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The Combined Use of Transcranial Direct Current Stimulation and Robotic Therapy for the Upper Limb
Published on: September 23, 2018
Transcranial direct current stimulation combined with upper limb functional training in children with spastic,
Renata Calhes Franco Moura1, Cibele Almeida Santos1, Luanda André Collange Grecco1
1Rehabilitation Sciences, Nove de Julho University (UNINOVE), São Paulo, SP, Brazil.
Insights
This study investigates functional training for children with cerebral palsy, comparing effects with and without transcranial direct current stimulation (tDCS) to improve upper limb function.
Area of Science:
- Neuroscience
- Rehabilitation Medicine
- Pediatric Neurology
Background:
- Spastic hemiparetic cerebral palsy affects upper limb function in children.
- Current rehabilitation strategies aim to improve motor skills and independence.
Purpose of the Study:
- To compare the effects of functional training with and without transcranial direct current stimulation (tDCS) on the paretic upper limb in children with cerebral palsy.
- To evaluate the impact of tDCS combined with functional training on motor function, spasticity, and performance in daily activities.
Main Methods:
- A prospective, randomized, controlled, double-blind clinical trial involving 34 children (6-16 years) with cerebral palsy (Manual Ability Classification System levels I-III).
- Participants were randomly assigned to functional training with either anodal tDCS or sham tDCS over the primary motor cortex.
- Evaluations included 3D movement analysis, electromyography, and standardized assessments for upper extremity function, spasticity, and disability.
Main Results:
- The study is designed to demonstrate the effects of the combined intervention.
- Statistical analysis will be performed to determine significant differences between groups (P ≤ 0.05).
Conclusions:
- Findings may contribute to the evidence base for using tDCS as an adjunct therapy for improving upper limb function in children with cerebral palsy.
- This research aims to inform clinical practice and future therapeutic approaches for this population.
Background:
The aim of the proposed study is to perform a comparative analysis of functional training effects for the paretic upper limb with and without transcranial direct current stimulation over the primary motor cortex in children with spastic hemiparetic cerebral palsy.
Methods:
The sample will comprise 34 individuals with spastic hemiparetic cerebral palsy, 6 to 16 years old, classified at level I, II, or III of the Manual Ability Classification System. Participants will be randomly allocated to two groups: (1) functional training of the paretic upper limb combined with anodic transcranial stimulation; (2) functional training of the paretic upper limb combined with sham transcranial stimulation. Evaluation will involve three-dimensional movement analysis and electromyography using the SMART-D 140® system (BTS Engineering) and the FREEEMG® system (BTS Engineering), the Quality of Upper Extremity Skills Test, to assess functional mobility, the Portable Device and Ashworth Scale, to measure movement resistance and spasticity, and the Pediatric Evaluation of Disability Inventory, to evaluate performance. Functional reach training of the paretic upper limb will include a range of manual activities using educational toys associated with an induced constraint of the non-paretic limb during the training. Training will be performed in five weekly 20-minute sessions for two weeks. Transcranial stimulation over the primary motor cortex will be performed during the training sessions at an intensity of 1 mA. Findings will be analyzed statistically considering a 5 % significance level (P ≤ 0.05).
Discussion:
This paper presents a detailed description of a prospective, randomized, controlled, double-blind, clinical trial designed to demonstrate the effects of combining transcranial direct current stimulation over the primary motor cortex and functional training of the paretic limb in children with cerebral palsy classified at level I, II, or III of the Manual Ability Classification System. The results will be published and evidence found may contribute to the use of transcranial stimulation for this population.
Trial Registration:
ReBEC RBR-6V4Y3K . Registered on 11 February 2015.
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