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Evaluating Transcranial Direct Current Stimulation as an Adjunct to In-Patient Physiotherapy in Paediatric Acquired
Jennifer L Ryan1,2, Deryk S Beal1,2, Darcy L Fehlings1,2
1From the: From the: Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Toronto, Ontario, Canada.
Insights
This study found transcranial direct current stimulation (tDCS) infeasible for pediatric acquired brain injury (ABI) rehabilitation due to low recruitment and retention. However, study procedures were viable for future research.
Area of Science:
- Neuroscience
- Pediatric Rehabilitation
- Clinical Trials
Background:
- Acquired brain injury (ABI) presents significant challenges for children and youth.
- Physiotherapy is a cornerstone of rehabilitation for pediatric ABI.
- Novel adjunct therapies are needed to enhance recovery outcomes.
Purpose of the Study:
- To assess the feasibility of transcranial direct current stimulation (tDCS) as an add-on therapy to inpatient physiotherapy for pediatric ABI.
- To evaluate eligibility, recruitment, retention, and tolerance of tDCS in this population.
Main Methods:
- A randomized feasibility trial involving children aged 5-18 with moderate to severe ABI.
- Participants received either active or sham anodal tDCS before physiotherapy sessions.
- Blinding of participants, therapists, assessors, and investigators was maintained.
Main Results:
- Only 6 out of 232 eligible children (2.6%) were recruited, with 4 participants enrolled.
- Retention was low, with only one participant completing the full protocol.
- The primary side effect reported was mild sub-electrode itchiness, indicating good tolerance.
Conclusions:
- The study was deemed infeasible due to significant challenges in eligibility and participant retention.
- Despite feasibility issues, the study procedures for assessment, treatment delivery, and data collection were viable.
- These established procedures can inform future research on tDCS for pediatric ABI.
Purpose:
Evaluate the feasibility of transcranial direct current stimulation (tDCS) as an adjunct to in-patient physiotherapy for children and youth with acquired brain injury (ABI).
Method:
This randomized feasibility trial allocated children (5-18 years of age with moderate to severe ABI) to receive either active or sham anodal tDCS immediately prior to 16 of their existing in-patient physiotherapy sessions. Participants, physiotherapists, assessors, and primary investigators were blinded to treatment allocation. Eligibility, recruitment, retention, tolerance, and preliminary treatment outcomes were evaluated against a priori feasibility targets.
Results:
Of 232 children admitted over 21 months, 6 were eligible (2.6%) and 4 were recruited (66.7%). One participant completed the entire study protocol, two were withdrawn for unrelated changes in medical stability, and one could not commence the study due to COVID-19 restrictions. Participants completed all tDCS sessions that were started with the primary transient side effect being sub-electrode itchiness.
Conclusions:
While the study was infeasible from eligibility and retention perspectives, study procedures (e.g., assessment, treatment, side effect tracking, physiotherapy documentation) were viable and should be applied to future paediatric tDCS studies.
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