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Metelski N, Gu Y, Quinn L, Friel KM, Gordon AM. Safety and efficacy of non-invasive brain stimulation for the upper extremities in children with cerebral palsy: A systematic review. Dev Med Child Neurol 2024; 66:573-597. [PMID: 37528530 DOI: 10.1111/dmcn.15720] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 06/17/2023] [Accepted: 06/21/2023] [Indexed: 08/03/2023]
Abstract
AIM To evaluate available evidence examining safety and efficacy of non-invasive brain stimulation (NIBS) on upper extremity outcomes in children with cerebral palsy (CP). METHOD We electronically searched 12 sources up to May 2023 using JBI and Cochrane guidelines. Two reviewers selected articles with predetermined eligibility criteria, conducted data extraction, and assessed risk of bias using the Cochrane Risk of Bias criteria. RESULTS Nineteen studies were included: eight using repetitive transcranial magnetic stimulation (rTMS) and 11 using transcranial direct current stimulation (tDCS). Moderate certainty evidence supports the safety of rTMS and tDCS for children with CP. Very low to moderate certainty evidence suggests that rTMS and tDCS result in little to no difference in upper extremity outcomes. INTERPRETATION Evidence indicates that NIBS is a safe and feasible intervention to target upper extremity outcomes in children with CP, although it also indicates little to no significant impact on upper extremity outcomes. These findings are discussed in relation to the heterogeneous participants' characteristics and stimulation parameters. Larger studies of high methodological quality are required to inform future research and protocols for NIBS.
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Affiliation(s)
- Nicole Metelski
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, New York, USA
| | - Yu Gu
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, New York, USA
| | - Lori Quinn
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, New York, USA
| | - Kathleen M Friel
- Burke Neurological Institute, White Plains, New York, and Weill Cornell Medicine, New York, New York, USA
| | - Andrew M Gordon
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, New York, USA
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2
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Mufti A, Gulati S, Kochhar KP, Alam I, Wadhwa S, Sikka K, Saxena R, Jain S. Novel Therapeutic Strategies of Non-Invasive Brain Stimulation and Nanomedicine in Pediatric Cerebral Palsy Patients. Neurol India 2024; 72:248-257. [PMID: 38691468 DOI: 10.4103/ni.ni_953_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 07/05/2023] [Indexed: 05/03/2024]
Abstract
Infantile central palsy (CP) is caused due to damage to the immature developing brain usually before birth, leading to altered topography and biochemical milieu. CP is a life-limiting disorder, which causes changes in sensory, motor, cognitive, and behavioral functioning. Understanding its pathophysiology is complex, and current therapeutic modalities, oral medication, surgical treatment, physical therapy, and rehabilitation provide minimal relief. As the brain is plastic, it has an inherent capacity to adapt to altered activity; thus, non-invasive brain stimulation (NIBS) strategies, like repetitive transcranial magnetic stimulation, which can modulate the neuronal activity and its function, may lead to recovery in CP patients. Further, in recent years, nanomedicine has shown a promising approach in pre-clinical studies for the treatment of central nervous system disorder because it can cross the blood-brain barrier, improve penetration, and provide sustained release of the drug. The review focuses on the principles and mechanisms of various NIBS techniques used in CP. We have also contemplated the effect of rehabilitation and nanomedicine in CP children, which will definitely lead to advancing our diagnostic as well as therapeutic abilities, in a vulnerable group of little ones.
