BRAIN RESEARCH 2021; 264:287-322. [PMID: 34167660 DOI: 10.1016/bs.pbr.2021.01.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Stroke is a major problem worldwide that impacts over 100 million adults and children annually. Rehabilitation therapy is the current standard of care to restore functional impairments post-stroke, however its effects are limited and many patients suffer persisting functional impairments and life-long disability. Noninvasive Brain Stimulation (NIBS) has emerged as a potential rehabilitation treatment option in both adults and children with brain injury. In the last decade, Transcranial Magnetic Stimulation (TMS), Transcranial Direct Current Stimulation (tDCS) and Transcutaneous Auricular Vagus Nerve Stimulation (taVNS) have been investigated to improve motor recovery in adults post-stroke. These promising adult findings using NIBS, however, have yet to be widely translated to the area of pediatrics. The limited studies exploring NIBS in children have demonstrated safety, feasibility, and utility of stimulation-augmented rehabilitation. This chapter will describe the mechanism of NIBS therapy (cortical excitability, neuroplasticity) that underlies its use in stroke and motor function and how TMS, tDCS, and taVNS are applied in adult stroke treatment paradigms. We will then discuss the current state of NIBS in early pediatric brain injury and will provide insight regarding practical considerations and future applications of NIBS in pediatrics to make this promising treatment option a viable therapy in children.
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Affiliation(s)
- Georgia H O'Leary
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Dorothea D Jenkins
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, United States
| | - Patricia Coker-Bolt
- Division of Occupational Therapy, College of Health Professions, Medical University of South Carolina, Charleston, SC, United States
| | - Mark S George
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States; Ralph H. Johnson VA Medical Center, Charleston, SC, United States
| | - Steve Kautz
- Ralph H. Johnson VA Medical Center, Charleston, SC, United States; Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC, United States
| | - Marom Bikson
- Department of Biomedical Engineering, City College of New York, New York, NY, United States
| | - Bernadette T Gillick
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Bashar W Badran
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, United States.
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23
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Ko EJ, Hong MJ, Choi EJ, Yuk JS, Yum MS, Sung IY. Effect of Anodal Transcranial Direct Current Stimulation Combined With Cognitive Training for Improving Cognition and Language Among Children With Cerebral Palsy With Cognitive Impairment: A Pilot, Randomized, Controlled, Double-Blind, and Clinical Trial. Front Pediatr 2021; 9:713792. [PMID: 34513765 PMCID: PMC8424100 DOI: 10.3389/fped.2021.713792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/03/2021] [Indexed: 11/23/2022] Open
Abstract
About 30-45% of cerebral palsy (CP) patients have cognitive impairment. Previous studies showed the evidence that transcranial direct current stimulation (tDCS) may have some benefits in attention-deficit/hyperactivity disorder, autism spectrum disorder, and motor development in CP. The aim of this study is to evaluate the effect of tDCS on cognition, language, and activities of daily living (ADL) among children with CP with cognitive impairment. It was a pilot, randomized, controlled, double-blind, clinical trial in a tertiary pediatric hospital, and 13 children with CP and a cognitive age under 42 months were enrolled. tDCS group (n = 8) had active tDCS and cognitive training (20 min/session, total 20 sessions, for 12 weeks) and sham group (n = 5) had sham tDCS and cognitive training. Primary outcome was the Bayley Scales of Infant Development II (BSID II). Secondary outcomes were the Pediatric Evaluation of Disability Inventory (PEDI), the Laboratory Temperament Assessment Battery (Lab-TAB), the Early Childhood Behavior Questionnaire (ECBQ), the Korean version of MacArthur-Bates Communicative Development Inventories (M-B CDI-K), the Sequenced Language Scale for Infants (SELSI) and the Preschool Receptive-Expressive Language Scale (PRES). After intervention, the tDCS group showed significant improvements in all measurements (p < 0.05) except the M-B CDI-K (grammar), whereas the sham group only showed significant improvements in the Lab-TAB (manipulation domain), the ECBQ (attentional shifting), and the M-B CDI-K (comprehension). The between-group differences in the degree of post-intervention improvement were not statistically significant. The degree of improvement was associated with better baseline cognitive function and younger age (p < 0.05). There were no major adverse events after tDCS. The combined application of tDCS and cognitive training was feasible and associated with improvements in cognitive function, ADL, and language among children with CP with cognitive impairment. However, considering that it is a pilot study, further larger-scale systematic investigation is needed. Clinical Trial Registration: The trial was registered in the Clinical Research Information Service database, identifier: KCT0003023.
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Affiliation(s)
- Eun Jae Ko
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Mi Jin Hong
- Department of Rehabilitation Medicine, Konyang Medical Center, University of Konyang College of Medicine, Daejeon, South Korea
| | - Eun Jung Choi
- Department of Rehabilitation Medicine, Seongnam Citizens Medical Center, Seongnam, South Korea
| | - Jin Sook Yuk
- Department of Rehabilitation Medicine, Asan Medical Center, Seoul, South Korea
| | - Mi Sun Yum
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, South Korea
| | - In Young Sung
- Department of Rehabilitation Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Chiu HC, Ada L, Bania TA. Mechanically assisted walking training for walking, participation, and quality of life in children with cerebral palsy. Cochrane Database Syst Rev 2020; 11:CD013114. [PMID: 33202482 PMCID: PMC8092676 DOI: 10.1002/14651858.cd013114.pub2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Cerebral palsy is the most common physical disability in childhood. Mechanically assisted walking training can be provided with or without body weight support to enable children with cerebral palsy to perform repetitive practice of complex gait cycles. It is important to examine the effects of mechanically assisted walking training to identify evidence-based treatments to improve walking performance. OBJECTIVES To assess the effects of mechanically assisted walking training compared to control for walking, participation, and quality of life in children with cerebral palsy 3 to 18 years of age. SEARCH METHODS In January 2020, we searched CENTRAL, MEDLINE, Embase, six other databases, and two trials registers. We handsearched conference abstracts and checked reference lists of included studies. SELECTION CRITERIA Randomized controlled trials (RCTs) or quasi-RCTs, including cross-over trials, comparing any type of mechanically assisted walking training (with or without body weight support) with no walking training or the same dose of overground walking training in children with cerebral palsy (classified as Gross Motor Function Classification System [GMFCS] Levels I to IV) 3 to 18 years of age. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS This review includes 17 studies with 451 participants (GMFCS Levels I to IV; mean age range 4 to 14 years) from outpatient settings. The duration of the intervention period (4 to 12 weeks) ranged widely, as did intensity of training in terms of both length (15 minutes to 40 minutes) and frequency (two to five times a week) of sessions. Six studies were funded by grants, three had no funding support, and eight did not report information on funding. Due to the nature of the intervention, all studies were at high risk of performance bias. Mechanically assisted walking training without body weight support versus no walking training Four studies (100 participants) assessed this comparison. Compared to no walking, mechanically assisted walking training without body weight support increased walking speed (mean difference [MD] 0.05 meter per second [m/s] [change scores], 95% confidence interval [CI] 0.03 to 0.07; 1 study, 10 participants; moderate-quality evidence) as measured by the Biodex Gait Trainer 2™ (Biodex, Shirley, NY, USA) and improved gross motor function (standardized MD [SMD] 1.30 [postintervention scores], 95% CI 0.49 to 2.11; 2 studies, 60 participants; low-quality evidence) postintervention. One study (30 participants) reported no adverse events (low-quality evidence). No study measured participation or quality of life. Mechanically assisted walking training without body weight support versus the same dose of overground walking training Two studies (55 participants) assessed this comparison. Compared to the same dose of overground walking, mechanically assisted walking training without body weight support increased walking speed (MD 0.25 m/s [change or postintervention scores], 95% CI 0.13 to 0.37; 2 studies, 55 participants; moderate-quality evidence) as assessed by the 6-minute walk test or Vicon gait analysis. It also improved gross motor function (MD 11.90% [change scores], 95% CI 2.98 to 20.82; 1 study, 35 participants; moderate-quality evidence) as assessed by the Gross Motor Function Measure (GMFM) and participation (MD 8.20 [change scores], 95% CI 5.69 to 10.71; 1 study, 35 participants; moderate-quality evidence) as assessed by the Pediatric Evaluation of Disability Inventory (scored from 0 to 59), compared to the same dose of overground walking training. No study measured adverse events or quality of life. Mechanically assisted walking training with body weight support versus no walking training Eight studies (210 participants) assessed this comparison. Compared to no walking training, mechanically assisted walking training with body weight support increased walking speed (MD 0.07 m/s [change and postintervention scores], 95% CI 0.06 to 0.08; 7 studies, 161 participants; moderate-quality evidence) as assessed by the 10-meter or 8-meter walk test. There were no differences between groups in gross motor function (MD 1.09% [change and postintervention scores], 95% CI -0.57 to 2.75; 3 studies, 58 participants; low-quality evidence) as assessed by the GMFM; participation (SMD 0.33 [change scores], 95% CI -0.27 to 0.93; 2 studies, 44 participants; low-quality evidence); and quality of life (MD 9.50% [change scores], 95% CI -4.03 to 23.03; 1 study, 26 participants; low-quality evidence) as assessed by the Pediatric Quality of Life Cerebral Palsy Module (scored 0 [bad] to 100 [good]). Three studies (56 participants) reported no adverse events (low-quality evidence). Mechanically assisted walking training with body weight support versus the same dose of overground walking training Three studies (86 participants) assessed this comparison. There were no differences between groups in walking speed (MD -0.02 m/s [change and postintervention scores], 95% CI -0.08 to 0.04; 3 studies, 78 participants; low-quality evidence) as assessed by the 10-meter or 5-minute walk test; gross motor function (MD -0.73% [postintervention scores], 95% CI -14.38 to 12.92; 2 studies, 52 participants; low-quality evidence) as assessed by the GMFM; and participation (MD -4.74 [change scores], 95% CI -11.89 to 2.41; 1 study, 26 participants; moderate-quality evidence) as assessed by the School Function Assessment (scored from 19 to 76). No study measured adverse events or quality of life. AUTHORS' CONCLUSIONS Compared with no walking, mechanically assisted walking training probably results in small increases in walking speed (with or without body weight support) and may improve gross motor function (with body weight support). Compared with the same dose of overground walking, mechanically assisted walking training with body weight support may result in little to no difference in walking speed and gross motor function, although two studies found that mechanically assisted walking training without body weight support is probably more effective than the same dose of overground walking training for walking speed and gross motor function. Not many studies reported adverse events, although those that did appeared to show no differences between groups. The results are largely not clinically significant, sample sizes are small, and risk of bias and intensity of intervention vary across studies, making it hard to draw robust conclusions. Mechanically assisted walking training is a means to undertake high-intensity, repetitive, task-specific training and may be useful for children with poor concentration.
