Effect of transcranial direct-current stimulation combined with treadmill training on balance and functional performance in children with cerebral palsy: a double-blind randomized controlled trial.

Natália De Almeida Carvalho Duarte,Manuela Galli,Felipe Fregni,Cláudia Santos Oliveira,Luanda André Collange Grecco,Barry J Byrne

doi:10.1371/journal.pone.0105777

Abstract

BackgroundCerebral palsy refers to permanent, mutable motor development disorders stemming from a primary brain lesion, causing secondary musculoskeletal problems and limitations in activities of daily living. The aim of the present study was to determine the effects of gait training combined with transcranial direct-current stimulation over the primary motor cortex on balance and functional performance in children with cerebral palsy.MethodsA double-blind randomized controlled study was carried out with 24 children aged five to 12 years with cerebral palsy randomly allocated to two intervention groups (blocks of six and stratified based on GMFCS level (levels I-II or level III).The experimental group (12 children) was submitted to treadmill training and anodal stimulation of the primary motor cortex. The control group (12 children) was submitted to treadmill training and placebo transcranial direct-current stimulation. Training was performed in five weekly sessions for 2 weeks. Evaluations consisted of stabilometric analysis as well as the administration of the Pediatric Balance Scale and Pediatric Evaluation of Disability Inventory one week before the intervention, one week after the completion of the intervention and one month after the completion of the intervention. All patients and two examiners were blinded to the allocation of the children to the different groups.ResultsThe experimental group exhibited better results in comparison to the control group with regard to anteroposterior sway (eyes open and closed; p<0.05), mediolateral sway (eyes closed; p<0.05) and the Pediatric Balance Scale both one week and one month after the completion of the protocol.ConclusionGait training on a treadmill combined with anodal stimulation of the primary motor cortex led to improvements in static balance and functional performance in children with cerebral palsy.Trial RegistrationEnsaiosclinicos.gov.br/RBR-9B5DH7

Highlights

Cerebral palsy (CP) involves a set of neurophysiological impairments caused by a global reduction in subcortical activity that compromises the activity of corticospinal and somatosensory circuits [1], [2], [3], [4], [5], [6]
Evaluations consisted of stabilometric analysis as well as the administration of the Pediatric Balance Scale (PBS) and Pediatric Evaluation of Disability Inventory (PEDI) one week before the intervention (Evaluation 1), one week after the completion of the intervention (Evaluation 2) and one month after the completion of the intervention (Evaluation 3)
The Gross Motor Function Classification System (GMFCS) and topography was analyzed by the chi square test

Summary

Introduction

Cerebral palsy (CP) involves a set of neurophysiological impairments caused by a global reduction in subcortical activity that compromises the activity of corticospinal and somatosensory circuits [1], [2], [3], [4], [5], [6]. Neurophysiological analyses have demonstrated global changes in cortex excitability in children with CP, even when the brain lesion is unilateral [8]. Such children have postural problems due to spasticity, muscle weakness and impaired muscle coordination. These postural problems can affect motor development, leading to difficulties in performing basic functional actions, such as sitting, standing and walking [9], [10], [11], [12]. Cerebral palsy refers to permanent, mutable motor development disorders stemming from a primary brain lesion, causing secondary musculoskeletal problems and limitations in activities of daily living. The aim of the present study was to determine the effects of gait training combined with transcranial direct-current stimulation over the primary motor cortex on balance and functional performance in children with cerebral palsy

Objectives

Methods

Results

Conclusion