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Affiliation(s)
- Aliya Mufti
- Department of Physiology, All India Institute of Medical Sciences, Ansari Nagar, Delhi, India
| | - Sheffali Gulati
- Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, Delhi, India
| | - Kanwal P Kochhar
- Department of Physiology, All India Institute of Medical Sciences, Ansari Nagar, Delhi, India
| | - Iqbal Alam
- Department of Physiology Hamdard Institute of Medical Sciences and Research, New Delhi, India
| | - Sanjay Wadhwa
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, Ansari Nagar, Delhi, India
| | - Kapil Sikka
- Department of ENT, All India Institute of Medical Sciences, Ansari Nagar, Delhi, India
| | - Rohit Saxena
- Department of Rajendra Prasad Centre, All India Institute of Medical Sciences, Ansari Nagar, Delhi, India
| | - Suman Jain
- Department of Physiology, All India Institute of Medical Sciences, Ansari Nagar, Delhi, India
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3
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Muscle Tonus Evaluation in Patients with Neurological Disorders: A Scoping Review. J Med Biol Eng 2023. [DOI: 10.1007/s40846-023-00773-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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4
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Sun YY, Wang L, Peng JL, Huang YJ, Qiao FQ, Wang P. Effects of repetitive transcranial magnetic stimulation on motor function and language ability in cerebral palsy: A systematic review and meta-analysis. Front Pediatr 2023; 11:835472. [PMID: 36873646 PMCID: PMC9978792 DOI: 10.3389/fped.2023.835472] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 01/26/2023] [Indexed: 02/18/2023] Open
Abstract
OBJECTIVE This review was conducted to assess the quality of the evidence of effectiveness of repetitive transcranial magnetic stimulation (rTMS) in treating motor and language ability of cerebral palsy (CP). METHOD Medline, Cochrane library, Web of Science, Embase, PubMed, and CNKI databases were searched up to July 2021 by two independent reviewers. Randomized controlled trials (RCTs) that were published in English and Chinese and met the following criteria were included. The population comprised patients who met the diagnostic criteria for CP. Intervention included the following: comparison about rTMS and sham rTMS or comparison about rTMS combine with other physical therapy and other physical therapy. Outcomes included motor function, as follows: gross motor function measure (GMFM), Gesell Development Diagnosis Scale, fine motor function measure (FMFM), Peabody developmental motor scale, and Modified Ashworth scale. For language ability, sign-significant relation (S-S) was included. Methodological quality was assessed using the Physiotherapy Evidence Database (PEDro) scale. RESULTS Finally, 29 studies were included in the meta-analysis. Results of evaluation using the Cochrane Collaborative Network Bias Risk Assessment Scale showed that 19 studies specifically explained randomization, among which two studies described allocation concealment, four studies blinded participants and persons and had low risk of bias, and six studies explained that the assessment of outcome measures was blinded. Significant improvements in motor function were observed. The GMFM of total score was determined by using the random-effect model [I2 = 88%; MD = -1.03; 95% CI (-1.35, -0.71); P < 0.0001] and FMFM was determined by using the fixed-effect model [P = 0.40 and I2 = 3%; SMDs = -0.48, 95% CI (-0.65, -0.30); P < 0.01]. For language ability, the language improvement rate was determined using a fixed-effect model [P = 0.88 and I2 = 0%; MD = 0.37, 95% CI (0.23, 0.57); P < 0.01]. According to the PEDro scale, 10 studies had low-quality, four studies had excellent quality, and the other studies had good quality. Using the GRADEpro GDT online tool, we included a total of 31 outcome indicators, as follows: 22 for low quality, seven for moderate quality, and two for very low quality. CONCLUSION The rTMS could improve the motor function and language ability of patients with CP. However, rTMS prescriptions varied, and the studies had low sample sizes. Studies using rigorous and standard research designs about prescriptions and large samples are needed to collect sufficient evidence about the effectiveness of using rTMS to treat patients with CP.