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Affiliation(s)
- Hsiu-Ching Chiu
- Department of Physical Therapy, I-Shou University, Kaohsiung, Taiwan
| | - Louise Ada
- Discipline of Physiotherapy, The University of Sydney, Lidcombe, Australia
| | - Theofani A Bania
- Department of Physiotherapy, School of Health Rehabilitation Science, University of Patras, Myrtia, Greece
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Liang JN, Ubalde L, Jacklin J, Hobson P, Wright-Avila S, Lee YJ. Immediate Effects of Anodal Transcranial Direct Current Stimulation on Postural Stability Using Computerized Dynamic Posturography in People With Chronic Post-stroke Hemiparesis. Front Hum Neurosci 2020; 14:341. [PMID: 33192377 PMCID: PMC7482582 DOI: 10.3389/fnhum.2020.00341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 08/03/2020] [Indexed: 11/13/2022] Open
Abstract
Postural stability is commonly decreased in individuals with chronic post-stroke hemiparesis due to multisystemic deficits. Transcranial direct current stimulation (tDCS) is a non-invasive method to modulate cortical excitability, inducing neuroplastic changes to the targeted cortical areas and has been suggested to potentially improve motor functions in individuals with neurological impairments. The purpose of this double-blinded, sham-controlled study was to examine the acute effects of anodal tDCS over the lesioned motor cortex leg area with concurrent limits of stability training on postural control in individuals with chronic post-stroke hemiparesis. Ten individuals with chronic post-stroke hemiparesis received either anodal or sham tDCS stimulation over the lesioned leg region of the motor cortex while undergoing 20 min of postural training. The type of stimulation to receive during the first session was pseudorandomized, and the two sessions were separated by 14 days. Before and immediately after 20 min of tDCS, the 10 m walk test, the Berg Balance Scale, and dynamic posturography assessments were performed. After a single session of anodal tDCS with concurrent postural training, we observed no changes in clinical measures of balance and walking, assessed using the Berg Balance Scale and 10 m walk test. For dynamic posturography assessments, participants demonstrated improvements in adaptation responses to toes-up and toes-down perturbations, regardless of the type of tDCS received. Additionally, improved performance in the shifting center of gravity was observed during anodal tDCS. Taken together, these preliminary findings suggest that tDCS can potentially be used as a feasible approach be incorporated into the rehabilitation of chronic post-stroke individuals with issues related to postural control and fear of falling, and that multiple sessions of tDCS stimulation may be needed to improve functional measures of postural control and walking.
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Affiliation(s)
- Jing Nong Liang
- Department of Physical Therapy, University of Nevada, Las Vegas, Las Vegas, NV, United States.,Interdisciplinary Doctoral Program in Neuroscience, University of Nevada, Las Vegas, Las Vegas, NV, United States
| | - Leonard Ubalde
- Department of Physical Therapy, University of Nevada, Las Vegas, Las Vegas, NV, United States.,Interdisciplinary Doctoral Program in Neuroscience, University of Nevada, Las Vegas, Las Vegas, NV, United States
| | - Jordon Jacklin
- Department of Physical Therapy, University of Nevada, Las Vegas, Las Vegas, NV, United States
| | - Peyton Hobson
- Department of Physical Therapy, University of Nevada, Las Vegas, Las Vegas, NV, United States
| | - Sara Wright-Avila
- Department of Physical Therapy, University of Nevada, Las Vegas, Las Vegas, NV, United States
| | - Yun-Ju Lee
- Department of Industrial Engineering and Engineering Management, National Tsing Hua University, Hsinchu, Taiwan
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26
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Johari S, Kahjoogh MA, Nezhad ZM, Hosseini SA, Zamani ZP, Shati M, Haghgoo HA. Effects of transcranial direct current stimulation combined with cognitive orientation to daily occupational performance in children with cerebral palsy: a protocol for a randomised controlled trial. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2020. [DOI: 10.12968/ijtr.2019.0065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aims Children with hemiplegic cerebral palsy have limitations in activities requiring reach and manipulation of objects with their affected upper extremity. Transcranial direct current stimulation and the cognitive orientation to occupational performance approach are relatively new interventions that may lead to promising results for these children. This article describes the method of a randomised clinical trial that will compare the effects of the combination of transcranial direct current stimulation and cognitive orientation to daily occupational performance with transcranial direct current stimulation and neurodevelopmental treatment. Methods A four-armed clinical trial with a sample size of 36 participants will be performed in Tehran. Participants will be randomly divided into four groups. Group A will receive neuro-developmental treatment with sham transcranial direct current stimulation, group B will receive neurodevelopmental treatment with transcranial direct current stimulation, group C will receive cognitive orientation to daily occupational performance with sham transcranial direct current stimulation, and group D will receive cognitive orientation to daily occupational performance with transcranial direct current stimulation. The examiner will be blind to the study and assessments will be done at baseline, after the end of the intervention and 1 month after the completion of the intervention (as follow up). Data analysis will be as repeated measure analysis of variance and intention to treat. Conclusions This article describes the protocol of a clinical trial that compares the effects of the combination of transcranial direct current stimulation and cognitive orientation to daily occupational performance with the combination of transcranial direct current stimulation and neurodevelopmental treatment on upper extremity goals and functions of children with hemiplegic cerebral palsy.
