Abstract
About 30–45% of cerebral palsy (CP) patients have cognitive impairment. Previous studies showed the evidence that transcranial direct current stimulation (tDCS) may have some benefits in attention-deficit/hyperactivity disorder, autism spectrum disorder, and motor development in CP. The aim of this study is to evaluate the effect of tDCS on cognition, language, and activities of daily living (ADL) among children with CP with cognitive impairment. It was a pilot, randomized, controlled, double-blind, clinical trial in a tertiary pediatric hospital, and 13 children with CP and a cognitive age under 42 months were enrolled. tDCS group (n = 8) had active tDCS and cognitive training (20 min/session, total 20 sessions, for 12 weeks) and sham group (n = 5) had sham tDCS and cognitive training. Primary outcome was the Bayley Scales of Infant Development II (BSID II). Secondary outcomes were the Pediatric Evaluation of Disability Inventory (PEDI), the Laboratory Temperament Assessment Battery (Lab-TAB), the Early Childhood Behavior Questionnaire (ECBQ), the Korean version of MacArthur–Bates Communicative Development Inventories (M-B CDI-K), the Sequenced Language Scale for Infants (SELSI) and the Preschool Receptive-Expressive Language Scale (PRES). After intervention, the tDCS group showed significant improvements in all measurements (p < 0.05) except the M-B CDI-K (grammar), whereas the sham group only showed significant improvements in the Lab-TAB (manipulation domain), the ECBQ (attentional shifting), and the M-B CDI-K (comprehension). The between-group differences in the degree of post-intervention improvement were not statistically significant. The degree of improvement was associated with better baseline cognitive function and younger age (p < 0.05). There were no major adverse events after tDCS. The combined application of tDCS and cognitive training was feasible and associated with improvements in cognitive function, ADL, and language among children with CP with cognitive impairment. However, considering that it is a pilot study, further larger-scale systematic investigation is needed.Clinical Trial Registration: The trial was registered in the Clinical Research Information Service database, identifier: KCT0003023.
Highlights
Cerebral palsy (CP) is characterized by early insults to the developing brain, resulting in ongoing problems in movements or postures that limit the performance of activities of daily living (ADL) [1]
Children who visited the outpatient clinic of the Pediatric Rehabilitation Medicine Division at Asan Medical Center from July 2018 through January 2019 were assessed for inclusion in the study according to the following inclusion criteria: [1] children with CP, diagnosed by pediatric physiatrists; [2] children with cognitive impairment and a cognitive age under 42 months, as assessed using the Bayley Scales of Infant Development II (BSID II); [3] children whose actual age was between 3 and 18 years; [4] children who had not changed medications for cognition, language, and physical function, and who had not changed the number of rehabilitation programs in which they participated; and [5] children whose caregivers provided written informed consent
Eight children were in the transcranial direct current stimulation (tDCS) group and five were in the sham group
Summary
Cerebral palsy (CP) is characterized by early insults to the developing brain, resulting in ongoing problems in movements or postures that limit the performance of activities of daily living (ADL) [1]. CP is usually accompanied by motor impairments; sensory and perception disturbances, global or specific cognitive impairment, communication disorders, behavioral problems, and seizures are commonly present [2]. About 30–45% of CP patients have cognitive impairment [3, 4], which can manifest as altered information processing, attention impairment, decreased executive function, and memory and language [5]. Interventions are known to be beneficial for alleviating motor impairments in children with CP, there are less rationale of the effect of cognitive training [7]. Cognitive training focusing on attention, memory, executive function, and perception–motor function is usually performed in children with CP
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