Transcranial direct current stimulation combined with upper limb functional training in children with spastic, hemiparetic cerebral palsy: study protocol for a randomized controlled trial

Abstract

BackgroundThe aim of the proposed study is to perform a comparative analysis of functional training effects for the paretic upper limb with and without transcranial direct current stimulation over the primary motor cortex in children with spastic hemiparetic cerebral palsy.MethodsThe sample will comprise 34 individuals with spastic hemiparetic cerebral palsy, 6 to 16 years old, classified at level I, II, or III of the Manual Ability Classification System. Participants will be randomly allocated to two groups: (1) functional training of the paretic upper limb combined with anodic transcranial stimulation; (2) functional training of the paretic upper limb combined with sham transcranial stimulation. Evaluation will involve three-dimensional movement analysis and electromyography using the SMART-D 140® system (BTS Engineering) and the FREEEMG® system (BTS Engineering), the Quality of Upper Extremity Skills Test, to assess functional mobility, the Portable Device and Ashworth Scale, to measure movement resistance and spasticity, and the Pediatric Evaluation of Disability Inventory, to evaluate performance. Functional reach training of the paretic upper limb will include a range of manual activities using educational toys associated with an induced constraint of the non-paretic limb during the training. Training will be performed in five weekly 20-minute sessions for two weeks. Transcranial stimulation over the primary motor cortex will be performed during the training sessions at an intensity of 1 mA. Findings will be analyzed statistically considering a 5 % significance level (P ≤ 0.05).DiscussionThis paper presents a detailed description of a prospective, randomized, controlled, double-blind, clinical trial designed to demonstrate the effects of combining transcranial direct current stimulation over the primary motor cortex and functional training of the paretic limb in children with cerebral palsy classified at level I, II, or III of the Manual Ability Classification System. The results will be published and evidence found may contribute to the use of transcranial stimulation for this population.Trial registrationReBEC RBR-6V4Y3K. Registered on 11 February 2015.

Effect of Transcranial Direct Current Stimulation Combined With Xbox-Kinect Game Experience on Upper Limb Movement in Down Syndrome: A Case Report

“…When selected based on executive properties, Xbox Kinect activities favor a gamut of objectives related to motor and cognitive learning (Gamberini et al, 2006;Jung et al, 2009;Biddiss and Beng, 2010;Damian et al, 2014). The combination of anodal tDCS administered over the primary motor cortex during motor training involving Xbox Kinect games has been used in several studies with the aim of improving gait and upper limb movements (Grecco et al, 2014b(Grecco et al, , 2017Moura et al, 2016;Duarte et al, 2019;Lazzari et al, 2019). This stimulation method combined with the executive potential of the game can modulate cortical excitability, thereby enhancing the effects obtained with training.…”

“…This is a significant factor in DS, as a limited arm movement leads to difficulties in activities involving reaching, grasping, and handling objects. Such problems compromise one's functional performance, with negative impacts on independence, mobility, and self-care (Nasseri et al, 2015;Moura et al, 2016;Grecco et al, 2017).…”

“…Stimulation was administered using a tDCS device (DC-Stimulator; neuroConn GmbH, Ilmenau, Germany) with three sponge (non-metallic) electrodes measuring 5 × 5 cm (25 cm 2 ) soaked in saline solution (Cruz, 2005;Nasseri et al, 2015;Santos et al, 2015;Grecco et al, 2017;Lopes et al, 2017a,b). The anodes were positioned over C3 and C4 (10-20 international electroencephalogram system), corresponding to the primary motor cortex (M1) (Cruz, 2005;Santos et al, 2015;Moura et al, 2016Moura et al, , 2017Grecco et al, 2017;Lopes et al, 2017a,b). The cathode was positioned over the belly of the deltoid muscle.…”

“…A current considered safe for the pediatric population (1 mA) (Santos et al, 2015;Moura et al, 2016) was administered for 20 consecutive minutes, during which the child underwent upper limb motor training with the aid of the Xbox 360 TM (Microsoft, Redmond, WA, USA) and the Kinect TM motion detector (Microsoft). The activity was performed in a specific room (2.5 × 4.0 m) at the Integrated Human Movement Lab.…”

Brain Activity and Upper Limb Movement Analysis in Individuals With Down Syndrome Undergoing Transcranial Direct Current Stimulation Combined With Virtual Reality Training: Study Protocol for a Longitudinal Randomized Controlled Trial.

“…The protocol will follow the safety procedures described in the literature for the use of tDCS in the population with neurological disorders. [42][43][44][45][46][47][48][49][50] Three 20-min sessions of tDCS concomitant with VR will be held for a total of ten sessions. [44][45][46][47][48][49][50] .…”