Abstract
Transcranial Direct Current Stimulation (tDCS) is an emerging tool to improve upper limb motor functions after stroke acquired in adulthood; however, there is a paucity of reports on its efficacy for upper limb motor rehabilitation in congenital or early-acquired stroke. In this pilot study we have explored, for the first time, the immediate effects, and their short-term persistence, of a single application of anodal tDCS on chronic upper limb motor disorders in children and young individuals with Unilateral Cerebral Palsy (UCP). To this aim, in a crossover sham-controlled study, eight subjects aged 10-28 years with UCP underwent two sessions of active and sham tDCS. Anodal tDCS (1.5 mA, 20 min) was delivered over the primary motor cortex (M1) of the ipsilesional hemisphere. Results showed, only following the active stimulation, an immediate improvement in unimanual gross motor dexterity of hemiplegic, but not of nonhemiplegic, hand in Box and Block test (BBT). Such improvement remained stable for at least 90 minutes. Performance of both hands in Hand Grip Strength test was not modified by anodal tDCS. Improvement in BBT was unrelated to participants' age or lesion size, as revealed by MRI data analysis. No serious adverse effects occurred after tDCS; some mild and transient side effects (e.g., headache, tingling, and itchiness) were reported in a limited number of cases. This study provides an innovative contribution to scientific literature on the efficacy and safety of anodal tDCS in UCP. This trial is registered with NCT03137940.
Highlights
Unilateral Cerebral Palsy (UCP) represents the most frequent form of CP, affecting about 30%-40% of all children with CP [1]
We focused on short-term effects since seminal neurophysiological studies in humans have showed that a single application of anodal Transcranial Direct Current Stimulation (tDCS) for 13 minutes can induce an increase of motor cortex excitability that persists for a maximum duration of 1.5 hours after stimulation [27]
With respect to the performance of the hemiplegic hand in the Box and Block test (BBT), the repeated-measure analysis of variance (rmANOVA) showed a main effect of Time (F2,14 = 4 13, p = 0 039, pη2 = 0 37) and a significant tDCS by Time interaction (F2,14 = 3 76, p = 0 049, pη2 = 0 39), while the main effect of tDCS did not reach significance (F1,7 = 1 06, p = 0 34, pη2 = 0 13)
Summary
Unilateral Cerebral Palsy (UCP) represents the most frequent form of CP, affecting about 30%-40% of all children with CP [1]. The upper limb is more involved, impacting daily use of hand in activities such as reaching, grasping, and manipulation of objects. UCP is associated with heterogeneous brain lesions, mainly due to perinatal stroke, and its clinical manifestation is related to timing (acquired vs congenital, acute vs chronic) and etiology of brain injury [1]. In order to improve functions of the hemiplegic hand, several types of intervention have been used with some success. There has been an increasing interest in the use of Noninvasive Brain Stimulation (NIBS) techniques, such as transcranial magnetic (TMS) and direct current electrical stimulation (tDCS), to enhance poststroke motor disorders and neurodevelopmental outcomes
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