Transcranial direct current stimulation (tDCS) paired with occupation-centered bimanual training in children with unilateral cerebral palsy: A preliminary study

Tonya L. Rich, Samuel Nemanich, Mo Chen, Kathleen Friel, Timothy Feyma, Linda Krach, Tanjila Nawshin, Gregg Meekins, Bernadette T. Gillick

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5 Scopus citations

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.

Original languageEnglish (US)
Article number9610812
JournalNeural plasticity
Volume2018
DOIs
StatePublished - 2018

Bibliographical note

Funding Information:
This study was funded by the National Institutes of Health (NIH) Eunice Kennedy Shriver National Institute of Child Health and Development K01 Award (HD078484-01A1), the Cerebral Palsy Foundation, the Foundation for Physical Therapy Magistro Family Grant, Minnesota's Discovery, Research and InnoVation Economy (MnDRIVE), and the University of Minnesota Marie Louise Wales Fellowship. The project described was also supported in part by Award UL1 TR000114 and KL2 TR000113. The authors thank the Center for Neurobehavioral Development and Center for Magnetic Resonance Imaging (P41 EB015894, 1S10OD017974-01) at the University of Minnesota. The research team also thanks Ben Andre, Andrew Kunz, Isabel Marbaker, Stephanie Palmer, Kayla Stark, Taylor Webster, and April Wheeler for serving as student interventionists; Gillette Lifetime Clinic seating specialist, Wayne Rydberg, for the custom tray fabrication; Dr. Marcie Ward for serving as a study physician; and Karen Chin for video scoring. Most importantly, the research team thank the families, caregivers, and participants involved in this study.

Funding Information:
This study was funded by the National Institutes of Health (NIH) Eunice Kennedy Shriver National Institute of Child Health and Development K01 Award (HD078484-01A1), the Cerebral Palsy Foundation, the Foundation for Physical Therapy Magistro Family Grant, Minnesota’s Discovery, Research and InnoVation Economy (MnDRIVE), and the University of Minnesota Marie Louise Wales Fellowship. The project described was also supported in part by Award UL1 TR000114 and KL2 TR000113. The authors thank the Center for Neurobehavioral Development and Center for Magnetic Resonance Imaging (P41 EB015894, 1S10OD017974-01) at the University of Minnesota. The research team also thanks Ben Andre, Andrew Kunz, Isabel Marbaker, Stephanie Palmer, Kayla Stark, Taylor Webster, and April Wheeler for serving as student interventionists; Gillette Lifetime Clinic seating specialist, Wayne Rydberg, for the custom tray fabrication; Dr. Marcie Ward for serving as a study physician; and Karen Chin for video scoring. Most importantly, the research team thank the families, caregivers, and participants involved in this study.

Publisher Copyright:
Copyright © 2018 Tonya L. Rich et al. This is an open access article distributed under the Creative Commons Attribution License

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