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

Main Article Content

Zainab Hassan
Syed Ali Hussain
Mohammad Reza Hadian Rasanani
Saeed Talebian
Azadeh Shadmehr
Hossein Bagheri
Samia Sarmad

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.

Article Details

How to Cite
Hassan, Z., Hussain, S. A., Rasanani, M. R. H., Talebian, S., Shadmehr, A., Bagheri, H., & Sarmad, S. (2024). Transcranial Direct Current Stimulation for Improving Spasticity, Gross Motor Functions, Balance and Gait in Spastic Cerebral Palsy: Systematic Review of Clinical Trials. Journal of Health and Rehabilitation Research, 4(1), 351–359. https://doi.org/10.61919/jhrr.v4i1.372
Section
Articles
Author Biographies

Zainab Hassan, Tehran University of Medical Sciences - Tehran – Iran

PhD candidate*, Student, School of Rehabilitation

Syed Ali Hussain, Tehran University of Medical Sciences - Tehran – Iran

PhD candidate*, Student, School of Rehabilitation

Mohammad Reza Hadian Rasanani, Tehran University of Medical Sciences - Tehran – Iran

Professor, School of Rehabilitation

Saeed Talebian, Tehran University of Medical Sciences - Tehran – Iran

Professor, School of Rehabilitation

Azadeh Shadmehr, Tehran University of Medical Sciences - Tehran – Iran

Professor, School of Rehabilitation

Hossein Bagheri, Tehran University of Medical Sciences - Tehran – Iran

Professor, School of Rehabilitation

Samia Sarmad, University of Lahore Teaching Hospital – Lahore

Assistant Professor

References

Oskoui M, Coutinho F, Dykeman J, Jetté N, Pringsheim TJDM, Neurology C. An update on the prevalence of cerebral palsy: a systematic review and meta‐analysis. 2013;55(6):509-19.

Rosenbaum P, Paneth N, Leviton A, Goldstein M, Bax M, Damiano D, et al. A report: the definition and classification of cerebral palsy April 2006. 2007;109(suppl 109):8-14.

Krause B, Cohen Kadosh RJFisn. Not all brains are created equal: the relevance of individual differences in responsiveness to transcranial electrical stimulation. 2014;8:25.

Nemanich ST, Lench DH, Sutter EN, Kowalski JL, Francis SM, Meekins GD, et al. Safety and feasibility of transcranial direct current stimulation stratified by corticospinal organization in children with hemiparesis. 2023;43:27-35.

McIntyre S, Goldsmith S, Webb A, Ehlinger V, Hollung SJ, McConnell K, et al. Global prevalence of cerebral palsy: A systematic analysis. 2022;64(12):1494-506.

Ayubi E, Sarhadi S, Mansori KJJoCN. Maternal infection during pregnancy and risk of cerebral palsy in children: a systematic review and meta-analysis. 2021;36(5):385-402.

Gilson K-M, Davis E, Reddihough D, Graham K, Waters E. Quality of life in children with cerebral palsy: implications for practice. Journal of Child Neurology. 2014;29(8):1134-40.

Upadhyay J, Tiwari N, Ansari MNJC, Pharmacology E, Physiology. Cerebral palsy: Aetiology, pathophysiology and therapeutic interventions. 2020;47(12):1891-901.

Volpe JJJP. Cerebral white matter injury of the premature infant—more common than you think. 2003;112(1):176-80.

Smithers‐Sheedy H, McIntyre S, Gibson C, Meehan E, Scott H, Goldsmith S, et al. A special supplement: findings from the Australian Cerebral Palsy Register, birth years 1993 to 2006. 2016;58:5-10.

Novak I, Morgan C, Adde L, Blackman J, Boyd RN, Brunstrom-Hernandez J, et al. Early, accurate diagnosis and early intervention in cerebral palsy: advances in diagnosis and treatment. 2017;171(9):897-907.

Novak I, Mcintyre S, Morgan C, Campbell L, Dark L, Morton N, et al. A systematic review of interventions for children with cerebral palsy: state of the evidence. 2013;55(10):885-910.

Nitsche MA, Paulus W. Excitability changes induced in the human motor cortex by weak transcranial direct current stimulation. The Journal of physiology. 2000;527(Pt 3):633.

Nitsche MA, Paulus WJTJop. Excitability changes induced in the human motor cortex by weak transcranial direct current stimulation. 2000;527(Pt 3):633.

Nitsche MA, Cohen LG, Wassermann EM, Priori A, Lang N, Antal A, et al. Transcranial direct current stimulation: state of the art 2008. 2008;1(3):206-23.

Fregni F, Pascual-Leone AJNcpN. Technology insight: noninvasive brain stimulation in neurology—perspectives on the therapeutic potential of rTMS and tDCS. 2007;3(7):383-93.