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Affiliation(s)
- Ying-Ying Sun
- School of Education and Psychology, University of Jinan, Jinan, China.,Jinan Tongkang Children's Hospital, Jinan, China
| | - Lei Wang
- Department of Rehabilitation Medicine, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Jin-Lin Peng
- Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, China
| | - Yi-Jie Huang
- Department of Rehabilitation Medicine, The Seventh Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
| | - Fu-Qiang Qiao
- School of Education and Psychology, University of Jinan, Jinan, China.,CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China
| | - Pu Wang
- Department of Rehabilitation Medicine, The Seventh Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
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5
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Fan J, Fu H, Xie X, Zhong D, Li Y, Liu X, Zhang H, Zhang J, Huang J, Li J, Jin R, Zheng Z. The effectiveness and safety of repetitive transcranial magnetic stimulation on spasticity after upper motor neuron injury: A systematic review and meta-analysis. Front Neural Circuits 2022; 16:973561. [PMID: 36426136 PMCID: PMC9679509 DOI: 10.3389/fncir.2022.973561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 10/17/2022] [Indexed: 11/09/2022] Open
Abstract
To systematically evaluate the effectiveness and safety of repetitive transcranial magnetic stimulation (rTMS) on spasticity after upper motor neuron (UMN) injury. Eight electronic databases were searched from inception to August 6, 2022. Randomized controlled trials (RCTs) investigating the effectiveness and safety of rTMS on spasticity after UMN injury were retrieved. Two reviewers independently screened studies, extracted data, and assessed the risk of bias. Review Manager 5.3 and Stata 14.0 software were used to synthesize data. The certainty of the evidence was appraised with the Grade of Recommendation, Assessment, Development and Evaluation tool. Forty-two studies with a total of 2,108 patients were included. The results of meta-analysis revealed that, compared with control group, rTMS could significantly decrease scores of the Modified Ashworth Scale (MAS) in patients with UMN injury. The subgroup analysis discovered that rTMS effectively decreased the MAS scores in patients with stroke. Meanwhile, rTMS treatment > 10 sessions has better effect and rTMS could decrease the MAS scores of upper limb. Thirty-three patients complained of twitching facial muscles, headache and dizziness, etc. In summary, rTMS could be recommended as an effective and safe therapy to relieve spasticity in patients with UMN injury. However, due to high heterogeneity and limited RCTs, this conclusion should be treated with caution.
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Affiliation(s)
- Jin Fan
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China,Mental Health Center, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, China
| | - Hui Fu
- Department of Rehabilitation Medicine, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Xiaolong Xie
- Department of Rehabilitation Medicine, The Affiliated Meishan Hospital of Chengdu University of Traditional Chinese Medicine, Meishan, China
| | - Dongling Zhong
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yuxi Li
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiaobo Liu
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Huiling Zhang
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jun Zhang
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jiaxi Huang
- Mental Health Center, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, China
| | - Juan Li
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China,Juan Li,
| | - Rongjiang Jin
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China,*Correspondence: Rongjiang Jin,
| | - Zhong Zheng
- Mental Health Center, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, China,Zhong Zheng,
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Wu F, Zhao H, Zhang Y, Wang M, Liu C, Wang X, Cheng Y, Jin C, Yang J, Li X. Morphologic Variants of the Hand Motor Cortex in Developing Brains from Neonates through Childhood Assessed by MR Imaging. AJNR Am J Neuroradiol 2022; 43:292-298. [PMID: 34992126 PMCID: PMC8985685 DOI: 10.3174/ajnr.a7386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 10/20/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND PURPOSE Knowledge of anatomic markers of the hand motor cortex is essential in the evaluation and treatment of motor neurologic diseases for both adults and developing populations. However, hand motor cortex variants in developing brains remain to be investigated. Our objective was to observe morphologic variants of the hand motor cortex in developing brains from neonates through childhood. MATERIALS AND METHODS In this study, 542 participants (0∼15 years of age) were retrospectively enrolled and divided into different age groups. The hand motor cortex morphology was evaluated on the basis of 3D T1WI. Variations in hand motor cortex variants were compared among different age groups. Inter-gender and interhemispheric differences of hand motor cortex variants were also evaluated. RESULTS Various hand motor cortex variants could be observed in developing brains, even in the neonatal period. One new morphologic shape, "immature Ω," was found in neonates and infants. The proportion of this new shape decreased dramatically during the first year after birth, then disappeared after 1 year of age. It persisted for a longer time in the right hemisphere and in males. However, sex or hemispheric effects on the distribution of the proportion of variants were not statistically significant. Furthermore, the proportion of concordance of the bilateral hand motor cortex showed an increasing trend with age (P = .006), higher in females than males. CONCLUSIONS Various hand motor cortex variants already existed at birth. The distribution of proportions of different variants developmentally varied during the first year after birth and became stable after 1 year of age. The concordance of the bilateral hand motor cortex could be influenced by age and sex.
