Effect of Transcranial Direct Current Stimulation versus Virtual Reality on Gait for Children with Bilateral Spastic Cerebral Palsy: A Randomized Clinical Trial

Abstract

Impaired gait is a common sequela in bilateral spastic cerebral palsy. We compared the effects of two novel research interventions—transcranial direct current stimulation and virtual reality—on spatiotemporal and kinetic gait impairments in children with bilateral spastic CP. Forty participants were randomized to receive either transcranial direct current stimulation or virtual reality training. Both groups received standard-of-care gait therapy during the assigned intervention and for the subsequent 10 weeks afterward. Spatiotemporal and kinetic gait parameters were evaluated at three different times: (i) before starting the intervention, (ii) after two weeks of intervention, and (iii) 10 weeks after intervention completion. Both groups exhibited higher velocity and cadence, as well as longer stance time, step length, and stride length after intervention (p < 0.001). Only the transcranial direct current stimulation group exhibited increased maximum force and maximum peak pressure after intervention (p’s ≤ 0.001), with continued improvements in spatiotemporal parameters at follow-up. The transcranial direct current stimulation group had higher gait velocities, stride length, and step length at follow-up compared to the virtual reality group (p ≤ 0.02). These findings suggest that transcranial direct current stimulation has a broader and longer-lasting effect on gait than virtual reality training for children with bilateral spastic cerebral palsy.

Enhancing Post-Operative Recovery in Spastic Diplegia through Physical Therapy Rehabilitation following Selective Dorsal Rhizotomy: A Case Report and Thorough Literature Analysis

“…Spasticity refers to a motor dysfunction that involves elevated muscle tone and can severely affect the motor skills of young children [1]. It is considered to be the most prevalent type of motor impairment, particularly in conditions such as cerebral palsy (CP) [2,3]. Around 20 percent of individuals diagnosed with spastic diplegia, which is a type of cerebral palsy also known as bilateral spastic CP (BSCP) and classified as level V based on the Gross Motor Classification System (GMFCS), are identified as belonging to GMFCS levels I to IV.…”

To check the effectiveness of transcranial direct current stimulation and mirror therapy on neonatal motor development and mental health in children with spastic quadriplegic cerebral palsy-Study protocol for randomized clinical trial

“…Patients aged 3-7 years, both male and female, diagnosed with Spastic Quadriplegic Cerebral Palsy through physical examination will included (4). Additionally,, Level-I, II and III patients on the Gross Motor Function Classi cation System (GMFCS) who can walk with or without assistance (32,33), tone less than or equal to 2 according to the modi ed Ashworth scale (34), and having a good understanding of the commands or on augmentative communication will be involved in the study (35).…”

“…Athetoid cerebral palsy; ataxic and mixed variety of CP and monoplegic; and diplegic hemiplegic cerebral palsy patients will be excluded. Children with history of neurosurgery or neurolytic block with in the previous 6 months, any history of cancer, orthopedic deformity (4), integumentary condition, skull metal implant or use of hearing aids will also be excluded (32).…”

“…Before allocation, subjects will be evaluated for eligibility to one of the three groups: Group-A (TDCS, MT with routine Physical Therapy), Group-B (TDCS with routine Physical Therapy) and Group-C (MT with routine Physical Therapy). A 30-minute session of TDCS will be administered at a 2 mA intensity over the M1 region of the brain, equally divided for 15 minutes for the right and left-sided extremities (32). The overall duration of mirror therapy will be 30 minutes: 15 minutes for the right sided extremities and 15 minutes for left sided extremities.…”

“…Firstly, in any rehab program, neuromuscular growth and mental health begins in the second week and mature in 8-12 weeks, combining the real-world clinical implementation impacts of the therapies. Secondly, because of ethical considerations, the children who are participating in the study must have the best possible chance of bene ting from it, given their time and effort (32). Study variables will be age, gender, height, weight, socioeconomic status, education and severity.…”