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Affiliation(s)
- Sahar Johari
- Department of Occupational Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mina Ahmadi Kahjoogh
- Department of Occupational Therapy, Faculty of Rehabilitation, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zahra Mossala Nezhad
- Department of Physical Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Seyed Ali Hosseini
- Department of Occupational Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Zahra Poor Zamani
- Department of Occupational Therapy, School of Rehabilitation, Iran University of Medical Sciences, Tehran, Iran
| | - Mohsen Shati
- School of Behavioral Sciences and Mental Health, Tehran Institute of Psychiatry
| | - Hojjat Allah Haghgoo
- Department of Occupational Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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27
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da Silva TD, Fontes AMGG, de Oliveira-Furlan BS, Roque TT, Lima AII, de Souza BMM, Alberissi CADO, Silveira AC, de Moraes ÍAP, Collett J, Silva RP, Airoldi MJ, Ribeiro-Papa DC, Dawes H, Monteiro CBDM. Effect of Combined Therapy of Virtual Reality and Transcranial Direct Current Stimulation in Children and Adolescents With Cerebral Palsy: A Study Protocol for a Triple-Blinded Randomized Controlled Crossover Trial. Front Neurol 2020; 11:953. [PMID: 32982950 PMCID: PMC7492207 DOI: 10.3389/fneur.2020.00953] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 07/23/2020] [Indexed: 12/12/2022] Open
Abstract
Background: Transcranial direct current stimulation (tDCS) and therapy-based virtual reality (VR) have been investigated separately. They have shown promise as efficient and engaging new tools in the neurological rehabilitation of individuals with cerebral palsy (CP). However, the recent literature encourages investigation of the combination of therapy tools in order to potentiate clinic effects and its mechanisms. Methods: A triple-blinded randomised sham-controlled crossover trial will be performed. Thirty-six individuals with gross motor function of levels I to IV (aged 4–14 years old) will be recruited. Individuals will be randomly assigned to Group A (active first) or S (sham first): Group A will start with ten sessions of active tDSC combined with VR tasks. After a 1-month washout, this group will be reallocated to another ten sessions with sham tDCS combined with VR tasks. In contrast, Group S will carry out the opposite protocol, starting with sham tDCS. For the active tDCS the protocol will use low frequency tDCS [intensity of 1 milliampere (mA)] over the primary cortex (M1) area on the dominant side of the brain. Clinical evaluations (reaction times and coincident timing through VR, functional scales: Abilhand-Kids, ACTIVLIM-CP, Paediatric Evaluation of Disability Inventory-PEDI- and heart rate variability-HRV) will be performed at baseline, during, and after active and sham tDCS. Conclusion: tDCS has produced positive results in treating individuals with CP; thus, its combination with new technologies shows promise as a potential mechanism for improving neurological functioning. The results of this study may provide new insights into motor rehabilitation, thereby contributing to the better use of combined tDCS and VR in people with CP. Trial Registration:ClinicalTrials.gov, NCT04044677. Registered on 05 August 2019.
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Affiliation(s)
- Talita Dias da Silva
- Programa de Pós-Graduação em Ciências da Reabilitação, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.,Departamento de Medicina (Cardiologia), Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.,Grupo de Pesquisa e Aplicações Tecnológicas em Reabilitação (PATER), Escola de Artes, Ciências e Humanidades, Universidade de São Paulo (EACH-USP), São Paulo, Brazil.,Faculdade de Medicina, Universidade Cidade de São Paulo (UNICID), São Paulo, Brazil
| | | | - Barbara Soares de Oliveira-Furlan
- Grupo de Pesquisa e Aplicações Tecnológicas em Reabilitação (PATER), Escola de Artes, Ciências e Humanidades, Universidade de São Paulo (EACH-USP), São Paulo, Brazil
| | - Tatiane Tedeschi Roque
- Grupo de Pesquisa e Aplicações Tecnológicas em Reabilitação (PATER), Escola de Artes, Ciências e Humanidades, Universidade de São Paulo (EACH-USP), São Paulo, Brazil
| | - Ana Izabel Izidório Lima
- Grupo de Pesquisa e Aplicações Tecnológicas em Reabilitação (PATER), Escola de Artes, Ciências e Humanidades, Universidade de São Paulo (EACH-USP), São Paulo, Brazil
| | - Bruna Mayara Magalhães de Souza
- Grupo de Pesquisa e Aplicações Tecnológicas em Reabilitação (PATER), Escola de Artes, Ciências e Humanidades, Universidade de São Paulo (EACH-USP), São Paulo, Brazil
| | - Camila Aparecida de Oliveira Alberissi
- Grupo de Pesquisa e Aplicações Tecnológicas em Reabilitação (PATER), Escola de Artes, Ciências e Humanidades, Universidade de São Paulo (EACH-USP), São Paulo, Brazil
| | - Ana Clara Silveira
- Grupo de Pesquisa e Aplicações Tecnológicas em Reabilitação (PATER), Escola de Artes, Ciências e Humanidades, Universidade de São Paulo (EACH-USP), São Paulo, Brazil
| | - Íbis Ariana Peña de Moraes
- Programa de Pós-Graduação em Ciências da Reabilitação, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.,Grupo de Pesquisa e Aplicações Tecnológicas em Reabilitação (PATER), Escola de Artes, Ciências e Humanidades, Universidade de São Paulo (EACH-USP), São Paulo, Brazil
| | - Johnny Collett
- Institute of Nursing and Allied Health Research, Oxford Brookes University, Oxford, United Kingdom.,Department of Clinical Neurology, University of Oxford, Oxford, United Kingdom
| | - Roger Pereira Silva
- Grupo de Pesquisa e Aplicações Tecnológicas em Reabilitação (PATER), Escola de Artes, Ciências e Humanidades, Universidade de São Paulo (EACH-USP), São Paulo, Brazil
| | - Marina Junqueira Airoldi
- Grupo de Pesquisa e Aplicações Tecnológicas em Reabilitação (PATER), Escola de Artes, Ciências e Humanidades, Universidade de São Paulo (EACH-USP), São Paulo, Brazil
| | - Denise Cardoso Ribeiro-Papa
- Departamento de Medicina (Cardiologia), Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.,Grupo de Pesquisa e Aplicações Tecnológicas em Reabilitação (PATER), Escola de Artes, Ciências e Humanidades, Universidade de São Paulo (EACH-USP), São Paulo, Brazil
| | - Helen Dawes
- Institute of Nursing and Allied Health Research, Oxford Brookes University, Oxford, United Kingdom.,Department of Clinical Neurology, University of Oxford, Oxford, United Kingdom
| | - Carlos Bandeira de Mello Monteiro
- Programa de Pós-Graduação em Ciências da Reabilitação, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.,Grupo de Pesquisa e Aplicações Tecnológicas em Reabilitação (PATER), Escola de Artes, Ciências e Humanidades, Universidade de São Paulo (EACH-USP), São Paulo, Brazil
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Diego APN, Leung AWS. Transcranial direct current stimulation for improving gross motor function in children with cerebral palsy: A systematic review. Br J Occup Ther 2020. [DOI: 10.1177/0308022619897885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction The functional abilities of children with cerebral palsy are often compromised because of limited motor function. Transcranial direct current stimulation is a neuromodulation tool used as an adjunct to other therapeutic modalities to improve gross motor function. This review aimed to examine the quality of evidence and the effectiveness of transcranial direct current stimulation for improving gross motor function in children with cerebral palsy. Method A systematic review was conducted, and eligible studies were critically appraised for methodological quality. Randomised controlled trials were selected to undergo meta-analysis for assessing the effectiveness of transcranial direct current stimulation on clinical outcomes. Results Eight studies, including seven randomised controlled trials, fitted the inclusion criteria. All the randomised controlled trials were rated ‘moderate’ quality based on the grading of recommendations assessment, development and evaluation (GRADE) system. Using meta-analysis, only cadence, an outcome measure of gait variables, demonstrated efficacy of intervention, mean difference 16.57 (10.88, 22.25); I2 = 0%, P = 0.83. Other gross motor and functional outcomes had either inconsistent mean difference or high heterogeneity. Conclusion Overall, the effectiveness of transcranial direct current stimulation as a treatment in children with cerebral palsy remains unclear, and the findings should be interpreted with caution. The quality of evidence was mostly moderate, and more vigorous research incorporating functional outcomes should be conducted to guide clinical practice.