Stagg CJ, Nitsche MAJTN. Physiological basis of transcranial direct current stimulation. 2011;17(1):37-53.

Lefaucheur J-P, Antal A, Ayache SS, Benninger DH, Brunelin J, Cogiamanian F, et al. Evidence-based guidelines on the therapeutic use of transcranial direct current stimulation (tDCS). 2017;128(1):56-92.

Bikson M, Grossman P, Thomas C, Zannou AL, Jiang J, Adnan T, et al. Safety of transcranial direct current stimulation: evidence based update 2016. 2016;9(5):641-61.

Gillick BT, Feyma T, Menk J, Usset M, Vaith A, Wood TJ, et al. Safety and feasibility of transcranial direct current stimulation in pediatric hemiparesis: randomized controlled preliminary study. 2015;95(3):337-49.

Auvichayapat N, Amatachaya A, Auvichayapat PJJMAT. Reduction of spasticity in cerebral palsy by anodal transcranial direct current stimulation. 2014;97(9):954-62.

Dumont AJL, Cimolin V, Parreira RB, Armbrust D, Fonseca DRP, Fonseca AL, et al. Effects of Transcranial Direct Current Stimulation Combined with Treadmill Training on Kinematics and Spatiotemporal Gait Variables in Stroke Survivors: A Randomized, Triple-Blind, Sham-Controlled Study. 2022;13(1):11.

Grecco LA, Duarte NA, Zanon N, Galli M, Fregni F, Oliveira CSJBjopt. Effect of a single session of transcranial direct-current stimulation on balance and spatiotemporal gait variables in children with cerebral palsy: a randomized sham-controlled study. 2014;18:419-27.

Elsner B, Kwakkel G, Kugler J, Mehrholz JJJon, rehabilitation. Transcranial direct current stimulation (tDCS) for improving capacity in activities and arm function after stroke: a network meta-analysis of randomised controlled trials. 2017;14:1-12.

Eriksen MB, Frandsen TF. The impact of patient, intervention, comparison, outcome (PICO) as a search strategy tool on literature search quality: a systematic review. Journal of the Medical Library Association: JMLA. 2018;106(4):420.

Cashin AG, McAuley JH. Clinimetrics: Physiotherapy Evidence Database (PEDro) Scale. Journal of Physiotherapy. 2020 2020/01/01/;66(1):59.

Vitrikas K, Dalton H, Breish D. Cerebral palsy: an overview. American family physician. 2020;101(4):213-20.

Dedoncker J, Baeken C, De Raedt R, Vanderhasselt M-A. Combined transcranial direct current stimulation and psychological interventions: State of the art and promising perspectives for clinical psychology. Biological psychology. 2021;158:107991.

Begemann MJ, Brand BA, Ćurčić-Blake B, Aleman A, Sommer IE. Efficacy of non-invasive brain stimulation on cognitive functioning in brain disorders: a meta-analysis. Psychological medicine. 2020;50(15):2465-86.

Liu Z, Dong S, Zhong S, Huang F, Zhang C, Zhou Y, et al. The effect of combined transcranial pulsed current stimulation and transcutaneous electrical nerve stimulation on lower limb spasticity in children with spastic cerebral palsy: a randomized and controlled clinical study. BMC pediatrics. 2021;21(1):1-17.

Salazar Fajardo JC, Kim R, Gao C, Hong J, Yang J, Wang D, et al. The effects of tDCS with NDT on the improvement of motor development in cerebral palsy. Journal of Motor Behavior. 2022;54(4):480-9.

Diego APN, Leung AW. Transcranial direct current stimulation for improving gross motor function in children with cerebral palsy: A systematic review. British Journal of Occupational Therapy. 2020;83(7):418-31.

Elnaggar RK, Mahmoud WS, Alsubaie SF, Abd El-Nabie WA. Effectiveness of a multi-modal exercise program incorporating plyometric and balance training in children with hemiplegic cerebral palsy: a three-armed randomized clinical trial. Physical & Occupational Therapy In Pediatrics. 2022;42(2):113-29.

Clark J, Kelliher A, editors. Understanding the needs and values of rehabilitation therapists in designing and implementing telehealth solutions. Extended Abstracts of the 2021 CHI Conference on Human Factors in Computing Systems; 2021.

Auvichayapat N, Amatachaya A, Auvichayapat P. Reduction of spasticity in cerebral palsy by anodal transcranial direct current stimulation. J Med Assoc Thai. 2014;97(9):954-62.

Clough BA, Cassimatis M, Noorbala L, Attary T, Ghazizadeh A, Hamilton K. Mental Healthcare in the ‘New Normal’: Digital Technologies for Pandemics. The Science behind the COVID Pandemic and Healthcare Technology Solutions: Springer; 2022. p. 435-64.

Most read articles by the same author(s)