Combined transcranial direct current stimulation and robotic upper limb therapy improves upper limb function in an adult with cerebral palsy.

Publication Type	Academic Article
Authors	Friel K, Lee P, Soles L, Smorenburg A, Kuo H, Gupta D, Edwards D
Journal	NeuroRehabilitation
Volume	41
Issue	1
Pagination	41-50
Date Published	01/01/2017
ISSN	1878-6448
Keywords	Cerebral Palsy, Motion Therapy, Continuous Passive, Neurological Rehabilitation, Robotics, Transcranial Direct Current Stimulation, Upper Extremity
Abstract	BACKGROUND: Robotic therapy can improve upper limb function in hemiparesis. Excitatory transcranial direct current stimulation (tDCS) can prime brain motor circuits before therapy. OBJECTIVE: We tested safety and efficacy of tDCS plus robotic therapy in an adult with unilateral spastic cerebral palsy (USCP). METHODS: In each of 36 sessions, anodal tDCS (2 mA, 20 min) was applied over the motor map of the affected hand. Immediately after tDCS, the participant completed robotic therapy, using the shoulder, elbow, and wrist (MIT Manus). The participant sat in a padded chair with affected arm abducted, forearm supported, and hand grasping the robot handle. The participant controlled the robot arm with his affected arm to move a cursor from the center of a circle to each of eight targets (960 movements). Motor function was tested before, after, and six months after therapy with the Wolf Motor Function Test (WMFT) and Fugl-Meyer (FM). RESULTS: Reaching accuracy on the robot task improved significantly after therapy. The WMFT and FM improved clinically meaningful amounts after therapy. The motor map of the affected hand expanded after therapy. Improvements were maintained six months after therapy. CONCLUSIONS: Combined tDCS and robotics safely improved upper limb function in an adult with USCP.
DOI	10.3233/NRE-171455
PubMed ID	28505986
PubMed Central ID	PMC5546204