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Author Spotlight: Repetitive Transcranial Magnetic Stimulation Combined with Movement Observation in Cerebral Palsy
Published on: August 9, 2024
Effects of exercise combined with brain stimulation on hand function in children with cerebral palsy: a meta-analysis
Shuoqi Li1, Shenhao Guo1, Ruihan Wang1
1School of Sports Science, Nantong University, Nantong, China.
Insights
Exercise with brain stimulation significantly improves hand function in children with cerebral palsy (CP). More than 16 sessions enhance grip strength, while transcranial direct current stimulation (tDCS) benefits fine motor control.
Area of Science:
- Neuroscience
- Pediatrics
- Rehabilitation Medicine
Background:
- Cerebral palsy (CP) is a common pediatric neurological disorder affecting motor function, particularly hand use.
- Impaired hand function in children with CP significantly impacts their daily activities and quality of life.
Purpose of the Study:
- To systematically review the impact of exercise combined with brain stimulation on hand function in children with CP.
- To compare the effectiveness of exercise alone versus exercise with brain stimulation techniques.
Main Methods:
- A systematic literature search was performed across major databases (Web of Science, Scopus, PubMed, EBSCO) from January 2010 to June 2025.
- Inclusion criteria focused on randomized controlled trials involving children with CP, exercise interventions (with or without brain stimulation), and assessments of gross motor function, fine manual control, and grip strength.
- Study quality was assessed using the Cochrane Risk of Bias tool, and data were analyzed using standardized mean differences (SMD) with RevMan 5.4 software.
Main Results:
- Exercise with brain stimulation, particularly over 16 sessions, significantly improved grip strength (SMD = 1.38).
- Fewer than 10 sessions showed no significant effect on grip strength (SMD = 0.19).
- Brain stimulation interventions generally enhanced fine manual control (SMD = 0.46), with transcranial direct current stimulation (tDCS) showing a notable improvement (SMD = 0.71) compared to repetitive transcranial magnetic stimulation (rTMS) (SMD = 0.19).
Conclusions:
- Exercise combined with brain stimulation is an effective strategy for enhancing hand function in children with cerebral palsy.
- A higher number of intervention sessions (over 16) appears crucial for maximizing grip strength benefits.
- tDCS shows promise as a specific brain stimulation technique for improving fine motor control in this population.
Background:
Cerebral palsy (CP) is a paediatric condition generally characterized by persistent motor disabilities in hand function. This review examined the impact of exercise with and without brain stimulation on hand function in children with CP.
Methodology:
A systematic literature search was conducted from January 2010 to June 2025 across four electronic databases: Web of Science, Scopus, PubMed, and EBSCO. This review established the inclusion criteria as follows: 1. Children with CP; 2. Randomised controlled trial; 3. Exercise with and without brain stimulation; 4. Measurements included gross motor function (GMF), fine manual control (FMC) and grip strength (GS) evaluated at pre- and post-intervention. The quality of the included studies was assessed using the Cochrane Risk of Bias tool. For data analysis, the standardized mean difference (SMD) was selected as the appropriate effect size index, and RevMan 5.4 software was employed to analyze the mean differences in the data extracted from the included articles. (Registration number: CRD420251106181).
Results:
The results showed that exercise with brain stimulation comprising more than 16 sessions could notably improve GS (SMD, 1.38 (0.88, 1.88), p < 0.05, I2 = 0%), whereas that comprising fewer than 10 sessions did not demonstrate a statistically significant effect (SMD, 0.19 (-0.29, 0.67), p = 0.44, I2 = 0%). Consequently, brain stimulation intervention could substantially enhance FMC (SMD, 0.46 (0.15, 0.76), p < 0.05, I2 = 47%). Subgroup analysis also presented that exercise with transcranial direct current stimulation (tDCS) resulted in a significant improvement in FMC (SMD, 0.71 (0.29, 1.14), p < 0.05, I2 = 49%) compared to exercise with repetitive transcranial magnetic stimulation (SMD, 0.19 (-0.25, 0.63), p = 0.09, I2 = 47%).
Conclusion:
This review demonstrated that exercise with brain stimulation could significantly enhance hand function in children with CP. Specifically, more than 16 sessions has greater benefits for GS, and the tDCS may confer benefits for FMC.
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