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Transcranial Photobiomodulation for Spasticity in Pediatric Cerebral Palsy: A Scoping Review of Neurodevelopmental
Amalio Jiménez1, Frederick R Carrick1,2,3,4,5, Monèm Jemni1,2,6
1The Carrick Institute, Cape Canaveral, FL 32920, USA.
Insights
Evidence for transcranial photobiomodulation (tPBM) in pediatric cerebral palsy (CP) spasticity is severely limited. Current studies lack rigor and standardization, indicating tPBM is an unproven experimental intervention for children with CP.
Area of Science:
- Neurology
- Pediatric Rehabilitation
- Biomedical Engineering
Background:
- Spasticity affects over 80% of children with cerebral palsy (CP), significantly impacting their disability.
- Transcranial photobiomodulation (tPBM) is an emerging non-invasive neuromodulatory technique.
- Existing evidence on tPBM for pediatric CP spasticity is fragmented and insufficient.
Purpose of the Study:
- To systematically map the existing literature on tPBM for spasticity in pediatric CP.
- To characterize neurodevelopmental considerations, treatment protocols, functional outcomes, and methodological gaps.
- To assess the current state of evidence for tPBM in this population.
Main Methods:
- Scoping review following PRISMA-ScR guidelines.
- Systematic search of eight databases (January 2000 - September 2025).
- Inclusion criteria: children (0-18 years) with CP and spasticity, investigating transcranial PBM.
Main Results:
- Only five primary studies (n=45 children) met inclusion criteria; only two used tPBM.
- Severe heterogeneity and lack of protocol standardization, including inconsistent or implausible dosimetry.
- Methodological quality is pre-preliminary; no sham-controlled or blinded trials exist.
- Reported spasticity reductions and motor improvements are unreliable due to high risk of bias.
Conclusions:
- Evidence for tPBM in pediatric CP spasticity is in a pre-preliminary stage.
- Critical limitations include a small study number, lack of methodological rigor, and absence of pediatric safety protocols.
- Foundational, sham-controlled, double-blind trials with standardized dosimetry are urgently needed.
Abstract:
Background: Spasticity, affecting over 80% of children with cerebral palsy (CP), is a major source of disability. Transcranial photobiomodulation (tPBM) is a promising non-invasive neuromodulatory intervention, but evidence for its use in pediatric CP spasticity is fragmented and limited. Objective: This scoping review aimed to systematically map the literature to characterize neurodevelopmental considerations, treatment protocols, functional outcomes, and methodological gaps related to tPBM for spasticity in pediatric CP. Methods: The review followed the PRISMA extension for Scoping Reviews (PRISMA-ScR). A systematic search was performed across eight databases from January 2000 to September 2025. The PCC framework guided inclusion of studies involving children/adolescents (0-18 years) with CP and spasticity, investigating PBM with a primary focus on transcranial application. Results: From 345 records, only five primary studies (total n = 45 children) met the inclusion criteria. The evidence base is severely limited and heterogeneous, with only two of the five studies applying tPBM. A profound lack of protocol standardization was identified, with frequent reports that are internally inconsistent or contain physically implausible dosimetry reporting. Methodological quality was pre-preliminary, with no sham-controlled or adequately blinded trials. Although all studies reported reductions in spasticity and/or motor improvements, the high risk of bias prevents attribution of the effects to tPBM. Conclusions: The evidence supporting tPBM for spasticity in pediatric CP is in a pre-preliminary stage, defined by a critically small number of studies, a pervasive lack of methodological rigor, and an absence of pediatric-specific safety protocols. The field requires an immediate pivot to foundational, sham-controlled, double-blind trials with standardized dosimetry before tPBM can be considered anything other than an unproven experimental intervention.