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Affiliation(s)
| | - Ada WS Leung
- Department of Occupational Therapy, University of Alberta, Edmonton, Canada
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Canada
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Enhancing Stroke Recovery Across the Life Span With Noninvasive Neurostimulation. J Clin Neurophysiol 2020; 37:150-163. [DOI: 10.1097/wnp.0000000000000543] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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Mahmoodifar E, Sotoodeh MS. Combined Transcranial Direct Current Stimulation and Selective Motor Training Enhances Balance in Children With Autism Spectrum Disorder. Percept Mot Skills 2019; 127:113-125. [DOI: 10.1177/0031512519888072] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Previous studies have shown that transcranial direct current stimulation (tDCS) over the primary motor cortex (M1) can facilitate the consolidation of motor skills in people who are typically developed, especially when tDCS is combined with goal-oriented exercises. Yet, the effect of tDCS on the motor skills of children with autism spectrum disorder is unknown. This study sought to investigate the effects of combined anodal tDCS and selective motor training on balance among 18 children with autism spectrum disorder (aged 6–14 years) who we randomly assigned to equal-sized experimental and control groups. The experimental group practiced motor training to improve balance after receiving 1.5 mA anodal tDCS over the left M1 for 20 minutes before each of 10 motor training sessions. The control (sham) group underwent a similar protocol with identical motor training, but tDCS was only artificially administered to them. We evaluated participants’ balance at baseline and after training. Data analysis showed that both anodal tDCS plus motor skill training and motor skill training with sham tDCS had significant positive impacts on balance, but tDCS participants who received both actual tDCS and motor skill training performed significantly better than those who received SHAM tDCS and motor skill training. These preliminary findings suggest that tDCS may enhance motor skill training for children with autism spectrum disorder, but replications with larger samples involving participants with varying levels of autistic symptoms and varied tDCS stimulation polarity are needed to affirm the practical use of this noninvasive brain stimulation.
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Affiliation(s)
- Elham Mahmoodifar
- Department of physical education, Mobarakeh Branch, Islamic Azad University, Mobarakeh, Isfahan, Iran
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Jafarzadeh A, Ehsani F, Yosephi MH, Zoghi M, Jaberzadeh S. Concurrent postural training and M1 anodal transcranial direct current stimulation improve postural impairment in patients with chronic low back pain. J Clin Neurosci 2019; 68:224-234. [DOI: 10.1016/j.jocn.2019.07.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 07/05/2019] [Indexed: 11/24/2022]
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de Paz RH, Serrano-Muñoz D, Pérez-Nombela S, Bravo-Esteban E, Avendaño-Coy J, Gómez-Soriano J. Combining transcranial direct-current stimulation with gait training in patients with neurological disorders: a systematic review. J Neuroeng Rehabil 2019; 16:114. [PMID: 31521179 PMCID: PMC6744683 DOI: 10.1186/s12984-019-0591-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 09/09/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Transcranial direct-current stimulation (tDCS) is an easy-to-apply, cheap, and safe technique capable of affecting cortical brain activity. However, its effectiveness has not been proven for many clinical applications. OBJECTIVE The aim of this systematic review was to determine whether the effect of different strategies for gait training in patients with neurological disorders can be enhanced by the combined application of tDCS compared to sham stimulation. Additionally, we attempted to record and analyze tDCS parameters to optimize its efficacy. METHODS A search in Pubmed, PEDro, and Cochrane databases was performed to find randomized clinical trials that combined tDCS with gait training. A chronological filter from 2010 to 2018 was applied and only studies with variables that quantified the gait function were included. RESULTS A total of 274 studies were found, of which 25 met the inclusion criteria. Of them, 17 were rejected based on exclusion criteria. Finally, 8 trials were evaluated that included 91 subjects with stroke, 57 suffering from Parkinson's disease, and 39 with spinal cord injury. Four of the eight assessed studies did not report improved outcomes for any of its variables compared to the placebo treatment. CONCLUSIONS There are no conclusive results that confirm that tDCS can enhance the effect of the different strategies for gait training. Further research for specific pathologies, with larger sample sizes and adequate follow-up periods, are required to optimize the existing protocols for applying tDCS.
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Affiliation(s)
- Rubén Hernández de Paz
- Toledo Physiotherapy Research Group (GIFTO), Faculty of Physiotherapy and Nursery, Castilla La Mancha University, 45071, Toledo, Spain
| | - Diego Serrano-Muñoz
- Toledo Physiotherapy Research Group (GIFTO), Faculty of Physiotherapy and Nursery, Castilla La Mancha University, 45071, Toledo, Spain.
| | - Soraya Pérez-Nombela
- Toledo Physiotherapy Research Group (GIFTO), Faculty of Physiotherapy and Nursery, Castilla La Mancha University, 45071, Toledo, Spain
| | - Elisabeth Bravo-Esteban
- Toledo Physiotherapy Research Group (GIFTO), Faculty of Physiotherapy and Nursery, Castilla La Mancha University, 45071, Toledo, Spain
| | - Juan Avendaño-Coy
- Toledo Physiotherapy Research Group (GIFTO), Faculty of Physiotherapy and Nursery, Castilla La Mancha University, 45071, Toledo, Spain
| | - Julio Gómez-Soriano
- Toledo Physiotherapy Research Group (GIFTO), Faculty of Physiotherapy and Nursery, Castilla La Mancha University, 45071, Toledo, Spain
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Saleem GT, Ewen JB, Crasta JE, Slomine BS, Cantarero GL, Suskauer SJ. Single-arm, open-label, dose escalation phase I study to evaluate the safety and feasibility of transcranial direct current stimulation with electroencephalography biomarkers in paediatric disorders of consciousness: a study protocol. BMJ Open 2019; 9:e029967. [PMID: 31401607 PMCID: PMC6701812 DOI: 10.1136/bmjopen-2019-029967] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Children with disorders of consciousness (DOC) represent the highest end of the acquired brain injury (ABI) severity spectrum for survivors and experience a multitude of functional impairments. Current clinical management in DOC uses behavioural evaluation measures and interventions that fail to (1) describe the physiological consequences of ABI and (2) elicit functional gains. In paediatric DOC, there is a critical need to develop evidence-based interventions to promote recovery of basic responses to improve rehabilitation and aid decision-making for medical teams and caregivers. The purpose of this investigation is to examine the safety, tolerability and feasibility of transcranial direct current stimulation (tDCS) in children with DOC. METHODS AND ANALYSIS This study is an open-label dose escalation trial evaluating the safety, tolerability and feasibility of tDCS in 10 children (5-17 years) receiving inpatient rehabilitation for DOC. This study will follow a modified rule-based design, allowing for intrapatient escalation, where a cohort of patients will be assigned to an initial tDCS current of 0.5 or 1 mA based on participant's head circumference and according to the safety data available in other paediatric populations. The subsequent assignment of increased current (1 or 2 mA) according to the prespecified rules will be based on the clinical observation of adverse events in the patients. The study will include up to three, 20 min sessions of anodal tDCS (sham, 0.5 or 1 mA, 1 or 2 mA) applied over the dorsolateral prefrontal cortex. The primary outcomes are adverse events, pain associated with tDCS and intolerable disruption of inpatient care. Secondary outcomes are changes in electroencephalography (EEG) phase-locking and event-related potential components and the Coma Recovery Scale-Revised total score from prestimulation to poststimulation. ETHICS AND DISSEMINATION The Johns Hopkins IRB (#IRB00174966) approved this study. Trial results will be disseminated through journals and conferences. REGISTRATION NUMBER NCT03618849.
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Affiliation(s)
- Ghazala T Saleem
- Kennedy Krieger Institute, Baltimore, Maryland, USA
- Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Joshua Benjamin Ewen
- Kennedy Krieger Institute, Baltimore, Maryland, USA
- Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jewel E Crasta
- Kennedy Krieger Institute, Baltimore, Maryland, USA
- Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Gabriela Lucila Cantarero
- Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Stacy J Suskauer
- Kennedy Krieger Institute, Baltimore, Maryland, USA
- Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Villalta Santos L, Benite Palma Lopes J, Almeida Carvalho Duarte N, Galli M, Collange Grecco LA, Santos Oliveira C. Effect of Anodic tDCS Over Motor Cortex Versus Cerebellum in Cerebral Palsy: A Study Protocol. Pediatr Phys Ther 2019; 31:301-305. [PMID: 31135599 DOI: 10.1097/pep.0000000000000626] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE To compare the clinical and functional effects of treadmill training combined with anodic transcranial direct current stimulation (atDCS) on the primary motor cortex (Cz), specifically on the area of motor cortex representation of the lower limbs, and on the cerebellum (Cb) in children with spastic cerebral palsy (CP). METHODS Thirty children and adolescents with spastic CP will be randomly allocated in 3 groups: (1) treadmill training and atDCS on Cz; (2) treadmill training and atDCS on Cb; (3) treadmill training and sham tDCS on Cz. Evaluations of gait spatial-temporal parameters, functional mobility, functional balance, gross motor function, and functional performance will be performed 1 week before intervention and 1 week, 1 month, and 3 months after intervention. Every 3 months the participants will cross over groups. DISCUSSION This is a protocol for an intervention study comparing the clinical and functional effects of atDCS over Cz and Cb.