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Affiliation(s)
- F. Wu
- From the Department of Radiology (F.W., H.Z., Y.Z., M.W., C.L., X.W., Y.C., C.J., J.Y., X.L.), the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China,Department of Radiology (F.W.), Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - H. Zhao
- From the Department of Radiology (F.W., H.Z., Y.Z., M.W., C.L., X.W., Y.C., C.J., J.Y., X.L.), the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Y. Zhang
- From the Department of Radiology (F.W., H.Z., Y.Z., M.W., C.L., X.W., Y.C., C.J., J.Y., X.L.), the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - M. Wang
- From the Department of Radiology (F.W., H.Z., Y.Z., M.W., C.L., X.W., Y.C., C.J., J.Y., X.L.), the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - C. Liu
- From the Department of Radiology (F.W., H.Z., Y.Z., M.W., C.L., X.W., Y.C., C.J., J.Y., X.L.), the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - X. Wang
- From the Department of Radiology (F.W., H.Z., Y.Z., M.W., C.L., X.W., Y.C., C.J., J.Y., X.L.), the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Y. Cheng
- From the Department of Radiology (F.W., H.Z., Y.Z., M.W., C.L., X.W., Y.C., C.J., J.Y., X.L.), the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - C. Jin
- From the Department of Radiology (F.W., H.Z., Y.Z., M.W., C.L., X.W., Y.C., C.J., J.Y., X.L.), the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - J. Yang
- From the Department of Radiology (F.W., H.Z., Y.Z., M.W., C.L., X.W., Y.C., C.J., J.Y., X.L.), the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - X. Li
- From the Department of Radiology (F.W., H.Z., Y.Z., M.W., C.L., X.W., Y.C., C.J., J.Y., X.L.), the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
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7
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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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8
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Gupta M, Bhatia D, Sinha TK, Dogra S, Jha S. Investigation of cognitive changes in cerebral palsy children employing different integrated sensing techniques. SENSORS INTERNATIONAL 2020. [DOI: 10.1016/j.sintl.2020.100016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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9
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Noninvasive Brain Stimulation for Rehabilitation of Pediatric Motor Disorders Following Brain Injury: Systematic Review of Randomized Controlled Trials. Arch Phys Med Rehabil 2019; 100:1945-1963. [DOI: 10.1016/j.apmr.2019.04.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 03/29/2019] [Accepted: 04/09/2019] [Indexed: 12/26/2022]
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10
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Şan AU, Yılmaz B, Kesikburun S. The Effect of Repetitive Transcranial Magnetic Stimulation on Spasticity in Patients with Multiple Sclerosis. J Clin Neurol 2019; 15:461-467. [PMID: 31591833 PMCID: PMC6785483 DOI: 10.3988/jcn.2019.15.4.461] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 04/02/2019] [Accepted: 04/02/2019] [Indexed: 11/17/2022] Open
Abstract
Background and Purpose This randomized controlled study examined the effect of repetitive transcranial magnetic stimulation (rTMS) on spasticity in patients with multiple sclerosis (MS). Methods This study included 16 patients with a history of MS and spasticity in the adductor hip muscles according to the Modified Ashworth Scale (MAS). The participants were randomized into the active group (n=10) and control group (n=6), in which active rTMS and sham rTMS were applied in 10 sessions, respectively. A physical therapy and rehabilitation program was applied along with rTMS sessions in both groups. The evaluation parameters were assessed at baseline and then 1 week and 1 month after applying rTMS. Results Statistical analyses with post-hoc correction revealed statistically significant improvements in the active group compared to the control group in the bilateral MAS score, Penn Spasm Frequency Scale score, patient satisfaction, amount of urine leakage, actual health status, perceived health status, energy and fatigue, role limitations due to physical problems, social function, overall quality of life, cognitive functioning, physical health composite score, mental health composite score, and total score on the Multiple Sclerosis Quality of Life-54 (MSQOL-54) (p<0.05). Statistically significant changes were detected in the MSQOL-54 social function and physical health composite scores of patients in the control group (p<0.05). Conclusions Active rTMS combined with a physical therapy program reduced spasticity in MS patients compared to the control group that received only physical therapy. Further comprehensive and more advanced studies are needed to confirm the present findings.
