Effect of Transcranial Direct Current Stimulation Combined With Virtual Reality Training on Balance in Children With Cerebral Palsy: A Randomized, Controlled, Double-Blind, Clinical Trial

Abstract

The authors' aim was to investigate the effects of continuous transcranial direct current stimulation (tDCS) combined with virtual reality training on static and functional balance in children with cerebral palsy (CP). Twenty children with CP (6 girls and 14 boys; M age = 7 years 6 months ± 2 years) were randomly allocated to two groups. The experimental group received active tDCS and the control group received sham stimulation during the 10 sessions of virtual reality mobility training protocols. The children were evaluated on 3 occasions (preintervention, postintervention, and 1-month follow-up). Static balance was evaluated using a force plate under 4 conditions: feet on force plate with (a) eyes open and (b) with eyes closed, and feet on foam mat with (c) eyes open and (d) with eyes closed. Functional balance was evaluated using the Pediatric Balance Scale and the Timed Up and Go Test. The analyses demonstrated statistically significant postintervention and follow-up effects favoring the experimental group over the control group with regard to the Pediatric Balance Scale, Timed Up and Go Test, and area of oscillation of the center of pressure when standing on the force plate with eyes open. The present findings suggest that tDCS can potentiate the effects of virtual reality training on static and functional balance among children with CP.

Protocol study for a randomised, controlled, double-blind, clinical trial involving virtual reality and anodal transcranial direct current stimulation for the improvement of upper limb motor function in children with Down syndrome

“…29 30 Moreover, a non-invasive brain stimulation method (tDCS) will be employed to facilitate motor cortical excitability in the areas subjacent to stimulation to enhance the effects of motor control and learning. [37][38][39][40][41][42] Lazzari et al 37 demonstrated the efficacy of the combination of tDCS and VR in potentiating motor effects on balance and functional mobility in children with cerebral palsy. 37 This document offers a detailed description of a randomised, controlled, double-blind, clinical trial designed to determine the effectiveness of VR training combined with tDCS on upper limb movements in individuals with DS.…”

“…The results of clinical trials have demonstrated its considerable potential in the treatment of neurological disorders and the investigation of processes of cortical excitability modulation. [37][38][39][40][41][42] Moreover, this type of intervention offers a better condition for sham stimulation, which confers greater specificity to the findings. 39 40 In the rehabilitation process, the aim of neuromodulating techniques is to enhance local synaptic efficiency and alter the maladaptive plasticity pattern that emerges after a cortical injury.…”

Effect of Combined Therapy of Virtual Reality and Transcranial Direct Current Stimulation in Children and Adolescents With Cerebral Palsy: A Study Protocol for a Triple-Blinded Randomized Controlled Crossover Trial

“…Some studies have produced positive results when combining VR and tDCS therapies in stimulating the lower limbs for gait improvement ( 12 ) and balance ( 28 , 29 ). However, no studies have investigated VR and tDCS interventions using an upper limb motor task, which might benefit different clinical conditions of individuals with CP.…”

Effects of Virtual Reality on Parkinsonian Gait: Blind Controlled Randomized Clinical Trial Protocol

“…This game was chosen based on its potential to stimulate motor coordination and improve physical fitness. The participant will simulate walking or running by lifting the knees in a stationary march, resulting in constant displacement of the center of gravity, involving symmetry, alternating actions and rhythm, which are essential to gait (26) .…”