The Possibility of Improvement in Balance and Function Following Conjunct Effects of Transcranial Direct Current Stimulation and Whole-Body Vibration Therapy in Spastic Cerebral Palsy Patients: A Hypothesis Study

Main Article Content

Zainab Hassan
Mohammad Reza Hadian Rasanani
Syed Ali Hussain
Azadeh Shadmehr
Saeed Talebian
Hossein Bagheri
S. Mohsen Mir
Syed Asadullah Arslan

Abstract

Cerebral palsy (CP) results from developmental brain injury, affecting posture and muscular coordination. Traditional treatments offer varying effectiveness, among them the most recent therapies are whole-body vibration therapy (WBVT) and transcranial direct current stimulation (tDCS). WBV enhances proprioceptive function, muscle mass, bone density, and joint stability by stimulating muscle spindle fibers and activating dormant motor units. It also modulates spastic reflexes through mechanoreceptors, proving more effective than traditional physiotherapy. tDCS, a non-invasive neuromodulation, reshapes cortical excitability and modulates synaptic plasticity by altering neuronal activity. It affects long-term potentiation and depression, crucial in learning and adaptive functions. tDCS's interaction with neurotransmitters, especially dopamine and GABA, and its effect on NMDA and dopaminergic receptors make it promising for CP rehabilitation. Both therapies offer novel insights into CP rehabilitation through their influence on central and peripheral neural system.


This hypothesis study tends to explore the conjunct effects of transcranial direct current stimulation (tDCS) and whole-body vibration therapy (WBVT) on improving balance and function in children with spastic cerebral palsy. The hypothesis suggests that WBVT's vibratory input, alongside tDCS's central stimulation, enhances function by modulating neuronal excitability and sensory information. The tonic vibration reflex (TVR) from WBV is believed to amplify muscle strength and modulate spinal excitability. When integrated with tDCS, it might accelerate excitability in the motor cortex, essential for brain-injured patient rehabilitation. Despite evidence of individual benefits from both therapies, conjunct effects remain under-researched. Preliminary results show improvements in balance, gait velocity, and motor functions. Validating this combined approach could revolutionize treatment for children with spastic cerebral palsy.

Article Details

How to Cite
Hassan, Z., Rasanani, M. R. H., Hussain , S. A., Shadmehr, A., Talebian, S., Bagheri, H., Mir, S. M., & Arslan, S. A. (2024). The Possibility of Improvement in Balance and Function Following Conjunct Effects of Transcranial Direct Current Stimulation and Whole-Body Vibration Therapy in Spastic Cerebral Palsy Patients: A Hypothesis Study. Journal of Health and Rehabilitation Research, 4(1), 447–455. https://doi.org/10.61919/jhrr.v4i1.429
Section
Articles
Author Biographies

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

PHD Student, School of Rehabilitation.

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

Professor, School of Rehabilitation.

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

PHD Student, School of Rehabilitation.

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

Professor, School of Rehabilitation.

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

Professor, School of Rehabilitation.

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

Professor, School of Rehabilitation.

S. Mohsen Mir, Tehran University of Medical Sciences- Tehran Iran.

School of Rehabilitation.

References

Sadowska M, Sarecka-Hujar B, Kopyta I. Cerebral palsy: current opinions on definition, epidemiology, risk factors, classification and treatment options. Neuropsychiatric disease and treatment. 2020:1505-18.

Prasad R, Verma N, Srivastava A, Das B, Mishra O. Magnetic resonance imaging, risk factors and co-morbidities in children with cerebral palsy. Journal of neurology. 2011;258:471-8.

Ikeudenta BA, Rutkofsky IH. Unmasking the enigma of cerebral palsy: a traditional review. Cureus. 2020;12(10).

Piscitelli D, Ferrarello F, Ugolini A, Verola S, Pellicciari L. Measurement properties of the Gross Motor Function Classification System, Gross Motor Function Classification System‐Expanded & Revised, Manual Ability Classification System, and Communication Function Classification System in cerebral palsy: a systematic review with meta‐analysis. Developmental Medicine & Child Neurology. 2021;63(11):1251-61.

Duma NE, Hlongwa M, Benjamin-Damons N, Hlongwana KW. Physiotherapy management of children with cerebral palsy in low-and middle-income countries: a scoping review protocol. Systematic Reviews. 2023;12(1):110.

