Transcranial Direct Current Stimulation for Improving Spasticity, Gross Motor Functions, Balance and Gait in Spastic Cerebral Palsy: Systematic Review of Clinical Trials.

Abstract

Context: Cerebral palsy is known as a non-progressive neuromotor disorder that is characterized by abnormalities of muscular tonicity, gross and fine motor skills, balance, posture and gait. Transcranial direct current stimulation (tDCS) has emerged as a rather promising therapeutic tool for the management of the above-mentioned symptoms and to possibly to optimize the rehabilitation strategies. Purpose: This review study evaluates the effectiveness of tDCS on spasticity, gross motor function, balance, and gait; it also tends to summarize the beneficial protocols of tDCS for spastic cerebral palsy patients. Methods: Comprehensive searches were performed on three electronic databases including PubMed, PEDro, and Cochrane. The inclusion criteria for considered articles were (1) English-language publications available in full text between 2000 and 2023.(2), The PEDro scale, where a score of at least 5 out of 10 was acceptable, (3) Human studies using the tDCS intervention with control group , and (4) Study design (PICOS) method, where P = spastic CP; I = transcranial direct current stimulation; C = conventional physical Therapy; O = muscle strength, spasticity, , and gait kinematics; and S = RCT. Results: Nine RCTs were included based on the inclusion criteria. This systematic review showed transcranial direct current stimulation is a non-invasive safe modality, and well-tolerated brain stimulation technique with positive effects on gross motor function, spasticity, balance, muscle strength, and gait. Besides, it can be used in conjunction with different modalities as well as conventional physical therapy. Conclusion: It can be concluded that transcranial direct current stimulation is a novel, fairly simple, low cost and low risk therapeutic modality that can be easily administered in a clinic as well as at home to produce a significant change in spasticity, balance, gross motor function, and gait.