Safety and effectiveness of non-invasive brain stimulation on mobility and balance function in children with cerebral palsy: a systematic review and meta-analysis.
Mengru Zhong, Yage Zhang, Jie Luo, Tingting Chen, Jingbo Zhang, Tingting Peng, Mingshan Han, Wen Le, Tingting Peng, Kaishou Xu
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Abstract
Background: Children with cerebral palsy (CP) experience significant mobility and balance impairments. Non-invasive brain stimulation (NIBS), including transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS), has emerged as a potential therapeutic intervention. Nevertheless, the safety and effectiveness of NIBS in children with CP remain uncertain and require further investigation. This study aimed to evaluate the safety and effectiveness of NIBS in improving mobility and balance function in children with CP.
Methods: Randomized controlled trials written in English were searched in five databases (PubMed, Embase, Scopus, Web of Science, and ProQuest), from the first available records in each database to April 2024. Statistical analysis focused on outcomes related to mobility and balance function immediately following intervention and one-month follow-up.
Results: A total of 16 studies encompassing 346 children with CP, aged 3-14 years, were included. The meta-analysis indicated that NIBS is safe and well-tolerated [Risk Difference = 0.16, 95% CI - 0.01-0.33], with a low incidence of adverse events. Significant improvements were observed in mobility post-intervention and at one-month follow-up, particularly in Gross Motor Function Measure scores [standard mean difference (SMD) = 0.47 to 0.63, P < 0.05]. Gait parameters, including gait velocity (SMD = 1.28, P < 0.01) and stride length (SMD = 0.70, P = 0.01) showed immediate improvements. However, no significant improvements were found in balance post-tDCS or at follow-up.
Conclusions: Our findings support the use of NIBS as a safe and feasible tool for enhancing mobility in children with CP, demonstrating both immediate and sustained improvements in gait parameters such as velocity and stride length. However, the impact on balance remains inconclusive. Future research should focus on extending follow-up periods, increasing sample sizes, and exploring tailored stimulation protocols to better understand the long-term efficacy and optimal application of NIBS in pediatric populations.
背景：脑瘫（CP）患儿有明显的活动能力和平衡障碍。非侵入性脑刺激（NIBS），包括经颅直流电刺激（tDCS）和重复经颅磁刺激（rTMS），已成为一种潜在的治疗干预手段。然而，NIBS在CP患儿中的安全性和有效性仍不确定，需要进一步研究。本研究旨在评估NIBS改善cp患儿行动能力和平衡功能的安全性和有效性。方法：检索5个数据库（PubMed、Embase、Scopus、Web of Science和ProQuest）中以英文撰写的随机对照试验，从每个数据库的第一个可查记录到2024年4月。统计分析的重点是在干预和1个月随访后立即与活动能力和平衡功能相关的结果。结果：共纳入16项研究，包括346名年龄在3-14岁的CP儿童。meta分析显示NIBS安全且耐受性良好[风险差异= 0.16,95% CI - 0.01-0.33]，不良事件发生率低。在干预后和一个月的随访中，活动能力显著改善，特别是大运动功能测量评分[标准平均差(SMD) = 0.47至0.63,P]。结论：我们的研究结果支持NIBS作为一种安全可行的工具，用于增强CP儿童的活动能力，显示步态参数（如速度和步长）的即时和持续改善。然而，对平衡的影响仍然没有定论。未来的研究应侧重于延长随访期，增加样本量，探索量身定制的刺激方案，以更好地了解NIBS在儿科人群中的长期疗效和最佳应用。
期刊介绍：
Journal of NeuroEngineering and Rehabilitation considers manuscripts on all aspects of research that result from cross-fertilization of the fields of neuroscience, biomedical engineering, and physical medicine & rehabilitation.
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