Houx L, Pons C, Saudreau H, Dubois A, Creusat M, Le Moine P, et al. No pain, no gain? Children with cerebral palsy and their experience with physiotherapy. Annals of physical and rehabilitation medicine. 2021;64(3):101448.

Bukola FM, Kolapo HT, Olubiyi O. Pattern of Presentation and Physiotherapy Approach to Management of Children with Cerebral Palsy at Public Hospitals in Ibadan, Nigeria. Rwanda Journal of Medicine and Health Sciences. 2022;5(2):141-50.

Alashram AR, Padua E, Aburub A, Raju M, Annino G. Transcranial direct current stimulation for upper extremity spasticity rehabilitation in stroke survivors: A systematic review of randomized controlled trials. PM&R. 2023;15(2):222-34.

Santos Ferreira I, Teixeira Costa B, Lima Ramos C, Lucena P, Thibaut A, Fregni F. Searching for the optimal tDCS target for motor rehabilitation. Journal of neuroengineering and rehabilitation. 2019;16:1-12.

Ashnagar Z, Shadmehr A, Hadian M, Talebian S, Jalaei S. The effects of whole body vibration on EMG activity of the upper extremity muscles in static modified push up position. Journal of back and musculoskeletal rehabilitation. 2016;29(3):557-63.

Bernardo-Filho M, Bemben D, Stark C, Taiar R. Biological consequences of exposure to mechanical vibration. SAGE Publications Sage CA: Los Angeles, CA; 2018. p. 1559325818799618.

Bonanni R, Cariati I, Romagnoli C, D’Arcangelo G, Annino G, Tancredi V. Whole body vibration: a valid alternative strategy to exercise? Journal of Functional Morphology and Kinesiology. 2022;7(4):99.

Di Giminiani R, Masedu F, Padulo J, Tihanyi J, Valenti M. The EMG activity–acceleration relationship to quantify the optimal vibration load when applying synchronous whole-body vibration. Journal of Electromyography and Kinesiology. 2015;25(6):853-9.

Du Q, Luo J, Cheng Q, Wang Y, Guo S. Vibrotactile enhancement in hand rehabilitation has a reinforcing effect on sensorimotor brain activities. Frontiers in Neuroscience. 2022;16:935827.

Lim C. Multi-sensorimotor training improves proprioception and balance in subacute stroke patients: a randomized controlled pilot trial. Frontiers in neurology. 2019;10:157.

Peungsuwan P, Chatchawan U, Donpunha W, Malila P, Sriboonreung T. Different Protocols for Low Whole-Body Vibration Frequency for Spasticity and Physical Performance in Children with Spastic Cerebral Palsy. Children. 2023;10(3):458.

Duquette SA, Guiliano AM, Starmer DJ. Whole body vibration and cerebral palsy: a systematic review. The Journal of the Canadian Chiropractic Association. 2015;59(3):245.

Gusso S, Munns CF, Colle P, Derraik JG, Biggs JB, Cutfield WS, et al. Effects of whole-body vibration training on physical function, bone and muscle mass in adolescents and young adults with cerebral palsy. Scientific reports. 2016;6(1):22518.

Ritzmann R, Stark C, Krause A. Vibration therapy in patients with cerebral palsy: a systematic review. Neuropsychiatric disease and treatment. 2018:1607-25.

Oroszi T, van Heuvelen MJG, Nyakas C, van der Zee EA. Vibration detection: its function and recent advances in medical applications. F1000Research. 2020;9.

Oroszi T, van Heuvelen MJ, Nyakas C, van der Zee EA. Vibration detection: its function and recent advances in medical applications. F1000Research. 2020;9.

Cai X, Qian G, Cai S, Wang F, Da Y, Ossowski Z. The effect of whole-body vibration on lower extremity function in children with cerebral palsy: A meta-analysis. Plos one. 2023;18(3):e0282604.

Auvichayapat N, Auvichayapat P. Transcranial Direct Current Stimulation in Treatment of Child Neuropsychiatric Disorders: Ethical Considerations. Frontiers in Human Neuroscience. 2022;16:842013.

Hameed MQ, Dhamne SC, Gersner R, Kaye HL, Oberman LM, Pascual-Leone A, et al. Transcranial magnetic and direct current stimulation in children. Current Neurology and Neuroscience Reports. 2017;17:1-15.

Reinhart RMG, Cosman JD, Fukuda K, Woodman GF. Using transcranial direct-current stimulation (tDCS) to understand cognitive processing. Attention, Perception, & Psychophysics. 2017 2017/01/01;79(1):3-23.

