Transcranial direct current stimulation combined with an intensive training program for upper limb rehabilitation in children with unilateral cerebral palsy. A randomized controlled pilot study

Background

Unilateral cerebral palsy (UCP) presents a greater functional alteration of the upper limb. Among the recommended interventions are certain therapeutic tools, such as transcranial direct current stimulation (tDCS) that could increase the therapeutic window and enhance the effect of interventions.

Aims

To determine the effectiveness of a 3-weeks intervention of cathodal tDCS applied over the motor cortex of the less affected hemisphere combined with a manual function intensive training program in the upper limbs on quality of movement and the spontaneous use of upper limb in children with UCP. Secondarily, quality of life and user´s experience was also assessed.

Methods and procedures

A pilot randomized triple-blind clinical trial was conducted. 18 children with UCP between 4 and 8 years were recruited and randomly allocated to one of the two experimental groups: 1) Active group: cathodal tDCS + intensive motor training; 2) Control group: Sham tDCS + intensive motor training. Assessments were performed before and after the intervention, and at three months follow-up.

Outcomes and results

Outcome measures: Shriners Hospital Upper Extremity Evaluation children's manual experience questionnaire, Paediatric Quality of Life Questionnaire and the Children's Manual Experience Questionnaire (miniCHEQ). Both groups improved in all variables but in the inter-group analysis only quality of life obtained significant results (p = 0.043).

Conclusions and implications

Adding cathodal tDCS to a program of intensive manual function therapy training did not produce a greater improvement on the spontaneous use, nor improving the experience of use in children with UCP. However, this technique has a short-term beneficial effect on quality of life.