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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 an intensive training program for upper limb rehabilitation in
Javier Merino-Andrés1, Rocío Palomo-Carrión2, Julio Gómez-Soriano1
1Toledo Physiotherapy Research Group (GIFTO), Faculty of Physiotherapy and Nursing, Universidad de Castilla-La Mancha, Toledo 45071, Spain; Toledo Physiotherapy Research Group (GIFTO), Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM), Toledo 45004, Spain.
Insights
Adding cathodal transcranial direct current stimulation (tDCS) to intensive therapy did not improve upper limb function in children with unilateral cerebral palsy (UCP). However, it showed a short-term benefit for quality of life.
Area of Science:
- Neuroscience
- Pediatric Rehabilitation
- Clinical Trials
Background:
- Unilateral cerebral palsy (UCP) significantly impacts upper limb function in children.
- Therapeutic interventions aim to improve motor control and daily activity participation.
- Transcranial direct current stimulation (tDCS) is explored as an adjunct therapy to enhance rehabilitation outcomes.
Purpose of the Study:
- To evaluate the effectiveness of cathodal tDCS combined with intensive motor training on upper limb function in children with UCP.
- To assess the impact on spontaneous upper limb use, quality of movement, and quality of life.
- To explore the user's experience with the combined intervention.
Main Methods:
- A pilot randomized triple-blind clinical trial involving 18 children (4-8 years) with UCP.
- Participants were assigned to either active cathodal tDCS or sham tDCS, both combined with intensive motor training.
- Assessments included upper extremity function, manual experience, and quality of life, conducted pre-intervention, post-intervention, and at 3-month follow-up.
Main Results:
- Both active and sham tDCS groups showed improvements across all measured variables.
- Inter-group analysis revealed no significant difference in upper limb function or manual experience.
- A statistically significant improvement in quality of life was observed in the active tDCS group (p=0.043).
Conclusions:
- Combining cathodal tDCS with intensive manual function therapy does not enhance spontaneous upper limb use or functional experience in children with UCP.
- The addition of cathodal tDCS demonstrated a short-term positive effect on the quality of life for children with UCP.
- Further research may be needed to optimize tDCS parameters or patient selection for improved motor outcomes.
Background:
Unilateral cerebral palsy (UCP) presents a greater functional alteration of the upper limb. Among the recommended interventions are certain therapeutic tools, such as transcranial direct current stimulation (tDCS) that could increase the therapeutic window and enhance the effect of interventions.
Aims:
To determine the effectiveness of a 3-weeks intervention of cathodal tDCS applied over the motor cortex of the less affected hemisphere combined with a manual function intensive training program in the upper limbs on quality of movement and the spontaneous use of upper limb in children with UCP. Secondarily, quality of life and user´s experience was also assessed.
Methods And Procedures:
A pilot randomized triple-blind clinical trial was conducted. 18 children with UCP between 4 and 8 years were recruited and randomly allocated to one of the two experimental groups: 1) Active group: cathodal tDCS + intensive motor training; 2) Control group: Sham tDCS + intensive motor training. Assessments were performed before and after the intervention, and at three months follow-up.
Outcomes And Results:
Outcome measures: Shriners Hospital Upper Extremity Evaluation children's manual experience questionnaire, Paediatric Quality of Life Questionnaire and the Children's Manual Experience Questionnaire (miniCHEQ). Both groups improved in all variables but in the inter-group analysis only quality of life obtained significant results (p = 0.043).
Conclusions And Implications:
Adding cathodal tDCS to a program of intensive manual function therapy training did not produce a greater improvement on the spontaneous use, nor improving the experience of use in children with UCP. However, this technique has a short-term beneficial effect on quality of life.
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