Ciechanski P, Kirton A. Transcranial direct-current stimulation (tDCS): principles and emerging applications in children. Pediatric Brain Stimulation. 2016:85-115.

Korai SA, Ranieri F, Di Lazzaro V, Papa M, Cirillo G. Neurobiological after-effects of low intensity transcranial electric stimulation of the human nervous system: from basic mechanisms to metaplasticity. Frontiers in Neurology. 2021;12:587771.

Roche N, Geiger M, Bussel B. Mechanisms underlying transcranial direct current stimulation in rehabilitation. Annals of physical and rehabilitation medicine. 2015;58(4):214-9.

Rajak BL, Gupta M, Bhatia D, Mukherjee A. Increasing number of therapy sessions of repetitive transcranial magnetic stimulation improves motor development by reducing muscle spasticity in cerebral palsy children. Annals of Indian Academy of Neurology. 2019;22(3):302.

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.

Gusso S, Munns CF, Colle P, Derraik JGB, Biggs JB, Cutfield WS, et al. Effects of whole-body vibration training on physical function, bone and muscle mass in adolescents and young adults with cerebral palsy. Scientific Reports. 2016 2016/03/03;6(1):22518.

Hamilton A, Wakely L, Marquez J. Transcranial direct-current stimulation on motor function in pediatric cerebral palsy: a systematic review. Pediatric Physical Therapy. 2018;30(4):291-301.

Sá-Caputo D, Paineiras-Domingos LL, Francisca-Santos A, Dos Anjos EM, Reis AS, Neves MFT, et al. Whole-body vibration improves the functional parameters of individuals with metabolic syndrome: An exploratory study. BMC Endocrine Disorders. 2019;19:1-10.

Kalaoglu E, Bucak OF, Kokce M, Ozkan M, Cetin M, Atasoy M, et al. Whole body vibration activates the tonic vibration reflex during voluntary contraction. Journal of Physical Therapy Science. 2023;35(6):408-13.

Gutierrez GM, Kaminski TW, Douex AT. Neuromuscular control and ankle instability. Pm&r. 2009;1(4):359-65.

Krause A, Gollhofer A, Freyler K, Jablonka L, Ritzmann R. Acute corticospinal and spinal modulation after whole body vibration. Journal of musculoskeletal & neuronal interactions. 2016;16(4):327.

Huang D, Yang Z, Wang Z, Wang P, Qu Y. The macroscopic and microscopic effect of low-frequency whole-body vibration after cerebral ischemia in rats. Metabolic Brain Disease. 2018;33:15-25.

Ridding M, Taylor J. Mechanisms of motor‐evoked potential facilitation following prolonged dual peripheral and central stimulation in humans. The Journal of physiology. 2001;537(2):623-31.

Ziemann U, Hallett M, Cohen LG. Mechanisms of deafferentation-induced plasticity in human motor cortex. Journal of Neuroscience. 1998;18(17):7000-7.

Stefan K, Kunesch E, Cohen LG, Benecke R, Classen J. Induction of plasticity in the human motor cortex by paired associative stimulation. Brain. 2000;123(3):572-84.

Celnik P, Paik N-J, Vandermeeren Y, Dimyan M, Cohen LG. Effects of combined peripheral nerve stimulation and brain polarization on performance of a motor sequence task after chronic stroke. Stroke. 2009;40(5):1764-71.

Cheng H-YK, Yu Y-C, Wong AM-K, Tsai Y-S, Ju Y-Y. Effects of an eight-week whole body vibration on lower extremity muscle tone and function in children with cerebral palsy. Research in developmental disabilities. 2015;38:256-61.

Buchanan DM, Bogdanowicz T, Khanna N, Lockman-Dufour G, Robaey P, D’Angiulli A. Systematic review on the safety and tolerability of transcranial direct current stimulation in children and adolescents. Brain sciences. 2021;11(2):212.

leFauCHeur J. 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). Clin Neurophysiol. 2017;128:56-92.

Ko M-S, Sim YJ, Kim DH, Jeon H-S. Effects of three weeks of whole-body vibration training on joint-position sense, balance, and gait in children with cerebral palsy: a randomized controlled study. Physiotherapy Canada. 2016;68(2):99-105.

Ibrahim MM, Eid MA, Moawd SA. Effect of whole-body vibration on muscle strength, spasticity, and motor performance in spastic diplegic cerebral palsy children. Egyptian Journal of Medical Human Genetics. 2014;15(2):173-9.

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