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Affiliation(s)
- Ayça Uran Şan
- Department of Physical Rehabilitation Medicine, Karabuk University Karabuk Training and Research Hospital, Karabuk, Turkey.
| | - Bilge Yılmaz
- Department of Physical Rehabilitation Medicine, Health Sciences University, Gulhane School of Medicine, Ankara, Turkey
| | - Serdar Kesikburun
- Department of Physical Rehabilitation Medicine, Health Sciences University, Gulhane School of Medicine, Ankara, Turkey
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11
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Rajak BL, Gupta M, Bhatia D, Mukherjee A. Increasing Number of Therapy Sessions of Repetitive Transcranial Magnetic Stimulation Improves Motor Development by Reducing Muscle Spasticity in Cerebral Palsy Children. Ann Indian Acad Neurol 2019; 22:302-307. [PMID: 31359942 PMCID: PMC6613416 DOI: 10.4103/aian.aian_102_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: Repetitive TMS (rTMS), a non-invasive neuro-stimulation tool based on the principle of electromagnetic induction is recently being employed both for investigational and interventional purposes. The stimulating effect of rTMS on motor cortex areas of the brain leads to increased motor activity and decreased muscle tone in spastic cerebral palsy (CP) patients. Objective: This modulatory effect of rTMS is used in this study to evaluate its effect on motor function and spasticity by increasing the number of therapy session and keeping frequency of 10Hz and pulse train of 2500 constant. Methods: Total thirty spastic CP patients participated in this study after written informed consent from their parents/guardians. The participants were equally divided into three groups, namely, S-20, S-30 and S-40 depending on the number of therapy sessions. The mean age±SD of participants in different groups were 8.9±3.6, 9.5±2.9 and 8.4±3.5 in S-20, S-30 and S-40 respectively. Participants in S-20, S-30 and S-40 were provided 20, 30 and 40 sessions of rTMS therapy respectively followed by physical therapy of 30 minutes daily. Each rTMS session was of 25 minutes duration and was administered once daily for 5 days a week. Prior to start and after completion of the therapy, pre and post assessment of gross motor function measure (GMFM) for motor function and modified Ashworth scale (MAS) for muscle spasticity was performed on all the participants. Outcomes: The result of pre-versus-post GMFM score showed that 4.27%, 3.12% and 2.36% motor gain was obtained after 40, 30 and 20 sessions of therapy respectively. In addition, significant reduction in spasticity in both upper and limb muscles was also observed in all the three groups.
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Affiliation(s)
- Bablu Lal Rajak
- Department of Biomedical Engineering, North-Eastern Hill University, Shillong, Meghalaya, India
| | - Meena Gupta
- Department of Biomedical Engineering, North-Eastern Hill University, Shillong, Meghalaya, India
| | - Dinesh Bhatia
- Department of Biomedical Engineering, North-Eastern Hill University, Shillong, Meghalaya, India
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12
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Gupta M, Rajak BL, Bhatia D, Mukherjee A. Neuromodulatory effect of repetitive transcranial magnetic stimulation pulses on functional motor performances of spastic cerebral palsy children. J Med Eng Technol 2018; 42:352-358. [PMID: 30175934 DOI: 10.1080/03091902.2018.1510555] [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] [Indexed: 01/11/2023]
Abstract
BACKGROUND Neuromodulation is emerging as a new therapeutic field towards treatment of neurological disorders through advances in medical devices. Repetitive Transcranial Magnetic Stimulation (rTMS) is one such neuromodulatory device that has received increasing interest as a tool for modulating cortical excitability that influence motor activity in both normal and diseased population. However, the therapeutic effect of rTMS varies depending on stimulation frequency, intensity, pulse trains, duration, etc. Our previous studies had already demonstrated that higher frequency of 10 Hz was effective in improving the motor activity of spastic CP patients. OBJECTIVE This study was aimed to evaluate the effect of different rTMS pulses on gross motor performance of spastic CP patients. METHOD Thirty spastic CP patients were divided equally into three groups P1500, P2000 and P2500 with mean age (in years) 7.7 ± SD4.4, 6.8 ± SD5.3 and 7.2 ± SD5.1 respectively. Gross Motor Function Measure (GMFM) was employed as an outcome measure to assess the motor performance. Constant rTMS frequency of 10 Hz was delivered to each participant but the number of stimulation pulse varied according to the groups; which were 1500, 2000 and 2500 pulses for P1500, P2000 and P2500 group respectively. rTMS therapy of 15 minutes duration was followed by physical therapy of 30 minutes daily for 20 days. RESULT Statistical analysis of pre versus post GMFM scores of different groups revealed significant result (p < .001) and the improvement in functional motor activity was 2.33% in P1500, 3.58% in P2000 and 5.17% in P2500 group. INTERPRETATION The result demonstrated modulatory effect of rTMS pulse by improving motor function of spastic CP patients.
