Abstract
AimTo identify challenges of combining robotic upper extremity rehabilitation with tDCS in children with upper extremity bilateral cerebral palsy (CP) by assessing feasibility, tolerability and safety.MethodsThis was an unblinded, open-label, pilot clinical trial. Participants completed 10 × 1 h sessions of robotic rehabilitation combined with motor cortex anodal tDCS. Feasibility, acceptability and practicality, were assessed including the number of participants completing the protocol, factors limiting participation, time required for sessions, and completion of functional assessments and tolerability scales. To assess safety, standardized clinical and robotic measures of sensorimotor function were performed. The trial was registered at clinicaltrials.gov (NCT04233710).ResultsEight children were recruited (mean age 8y ± 1.8y, range 6–11 years) and 5 completed the intervention. There were no serious adverse events. One child developed focal seizures 6 weeks after the trial that were deemed to be unrelated. Barriers to completion included time and scheduling demands and patient factors, specifically cognitive/behavioral impairments and dyskinesia. No decline in clinical function was appreciated.ConclusionsRobotic upper extremity rehabilitation combined with tDCS may be feasible in children with bilateral CP. Careful participant selection, family engagement, and protocol adaptations are recommended to better understand the feasibility and tolerability of future trials.
Highlights
Cerebral palsy (CP) is the leading form of lifelong motor disability and affects millions of people worldwide
Most of the studies investigated these new therapies in children with unilateral CP but whether these tools translate to treating children with bilateral impairments has not been well-studied [3]
Participants attended for 10 consecutive weekdays for a 60-min session of robotic rehabilitation combined with Transcranial direct current stimulation (tDCS), in addition to three assessment visits
Summary
Cerebral palsy (CP) is the leading form of lifelong motor disability and affects millions of people worldwide. Bilateral spastic CP is the most common pattern [1]. Moderate to severe impairment of upper extremity function [Manual Ability Classification System (MACS) III-V] occurs in up to half of all children with bilateral spastic CP [2]. Progress is being made toward novel, evidence-based upper extremity therapies [4]. Most of the studies investigated these new therapies in children with unilateral CP but whether these tools translate to treating children with bilateral impairments has not been well-studied [3]. The inclusion of children with bilateral CP in trials for novel upper extremity studies is essential to ensure equitable access to remedial therapies for an under-represented group with disproportionate functional impacts of injury
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