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Affiliation(s)
- Lucas Villalta Santos
- Health Sciences (Mr Santos, Ms Lopes, and Drs Duarte and Oliveira), Santa Casa de São Paulo School of Medical Sciences, São Paulo, SP, Brazil; Vento Leste-Specialized Childcare Habilitation (Mr Santos and Dr Grecco), Sorocaba, SP, Brazil; Department of Electronic Information and Bioengineering (Dr Galli), Politecnico di Milano, Milan, Italy; Laboratory of Integrated Human Movements (Dr Grecco), Universidade de Sorocaba, Sorocaba, SP, Brazil; Center of Pediatric Neurostimulation (Dr Grecco), São Paulo, SP, Brazil; University Center of Anápolis (Dr Oliveira), Anápolis, GO, Brazil
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de Moura MCDS, Hazime FA, Marotti Aparicio LV, Grecco LAC, Brunoni AR, Hasue RH. Effects of transcranial direct current stimulation (tDCS) on balance improvement: a systematic review and meta-analysis. Somatosens Mot Res 2019; 36:122-135. [PMID: 31181963 DOI: 10.1080/08990220.2019.1624517] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background: Transcranial direct current stimulation (tDCS) has emerged as a promising therapeutic tool to improve balance and optimize rehabilitation strategies. However, current literature shows the methodological heterogeneity of tDCS protocols and results, hindering any clear conclusions about the effects of tDCS on postural control. Objective: Evaluate the effectiveness of tDCS on postural control, and identify the most beneficial target brain areas and the effect on different populations. Methods: Two independent reviewers selected randomized tDCS clinical-trials studies from PubMed, Scopus, Web of Science, and reference lists of retrieved articles published between 1998 and 2017. Most frequently reported centre of pressure (COP) variables were selected for meta-analysis. Other postural control outcomes were discussed in the review. Results: Thirty studies were included in the systematic review, and 11 were submitted to a meta-analysis. A reduction of COP displacement area has been significantly achieved by tDCS, evidencing an improvement in balance control. Individuals with cerebral palsy (CP) and healthy young adults are mostly affected by stimulation. The analysis of the impact of tDCS over different brain areas revealed a significant effect after primary motor cortex (M1) stimulation, however, with no clear results after cerebellar stimulation due to divergent results among studies. Conclusions: tDCS appears to improve balance control, more evident in healthy and CP subjects. Effects are observed when primary MI is stimulated. Cerebellar stimulation should be better investigated.
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Affiliation(s)
- Maria Clara D Soares de Moura
- a Department of Physical Therapy, Communication Sciences and Disorders, and Occupational Therapy, Faculty of Medicine , University of São Paulo , São Paulo , Brazil
| | - Fuad A Hazime
- b Department of Physical Therapy , Federal University of Piauí , Piauí , Brazil
| | - Luana V Marotti Aparicio
- c Service of Interdisciplinary Neuromodulation, Laboratory of Neurosciences (LIM-27) and National Institute of Biomarkers in Psychiatry (INBioN), Department and Institute of Psychiatry, Hospital of Clinics, Faculty of Medicine , University of São Paulo , São Paulo , Brazil
| | | | - André R Brunoni
- c Service of Interdisciplinary Neuromodulation, Laboratory of Neurosciences (LIM-27) and National Institute of Biomarkers in Psychiatry (INBioN), Department and Institute of Psychiatry, Hospital of Clinics, Faculty of Medicine , University of São Paulo , São Paulo , Brazil.,e Department of Psychiatry and Psychotherapy , Ludwig-Maximilians-University , Munich , Germany
| | - Renata Hydeé Hasue
- a Department of Physical Therapy, Communication Sciences and Disorders, and Occupational Therapy, Faculty of Medicine , University of São Paulo , São Paulo , Brazil
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The Therapeutic Potential of Non-invasive Neurostimulation for Motor Skill Learning in Children with Neurodevelopmental Disorders. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2019. [DOI: 10.1007/s40474-019-0155-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Fleming MK, Theologis T, Buckingham R, Johansen-Berg H. Transcranial direct current stimulation for promoting motor function in cerebral palsy: a review. J Neuroeng Rehabil 2018; 15:121. [PMID: 30572926 PMCID: PMC6302403 DOI: 10.1186/s12984-018-0476-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 12/14/2018] [Indexed: 01/25/2023] Open
Abstract
Transcranial direct current stimulation (tDCS) has the potential to improve motor function in a range of neurological conditions, including Cerebral Palsy (CP). Although there have been many studies assessing tDCS in adult stroke, the literature regarding the efficacy of tDCS in CP is more limited. This review therefore focuses on the neurophysiological and clinical findings in children and adolescents with CP. Initial studies applying anodal tDCS to promote lower limb function are promising, with improvements in gait, mobility and balance reported. However, the results of upper limb studies are mixed and more research is needed. Studies investigating neurophysiological changes or predictors of response are also lacking. Large-scale longitudinal studies are needed for the lower limb to ascertain whether the initial pilot results translate into clinically meaningful improvements. Future studies of the upper limb should focus on determining the optimal stimulation parameters and consider tailoring stimulation to the individual based on the (re)organisation of their motor system.
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Affiliation(s)
- Melanie K Fleming
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU, UK.
| | - Tim Theologis
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Rachel Buckingham
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Heidi Johansen-Berg
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU, UK
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Transcranial Direct Current Stimulation in Pediatric Motor Disorders: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2018; 100:724-738. [PMID: 30414398 DOI: 10.1016/j.apmr.2018.10.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 10/11/2018] [Accepted: 10/16/2018] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To systematically examine the safety and effectiveness of transcranial direct current stimulation (tDCS) interventions in pediatric motor disorders. DATA SOURCES PubMed, EMBASE, Cochrane, CINAHL, Web of Science, and ProQuest databases were searched from inception to August 2018. STUDY SELECTION tDCS randomized controlled trials (RCTs), observational studies, conference proceedings, and dissertations in pediatric motor disorders were included. Two authors independently screened articles based on predefined inclusion criteria. DATA EXTRACTION Data related to participant demographics, intervention, and outcomes were extracted by 2 authors. Quality assessment was independently performed by 2 authors. DATA SYNTHESIS A total of 23 studies involving a total of 391 participants were included. There was no difference in dropout rates between active (1 of 144) and sham (1 of 144) tDCS groups, risk difference 0.0, 95% confidence interval (-.05 to .04). Across studies, the most common adverse effects in the active group were tingling (17.2%), discomfort (8.02%), itching (6.79%), and skin redness (4%). Across 3 studies in children with cerebral palsy, tDCS significantly improved gait velocity (MD=.23; 95% confidence interval [0.13-0.34]; P<.0005), stride length (MD=0.10; 95% confidence interval [0.05-0.15]; P<.0005), and cadence (MD=15.7; 95% confidence interval [9.72-21.68]; P<.0005). Mixed effects were found on balance, upper extremity function, and overflow movements in dystonia. CONCLUSION Based on the studies reviewed, tDCS is a safe technique in pediatric motor disorders and may improve some gait measures and involuntary movements. Research to date in pediatric motor disorders shows limited effectiveness in improving balance and upper extremity function. tDCS may serve as a potential adjunct to pediatric rehabilitation; to better understand if tDCS is beneficial for pediatric motor disorders, more well-designed RCTs are needed.
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Rios DM, Correia Rios M, Bandeira ID, Queiros Campbell F, de Carvalho Vaz D, Lucena R. Impact of Transcranial Direct Current Stimulation on Reading Skills of Children and Adolescents With Dyslexia. Child Neurol Open 2018; 5:2329048X18798255. [PMID: 30306098 PMCID: PMC6174647 DOI: 10.1177/2329048x18798255] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 07/26/2018] [Accepted: 08/10/2018] [Indexed: 12/27/2022] Open
Abstract
Introduction: Rehabilitation techniques have been used to facilitate reading acquisition in dyslexia. However, many individuals continue to present academic impairment throughout life. New intervention strategies are necessary to further help this population. Objectives: Assess the impact of transcranial direct current stimulation on reading skills in children and adolescents with dyslexia. Methods: The study was conducted with one-group pretest–posttest. Participants received 2 mA transcranial direct current stimulation during 30 minutes for 5 consecutive days. Reading performance was measured by a group of tasks (identification and reading of letters, syllables, words, nonwords, and text). Results: A significant increase in the number of correct answers for nonwords and text tasks was observed after transcranial direct current stimulation (P = .035 and P = .012, respectively). Conclusion: The transcranial direct current stimulation seems to be a promising tool for the treatment of reading problems in dyslexia. Future studies are necessary to confirm the effects of transcranial direct current stimulation and to establish optimal intervention protocol in this population.
