Weill Cornell Medicine
Citigroup Biomedical Imaging Center
Weill Cornell Medicine
Citigroup Biomedical Imaging Center

Transcranial Direct Current Stimulation (tDCS) Paired with Occupation-Centered Bimanual Training in Children with Unilateral Cerebral Palsy: A Preliminary Study.

Publication Type Academic Article
Authors Rich T, Nemanich S, Chen M, Friel K, Feyma T, Krach L, Nawshin T, Meekins G, Gillick B
Journal Neural Plast
Volume 2018
Pagination 9610812
Date Published 11/05/2018
ISSN 1687-5443
Keywords Cerebral Palsy, Motor Cortex, Physical Therapy Modalities, Pyramidal Tracts
Abstract OBJECTIVE: We investigated the preliminary efficacy of cathodal transcranial direct current stimulation (tDCS) combined with bimanual training in children and young adults with unilateral cerebral palsy based on the principle of exaggerated interhemispheric inhibition (IHI). METHODS: Eight participants with corticospinal tract (CST) connectivity from the lesioned hemisphere participated in an open-label study of 10 sessions of cathodal tDCS to the nonlesioned hemisphere (20 minutes) concurrently with bimanual, goal-directed training (120 minutes). We measured the frequency of adverse events and intervention efficacy with performance (bimanual-Assisting Hand Assessment (AHA)-and unimanual-Box and Blocks), self-report (Canadian Occupational Performance Measure (COPM), ABILHAND), and neurophysiologic (motor-evoked potential amplitude, cortical silent period (CSP) duration, and motor mapping) assessments. RESULTS: All participants completed the study with no serious adverse events. Three of 8 participants showed gains on the AHA, and 4 of 8 participants showed gains in Box and Blocks (more affected hand). Nonlesioned CSP duration decreased in 6 of 6 participants with analyzable data. Cortical representation of the first dorsal interosseous expanded in the nonlesioned hemisphere in 4 of 6 participants and decreased in the lesioned hemisphere in 3 of 4 participants with analyzable data. CONCLUSIONS: While goal achievement was observed, objective measures of hand function showed inconsistent gains. Neurophysiologic data suggests nonlinear responses to cathodal stimulation of the nonlesioned hemisphere. Future studies examining the contributions of activity-dependent competition and cortical excitability imbalances are indicated.
DOI 10.1155/2018/9610812
PubMed ID 30627151
PubMed Central ID PMC6304908
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