Robotic Rehabilitation and Transcranial Direct Current Stimulation in Children With Bilateral Cerebral Palsy

Area of Science:

• Neurorehabilitation
• Pediatric Neurology
• Robotics

Background:

• Bilateral cerebral palsy (CP) significantly impacts upper extremity function in children.
• Robotic-assisted therapy and transcranial direct current stimulation (tDCS) show promise for rehabilitation.
• Combining these interventions presents unique challenges in pediatric populations.

Purpose of the Study:

• To assess the feasibility, tolerability, and safety of combining robotic upper extremity rehabilitation with anodal transcranial direct current stimulation (tDCS) in children with bilateral CP.
• To identify challenges and barriers to implementing this combined therapy in young patients.

Main Methods:

• An unblinded, open-label pilot clinical trial was conducted.
• Eight children with bilateral CP (ages 6-11) participated in 10 sessions of robotic therapy combined with motor cortex tDCS.
• Feasibility, acceptability, practicality, and safety were assessed through various measures, including participant completion rates and adverse events.

Main Results:

• Five out of eight children completed the intervention protocol.
• No serious adverse events occurred during the trial; one unrelated seizure event was noted post-trial.
• Barriers to completion included time constraints and patient-specific factors like cognitive/behavioral impairments and dyskinesia.
• No decline in sensorimotor function was observed.

Conclusions:

• The combination of robotic upper extremity rehabilitation and tDCS appears feasible in children with bilateral CP.
• Future trials require careful participant selection, robust family engagement, and protocol adaptations to enhance feasibility and tolerability.
• Further research is warranted to optimize this combined therapeutic approach for pediatric CP.