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Affiliation(s)
- Débora Medeiros Rios
- Department of Neuroscience and Mental Health, Medical School of Bahia, Federal University of Bahia, Salvador, Brazil
| | | | - Igor Dórea Bandeira
- Department of Neuroscience and Mental Health, Medical School of Bahia, Federal University of Bahia, Salvador, Brazil
| | - Fernanda Queiros Campbell
- Department of Biomorphology, Health Sciences Institute, Federal University of Bahia, Salvador, Brazil
| | - Daniel de Carvalho Vaz
- Department of Neuroscience and Mental Health, Medical School of Bahia, Federal University of Bahia, Salvador, Brazil
| | - Rita Lucena
- Department of Neuroscience and Mental Health, Medical School of Bahia, Federal University of Bahia, Salvador, Brazil
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Transcranial Direct-Current Stimulation on Motor Function in Pediatric Cerebral Palsy: A Systematic Review. Pediatr Phys Ther 2018; 30:291-301. [PMID: 30199513 DOI: 10.1097/pep.0000000000000535] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
PURPOSE To determine effects of transcranial direct-current stimulation (tDCS) on motor function for children with cerebral palsy. METHODS Six electronic databases were searched using terms related to tDCS, combined with functional deficits/associated clinical measures. Results were filtered, including randomized controlled trials in English and children with cerebral palsy. Data were extracted using standardized procedures, and the PEDro scale was used to assess quality and meta-analyses conducted. RESULTS From 135 articles, 9 studies with moderate quality met inclusion criteria. Six were included in 7 separate meta-analyses supporting a benefit of tDCS for static balance, only at follow-up. Benefits of tDCS on dynamic balance, step length, and mobility were not established. CONCLUSIONS The findings from meta-analyses suggest that tDCS may provide improvements in static balance at follow-up in children with cerebral palsy and positive effects on gait velocity; however, there was heterogeneity. Further research is needed before this therapy can be endorsed.
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Sánchez-Kuhn A, Pérez-Fernández C, Moreno M, Flores P, Sánchez-Santed F. Differential Effects of Transcranial Direct Current Stimulation (tDCS) Depending on Previous Musical Training. Front Psychol 2018; 9:1465. [PMID: 30250439 PMCID: PMC6139306 DOI: 10.3389/fpsyg.2018.01465] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 07/25/2018] [Indexed: 12/23/2022] Open
Abstract
Previous studies have shown that transcranial direct current stimulation (tDCS) facilitates motor performance, but individual differences such as baseline performance seem to influence this effect. Accordingly, musicians offer an inter-individual differences model due to anatomical and functional variances displayed among the motor cortex regions. The aim of the present work was to study if the baseline motor skill predicts whether tDCS can enhance motor learning. For that objective, we administered anodal (n = 20) or sham (n = 20) tDCS on the right primary motor cortex region of 40 right-handed healthy participants, who were divided into four groups: musicians (tDCS/sham) and non-musicians (tDCS/sham). We measured the skill index (SI) presented in the sequential finger-tapping task (SEQTAP) at baseline, during three 20 min/2 mA stimulation sessions, and in follow-up tests after 20 min and 8 days. Depending on the normality of the data distribution, statistical differences were estimated by ANOVA and Bonferroni post hoc test or Kruskal-Wallis and U Mann-Whitney. Results showed that musicians scored higher in baseline performance than non-musicians. The non-musicians who received tDCS scored higher than the sham group in the first and second stimulation session. This effect was extended to the 20 min and 8 days follow-up test. In musicians, there was no effect of tDCS. The present method seems to be suitable for the achievement of positive and consolidated tDCS effects on motor learning in inexperienced participants, but not in musicians. These data may have an implication for the rehabilitation of motor impairments, contributing to more individualized stimulation protocols.
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Affiliation(s)
- Ana Sánchez-Kuhn
- Department of Psychology and CIAIMBITAL, CeiA3, University of Almería, Almería, Spain
| | | | - Margarita Moreno
- Department of Psychology and CIAIMBITAL, CeiA3, University of Almería, Almería, Spain
| | - Pilar Flores
- Department of Psychology and CIAIMBITAL, CeiA3, University of Almería, Almería, Spain
- Instituto de Neurorehabilitación Infantil InPaula, Almería, Spain
| | - Fernando Sánchez-Santed
- Department of Psychology and CIAIMBITAL, CeiA3, University of Almería, Almería, Spain
- Instituto de Neurorehabilitación Infantil InPaula, Almería, Spain
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Abstract
Transcranial direct current stimulation (tDCS) modulates spontaneous neuronal activity that can generate long-term neuroplastic changes. It has been used in numerous therapeutic trials showing significant clinical effects especially when combined with other behavioral therapies. One area of intensive tDCS research is chronic pain. Since the initial tDCS trials for chronic pain treatment using current parameters of stimulation, more than 60 clinical trials have been published testing its effects in different pain syndromes. However, as the field moves in the direction of clinical application, several aspects need to be taken into consideration regarding tDCS effectiveness and parameters of stimulation. In this article, we reviewed the evidence of tDCS effects for the treatment of chronic pain and critically analyzed the literature pertaining its safety and efficacy, and how to optimize tDCS clinical effects in a therapeutic setting. We discuss optimization of tDCS effects in 3 different domains: (i) parameters of stimulation, (ii) combination therapies, and (iii) subject selection. This article aims to provide insights for the development of future tDCS clinical trials.
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Affiliation(s)
- Camila Bonin Pinto
- Laboratory of Neuromodulation & Center for Clinical Research Learning, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, USA
| | - Beatriz Teixeira Costa
- Laboratory of Neuromodulation & Center for Clinical Research Learning, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, USA
| | - Dante Duarte
- Laboratory of Neuromodulation & Center for Clinical Research Learning, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, USA
| | - Felipe Fregni
- Laboratory of Neuromodulation & Center for Clinical Research Learning, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, USA
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Gillick B, Rich T, Nemanich S, Chen CY, Menk J, Mueller B, Chen M, Ward M, Meekins G, Feyma T, Krach L, Rudser K. Transcranial direct current stimulation and constraint-induced therapy in cerebral palsy: A randomized, blinded, sham-controlled clinical trial. Eur J Paediatr Neurol 2018; 22:358-368. [PMID: 29456128 PMCID: PMC5899638 DOI: 10.1016/j.ejpn.2018.02.001] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 01/22/2018] [Accepted: 02/01/2018] [Indexed: 12/16/2022]
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.
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Affiliation(s)
- Bernadette Gillick
- Department of Rehabilitation Medicine, University of Minnesota, 420 Delaware St SE, MMC 388, Minneapolis, MN, 55455, USA.
| | - Tonya Rich
- Department of Rehabilitation Medicine, University of Minnesota, 420 Delaware St SE, MMC 388, Minneapolis, MN, 55455, USA
| | - Samuel Nemanich
- Department of Rehabilitation Medicine, University of Minnesota, 420 Delaware St SE, MMC 388, Minneapolis, MN, 55455, USA
| | - Chao-Ying Chen
- Department of Rehabilitation Medicine, University of Minnesota, 420 Delaware St SE, MMC 388, Minneapolis, MN, 55455, USA
| | - Jeremiah Menk
- School of Public Health, Division of Biostatistics, University of Minnesota, 420 Delaware St SE, MMC 303, Minneapolis, MN, 55455, USA
| | - Bryon Mueller
- Department of Psychiatry, University of Minnesota, 2450 Riverside Ave. S, Minneapolis, MN, 55454, USA
| | - Mo Chen
- Institute for Engineering and Medicine, University of Minnesota, 420 Delaware St. SE, MMC 609, Minneapolis, MN, 55455, USA
| | - Marcie Ward
- Gillette Children's Specialty Healthcare, 200 East University Ave., St. Paul, MN, 55101, USA
| | - Gregg Meekins
- Department of Neurology, University of Minnesota, 420 Delaware St SE, MMC 295, Minneapolis, MN, 55455, USA
| | - Tim Feyma
- Gillette Children's Specialty Healthcare, 200 East University Ave., St. Paul, MN, 55101, USA
| | - Linda Krach
- Courage Kenny Rehabilitation Institute, 800 East 28th St., Minneapolis, MN, 55407, USA
| | - Kyle Rudser
- School of Public Health, Division of Biostatistics, University of Minnesota, 420 Delaware St SE, MMC 303, Minneapolis, MN, 55455, USA
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Lopes JBP, de Moura RCF, Lazzari RD, de Almeida Carvalho Duarte N, Dumont AJL, Oliveira CS. Evaluation of upper limb movements in children with Down's syndrome: A systematic review. Infant Behav Dev 2018; 51:45-51. [PMID: 29649724 DOI: 10.1016/j.infbeh.2018.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 02/16/2018] [Accepted: 03/13/2018] [Indexed: 10/17/2022]
Abstract
The aim of the present study was to perform a review of the literature on current quantitative clinical methods for the evaluation of upper limb movements in children and adolescents with Down syndrome, with a focus on describing the variables, protocols, motor function and motor control. METHODS A survey of PubMed, Scielo, BVS Bireme and PEDro databases using the following key words: upper limb and EMG and Down syndrome; upper limb and kinematics and Down syndrome; upper limb and motion analysis and Down syndrome; movement and upper limb and Down syndrome; upper limb and Down syndrome; reach and Down syndrome. RESULTS In all, 344 articles and five were selected to compose the present systematic review. No standardization was found among the studies analyzed with regard to data collection, data processing or procedures for the evaluation of the variables. CONCLUSION A kinematic evaluation is effective for the discussion of the results, but methodological differences among the studies and inconsistent results exert a negative influence on clinical interpretations and the possibility of reproducibility. The standardization of an upper limb movement evaluation protocol using kinematic analysis is important, as it would provide the basis for comparable, reproducible results and facilitate the planning of treatment interventions.
