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Updated: Jul 30, 2025
Author Spotlight: Repetitive Transcranial Magnetic Stimulation Combined with Movement Observation in Cerebral Palsy
Published on: August 9, 2024
Brain Stimulation and Constraint Induced Movement Therapy in Children With Unilateral Cerebral Palsy: A Randomized
Juhi Gupta1, Sheffali Gulati1, Upinder Pal Singh2
1Centre of Excellence & Advanced Research for Childhood Neurodevelopmental Disorders, Child Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.
Insights
Combining repetitive transcranial magnetic stimulation (rTMS) with modified constraint-induced movement therapy (mCIMT) significantly improves upper limb function in children with cerebral palsy (CP). This combined therapy is safe and feasible for pediatric rehabilitation.
Area of Science:
- Neuroscience
- Rehabilitation Medicine
- Pediatric Neurology
Background:
- Cerebral palsy (CP) necessitates effective rehabilitation strategies for children.
- Optimizing upper limb function is a key goal in CP management.
Purpose of the Study:
- To evaluate the safety, feasibility, and efficacy of combining 6-Hz primed, low-frequency repetitive transcranial magnetic stimulation (rTMS) with modified constraint-induced movement therapy (mCIMT).
- To assess the impact of this combined therapy on upper limb function in children with unilateral CP.
Main Methods:
- A randomized controlled trial involving 46 children (5-18 years) with unilateral CP.
- Participants received either mCIMT with real rTMS or mCIMT with sham rTMS over 4 weeks.
- Upper limb function was assessed using the Quality of Upper Extremity Skills Test (QUEST) and other measures.
Main Results:
- The intervention group (mCIMT + real rTMS) showed significantly greater improvement in total QUEST scores compared to the control group (mCIMT + sham rTMS).
- Improvements were observed in specific QUEST domains ('weight bearing', 'protective extension') and were sustained at 12 weeks.
- Quality of life scores (CP-QOL) also improved, with no serious adverse events reported.
Conclusions:
- 6-Hz primed rTMS combined with mCIMT is a safe and feasible approach.
- This combination therapy is superior to mCIMT alone for enhancing upper limb function in children with unilateral CP.
- The findings support the integration of rTMS into CP rehabilitation programs.
Background:
There is a crucial need to devise optimum rehabilitation programs for children with cerebral palsy (CP).
Objective:
This study aimed to assess the feasibility, safety, and efficacy of combining 6-Hz primed, low-frequency, repetitive transcranial magnetic stimulation (rTMS) with modified constraint-induced movement therapy (mCIMT) in improving upper limb function in children with unilateral CP.
Methods:
Children aged 5 to 18 years with unilateral CP were randomized (23 in each arm) to receive 10 sessions of mCIMT with real rTMS (intervention arm) or mCIMT with sham rTMS (control arm), on alternate weekdays over 4 weeks. The primary outcome was the difference in mean change in Quality of Upper Extremity Skills Test (QUEST) scores. Secondary outcomes were changes in QUEST domain scores, speed and strength measures, CP quality of life (CP-QOL) scale scores, and safety of rTMS.
Results:
All 46 children completed the trial except one. At 4 weeks, the mean change in total QUEST scores was significantly higher in the intervention arm as compared to the control arm (11.66 ± 6.97 vs 6.56 ± 4.3, d = 5.1, 95% CI 1.7-8.5, P = .004). Change in "weight bearing" and "protective extension" domain score was significantly higher for children in the intervention arm. These improvements were sustained at 12 weeks (P = .028). CP-QOL scores improved at 12 weeks. No serious adverse events were seen.
Conclusion:
A 6-Hz primed rTMS combined with mCIMT is safe, feasible, and superior to mCIMT alone in improving the upper limb function of children with unilateral CP.
Trial Registration:
ClinicalTrials.gov Identifier: NCT03792789.
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