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Affiliation(s)
- Meena Gupta
- a Department of Biomedical Engineering , North Eastern Hill University , Shillong , India
| | - Bablu Lal Rajak
- a Department of Biomedical Engineering , North Eastern Hill University , Shillong , India
| | - Dinesh Bhatia
- a Department of Biomedical Engineering , North Eastern Hill University , Shillong , India
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13
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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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14
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Efficacy of photobiomodulation therapy on masseter thickness and oral health-related quality of life in children with spastic cerebral palsy. Lasers Med Sci 2017; 32:1279-1288. [PMID: 28536904 DOI: 10.1007/s10103-017-2236-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 05/16/2017] [Indexed: 12/16/2022]
Abstract
The study aimed to evaluate the efficacy of photobiomodulation therapy (PBMT) on bilateral masseter muscle thickness and amplitude of mouth opening in children with spastic cerebral palsy (CP), and the impact on their oral health-related quality of life (OHRQOL). Three groups were included: experimental CP group (EG: n = 26 with oral complaints), positive control CP group (PCG: n = 26 without complaints), and negative control group (NCG: n = 26 without CP). In the EG, the masseter muscles on both sides were irradiated with an infrared low-level Ga-Al-As laser (λ = 808 ± 3 nm, 120 mW) using a 3 J/cm2 energy dose per site, with a 20 s exposure time per site (spot area: 4 mm2; irradiance: 3 W/cm2; energy delivery per point: 2.4 J) six times over six consecutive weeks. Masseter thickness, assessed through ultrasonography, and the amplitude of mouth opening were measured in the EG before and after six applications of PBMT and once in the PCG and NCG. The Parental-Caregiver Perception Questionnaire (P-CPQ) was used to evaluate OHRQOL. ANOVA, chi-square, t tests, and multilevel linear regression were used for statistical analysis. In the EG, the study results revealed average increments of 0.77 (0.08) millimeter in masseter thickness (P < 0.05) and 7.39 (0.58) millimeter for mouth opening (P < 0.05) and reduction in all P-CPQ domains (P < 0.001), except for social well-being. The six applications of PBMT increased masseter thickness and mouth opening amplitude and reduced the impact of spastic CP on OHRQOL.
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Naro A, Leo A, Russo M, Casella C, Buda A, Crespantini A, Porcari B, Carioti L, Billeri L, Bramanti A, Bramanti P, Calabrò RS. Breakthroughs in the spasticity management: Are non-pharmacological treatments the future? J Clin Neurosci 2017; 39:16-27. [DOI: 10.1016/j.jocn.2017.02.044] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 02/12/2017] [Indexed: 12/16/2022]
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Spasticity Management: The Current State of Transcranial Neuromodulation. PM R 2017; 9:1020-1029. [DOI: 10.1016/j.pmrj.2017.03.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 03/20/2017] [Accepted: 03/31/2017] [Indexed: 12/18/2022]
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