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Affiliation(s)
| | | | | | | | | | - Claudia Santos Oliveira
- Health Sciences Program, Faculty of Medical Sciences of Santa Casa de São Paulo, Brazil; University Center Of Anápolis, Goias, Brazil
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Effect of Transcranial Direct Current Stimulation of Motor Cortex in Cerebral Palsy: A Study Protocol. Pediatr Phys Ther 2018; 30:67-71. [PMID: 29252842 DOI: 10.1097/pep.0000000000000467] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess the best electrode position of transcranial direct current stimulation combined with treadmill training in children with unilateral spastic cerebral palsy. METHODS Thirty children with cerebral palsy were randomly allocated to 3 groups: (1) treadmill training combined with anodal electrode positioned over the primary motor cortex in the region of the dominant hemisphere and the cathode positioned in the supraorbital region contralateral to anode; (2) sham anodal transcranial direct current stimulation over the primary motor cortex and sham cathode over the contralateral supraorbital region combined with treadmill training; (3) treadmill training combined with the anodal electrode positioned over the primary motor cortex in the region of the injured hemisphere and the cathode positioned contralateral to anode over the primary motor cortex. Evaluations of gait, balance, quality of life, and electromyographic activity were performed. DISCUSSION This is the protocol for an intervention study investigating electrode position to achieve improved function.
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Gillick BT, Gordon AM, Feyma T, Krach LE, Carmel J, Rich TL, Bleyenheuft Y, Friel K. Non-Invasive Brain Stimulation in Children With Unilateral Cerebral Palsy: A Protocol and Risk Mitigation Guide. Front Pediatr 2018; 6:56. [PMID: 29616203 PMCID: PMC5864860 DOI: 10.3389/fped.2018.00056] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 02/26/2018] [Indexed: 01/04/2023] Open
Abstract
Non-invasive brain stimulation has been increasingly investigated, mainly in adults, with the aims of influencing motor recovery after stroke. However, a consensus on safety and optimal study design has not been established in pediatrics. The low incidence of reported major adverse events in adults with and without clinical conditions has expedited the exploration of NIBS in children with paralleled purposes to influence motor skill development after neurological injury. Considering developmental variability in children, with or without a neurologic diagnosis, adult dosing and protocols may not be appropriate. The purpose of this paper is to present recommendations and tools for the prevention and mitigation of adverse events (AEs) during NIBS in children with unilateral cerebral palsy (UCP). Our recommendations provide a framework for pediatric NIBS study design. The key components of this report on NIBS AEs are (a) a summary of related literature to provide the background evidence and (b) tools for anticipating and managing AEs from four international pediatric laboratories. These recommendations provide a preliminary guide for the assessment of safety and risk mitigation of NIBS in children with UCP. Consistent reporting of safety, feasibility, and tolerability will refine NIBS practice guidelines contributing to future clinical translations of NIBS.
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Affiliation(s)
- Bernadette T Gillick
- Physical Therapy Division, Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Andrew M Gordon
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, United States
| | - Tim Feyma
- Gillette Children's Specialty Healthcare, Pediatric Neurology, St. Paul, MN, United States
| | - Linda E Krach
- Courage Kenny Rehabilitation Institute, Minneapolis, MN, United States
| | - Jason Carmel
- Weill-Cornell Medical College, Blythedale Children's Hospital, Burke Medical Research Institute, White Plains, NY, United States
| | - Tonya L Rich
- Rehabilitation Science, University of Minnesota, Minneapolis, MN, United States
| | - Yannick Bleyenheuft
- Institute of Neuroscience (IoNS), Universite catholique de Louvain, Brussels, Belgium
| | - Kathleen Friel
- Weill-Cornell Medical College, Blythedale Children's Hospital, Burke Medical Research Institute, White Plains, NY, United States
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47
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Luz-Santos C, Ribeiro Camatti J, Barbosa Paixão A, Nunes Sá K, Montoya P, Lee M, Fontes Baptista A. Additive effect of tDCS combined with Peripheral Electrical Stimulation to an exercise program in pain control in knee osteoarthritis: study protocol for a randomized controlled trial. Trials 2017; 18:609. [PMID: 29268764 PMCID: PMC5740917 DOI: 10.1186/s13063-017-2332-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 11/08/2017] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Knee osteoarthritis (OA) has been linked to maladaptive plasticity in the brain, which may contribute to chronic pain. Neuromodulatory approaches, such as Transcranial Direct Current Stimulation (tDCS) and Peripheral Electrical Stimulation (PES), have been used therapeutically to counteract brain maladaptive plasticity. However, it is currently unclear whether these neuromodulatory techniques enhance the benefits of exercise when administered together. Therefore, this protocol aims to investigate whether the addition of tDCS combined or not with PES enhances the effects of a land-based strengthening exercise program in patients with knee OA. METHODS Patients with knee OA (n = 80) will undertake a structured exercise program for five consecutive days. In addition, they will be randomized into four subgroups receiving either active anodal tDCS and sham PES (group 1; n = 20), sham tDCS and active PES (group 2, n = 20), sham tDCS and PES (group 3, n = 20), or active tDCS and PES (group 4, n = 20) for 20 min/day for five consecutive days just prior to commencement of the exercise program. The primary outcomes will be subjective pain intensity (VAS) and related function (WOMAC). Secondary outcomes will include quality of life (SF-36), anxiety and depression symptoms (HAD), self-perception of improvement, pressure pain thresholds over the knee, quadriceps strength, and quadriceps electromyographic activity during maximum knee extension voluntary contraction. We will also investigate cortical excitability using transcranial magnetic stimulation. Outcome measures will be assessed at baseline, 1 month after, before any intervention, after 5 days of intervention, and at 1 month post exercise intervention. DISCUSSION The motor cortex becomes less responsive in knee OA because of poorly adapted plastic changes, which can impede exercise therapy benefits. Adding tDCS and/or PES may help to counteract those maladaptive plastic changes and improve the benefits of exercises, and the combination of both neuromodulatory techniques must have a higher magnitude of effect. TRIAL REGISTRATION Brazilian Registry on Clinical Trials (ReBEC) - Effects of electrical stimulation over the skull and tight together with exercises for knee OA; protocol number RBR-9D7C7B. TRIAL REGISTRATION ID: RBR-9D7C7B . Registered on 29 February 2016.
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Affiliation(s)
- Cleber Luz-Santos
- Functional Electrostimulation Laboratory, Health Sciences Institute, Federal University of Bahia, Salvador, Brazil
- Graduate Program in Medicine and Health, Faculty of Medicine, Federal University of Bahia, Salvador, Brazil
| | - Janine Ribeiro Camatti
- Functional Electrostimulation Laboratory, Health Sciences Institute, Federal University of Bahia, Salvador, Brazil
- Center for Mathematics, Computation and Cognition, Federal University of ABC, São Bernardo do Campo, São Paulo 09.080-045 Brazil
- Graduate Program in Neuroscience and Cognition, Federal University of ABC, São Bernardo do Campo, Brazil
| | - Alaí Barbosa Paixão
- Functional Electrostimulation Laboratory, Health Sciences Institute, Federal University of Bahia, Salvador, Brazil
- Graduate Program in Medicine and Health, Faculty of Medicine, Federal University of Bahia, Salvador, Brazil
| | - Katia Nunes Sá
- Functional Electrostimulation Laboratory, Health Sciences Institute, Federal University of Bahia, Salvador, Brazil
- Bahian School of Medicine and Public Health, Salvador, Brazil
| | - Pedro Montoya
- Research Institute on Health Sciences, University of Balearic Islands, Palma de Majorca, Spain
| | - Michael Lee
- Graduate School of Health, Discipline of Physiotherapy, University of Technology Sydney, Sydney, NSW Australia
| | - Abrahão Fontes Baptista
- Functional Electrostimulation Laboratory, Health Sciences Institute, Federal University of Bahia, Salvador, Brazil
- Graduate Program in Medicine and Health, Faculty of Medicine, Federal University of Bahia, Salvador, Brazil
- Center for Mathematics, Computation and Cognition, Federal University of ABC, São Bernardo do Campo, São Paulo 09.080-045 Brazil
- Graduate Program in Neuroscience and Cognition, Federal University of ABC, São Bernardo do Campo, Brazil
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Fruhauf AMA, Politti F, Dal Corso S, Costa GC, Teodósio ADC, Silva SM, Corrêa JCF, Corrêa FI. Immediate effect of transcranial direct current stimulation combined with functional electrical stimulation on activity of the tibialis anterior muscle and balance of individuals with hemiparesis stemming from a stroke. J Phys Ther Sci 2017; 29:2138-2146. [PMID: 29643591 PMCID: PMC5890217 DOI: 10.1589/jpts.29.2138] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Accepted: 09/20/2017] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The aim of the present study was to evaluate the immediate effects of transcranial direct current stimulation (tDCS) and functional electrical stimulation (FES) on activity of the tibialis anterior muscle (TA) and static balance of individuals with hemiparesis stemming from stroke. [Subjects and Methods] A randomized, double-blind, crossover, clinical trial conducted with 30 individuals with chronic post-stroke hemiparesis. Median frequency of electrical activity of the TA were determined using electromyography in five contractions concentrics and Static balance (body sway velocity and frequency), both before and immediately after the intervention. The participants were submitted to four 20-minute intervention protocols with 48-hour interval: anodal tDCS + sham FES; sham tDCS + active FES; anodal tDCS + active FES and sham tDCS + sham FES. Anodal tDCS was administered over C3 or C4, the cathode was positioned in the supraorbital region on the contralateral side and FES was administered to the affected TA. [Results] No significant differences among the protocols were found regarding electrical activity of the TA and static balance. [Conclusion] The results demonstrate that tDCS alone or in combination with FES had no immediate effect on electrical activity of the TA and static balance of the 30 individuals analyzed.
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Affiliation(s)
- Aline Marina Alves Fruhauf
- Postgraduate Program in Rehabilitation Sciences, University Nove de Julho: Rua Adolpho Pinto 109, Barra Funda, São Paulo, Brazil
| | - Fabiano Politti
- Postgraduate Program in Rehabilitation Sciences, University Nove de Julho: Rua Adolpho Pinto 109, Barra Funda, São Paulo, Brazil
| | - Simone Dal Corso
- Postgraduate Program in Rehabilitation Sciences, University Nove de Julho: Rua Adolpho Pinto 109, Barra Funda, São Paulo, Brazil
| | - Gláucio Carneiro Costa
- Postgraduate Program in Rehabilitation Sciences, University Nove de Julho: Rua Adolpho Pinto 109, Barra Funda, São Paulo, Brazil
| | - Amanda da Conceição Teodósio
- Postgraduate Program in Rehabilitation Sciences, University Nove de Julho: Rua Adolpho Pinto 109, Barra Funda, São Paulo, Brazil
| | - Soraia Micaela Silva
- Postgraduate Program in Rehabilitation Sciences, University Nove de Julho: Rua Adolpho Pinto 109, Barra Funda, São Paulo, Brazil
| | - João Carlos Ferrari Corrêa
- Postgraduate Program in Rehabilitation Sciences, University Nove de Julho: Rua Adolpho Pinto 109, Barra Funda, São Paulo, Brazil
| | - Fernanda Ishida Corrêa
- Postgraduate Program in Rehabilitation Sciences, University Nove de Julho: Rua Adolpho Pinto 109, Barra Funda, São Paulo, Brazil
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Ehsani F, Samaei A, Zoghi M, Hedayati R, Jaberzadeh S. The effects of cerebellar transcranial direct current stimulation on static and dynamic postural stability in older individuals: a randomized double-blind sham-controlled study. Eur J Neurosci 2017; 46:2875-2884. [PMID: 28973782 DOI: 10.1111/ejn.13731] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 09/25/2017] [Accepted: 09/27/2017] [Indexed: 12/31/2022]
Abstract
The aging population is growing rapidly. Risk of falling is higher in older people compared to young adults due to several reasons including poor posture and balance. The main aim of this study was to investigate the effect of cerebellar anodal transcranial direct current stimulation (a-tDCS) on static and dynamic postural stability in older individuals. Twenty-nine older adults participated in this study and were randomly allocated to two groups of active a-tDCS (experimental; n = 14) or sham tDCS group (n = 15). Experimental group received cerebellar a-tDCS for 20 min with intensity of 1.5 mA. Anterior-posterior and medial-lateral postural stability indices (postural sway) in addition to Berg Balance Score were measured before and after the intervention. Postural sways in static and dynamic postural tasks were significantly decreased (P < 0.05) after cerebellar a-tDCS, in addition to Berg Balance Score that increased significantly in active cerebellar a-tDCS group (P < 0.05). However, there were no significant changes in postural stability indices or Berg Balance Score in sham group (P > 0.05). The findings indicated immediate effect of cerebellar a-tDCS on improvement of postural control and balance in older individuals.
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Affiliation(s)
- Fatemeh Ehsani
- Neuromuscular Rehabilitation Research Center, Semnan University of Medical Sciences, Semnan, 3513138111, Iran
| | - Afshin Samaei
- Department of Internal Medicine, Neuromuscular Rehabilitation Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Maryam Zoghi
- Discipline of Physiotherapy, Department of Rehabilitation, Nutrition and Sport, School of Allied Health, La Trobe University, Bundoora, Vic., Australia
| | - Rozita Hedayati
- Neuromuscular Rehabilitation Research Center, Semnan University of Medical Sciences, Semnan, 3513138111, Iran
| | - Shapour Jaberzadeh
- Department of Physiotherapy, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic., Australia
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Rasooli AH, Birgani PM, Azizi S, Shahrokhi A, Mirbagheri MM. Therapeutic effects of an anti-gravity locomotor training (AlterG) on postural balance and cerebellum structure in children with Cerebral Palsy. IEEE Int Conf Rehabil Robot 2017; 2017:101-105. [PMID: 28813801 DOI: 10.1109/icorr.2017.8009229] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We evaluated the therapeutic effects of anti-gravity locomotor treadmill (AlterG) training on postural stability in children with Cerebral Palsy (CP) and spasticity, particularly in the lower extremity. AlterG can facilitate walking by reducing the weight of CP children by up to 80%; it can also help subjects maintain an appropriate posture during the locomotor AlterG training. Thus, we hypothesized that AlterG training, for a sufficient period of time, has a potential to produce cerebellum neuroplasticity, and consequently result in an effective permanent postural stability. AlterG training was given for 45 minutes, three times a week for two months. Postural balance was evaluated using posturography. The parameters of the Romberg based posturography were extracted to quantify the Center of Balance (CoP). The neuroplasticity of Cerebellum was evaluated using a Diffusion Tensor Imaging (DTI). The evaluations were done pre- and post-training. The Fractional Anisotropy (FA) feature was used for quantifying structural changes in the cerebellum. The results showed that AlterG training resulted in an increase in average FA value of the cerebellum white matter following the training. The results of the posturography evaluations showed a consistent improvement in postural stability. These results were consistent in all subjects. Our findings indicated that the improvement in the posture was accompanied with the enhancement of the cerebellum white matter structure. The clinical implication is that AlterG training can be considered a therapeutic tool for an effective and permanent improvement of postural stability in CP children.
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