Effect of a single session of transcranial direct current stimulation combined with virtual reality training on functional mobility in children with cerebral palsy: A randomized, controlled, double-blind trial.

Abstract

Introduction:Abnormal postural control in children with cerebral palsy (CP) exerts a negative impact on activities of daily living. The Timed UpandGo (TUG) test is a valid, reliable test for the evaluation of functional mobility in children with CP. Objective:The aim of the present study was to determine the effects of a single session of transcranial direct current stimulation (tDCS) over the primary motor cortex combined with mobility training using a virtual reality system on functional mobility in children with CP. Method: The sample was composed of 12 children with CP aged 4 to 12 years, who were randomly allocated to an experimental group (virtual reality training + active tDCS) and control group (virtual reality training + placebo tDCS). Evaluations involved the TUG test performed 20 minutes before the intervention as well as immediately after the intervention. The paired t-test was used for the intra-group comparisons and both the unpaired t-test and Levene's test were used for the intergroup comparisons, with a p-value < 0.05 indicative of statistical significance. Results: The data were expressed as mean and standard deviation. In the control group, the time needed to complete the TUG was 14.40 ± 5.79 s before the intervention 13.81 ± 5.18 s after the test (p=0.279). In the experimental group, the time needed to complete the TUG went from 15.73 ± 5.77 s before the test to 13.96 ± 5.48 s after the test(p=0.004). However, no statistically significant difference was found in the inter-group analysis (p=0.853). Conclusion: The findings suggest that tDCSfavors an increase in gait velocity in children with cerebral palsy. Keywords: cerebral palsy, child, physical therapy, cerebral cortex, electrical stimulation, functionality, Timed Up&Go, TUG. ResumoIntrodução: Controle postural anormal em crianças com paralisia cerebral (PC) exerce um impacto negativo sobre as atividades da vida diária. O teste cronometrado Timed Up and Go (TUG) é um teste válido e confiável para a avaliação da mobilidade funcional em crianças com PC. Objetivo: A finalidade do presente estudo foi determinar os efeitos de uma única sessão de estimulação transcraniana por corrente contínua (ETCC) sobre o córtex motor primário combinado com treinamento de mobilidade usando um sistema de realidade virtual sobre a mobilidade funcional em crianças com PC. Metódo: A amostra foi composta de 12 crianças com PC com idades entre 4 e 12 anos, que foram distribuídos aleatoriamente em um grupo experimental (treinamento de realidade virtual + ETCC ativa) e grupo controle (formação de realidade virtual + ETCC placebo). As avaliações envolveram a TUG realizadas 20 minutos antes da intervenção, bem como imediatamente após a intervenção. O teste t pareado foi utilizado para as comparações intra-grupo e foram utilizados tanto o teste t não pareado e teste de Levene para as comparações entre os grupos, com um valor de p <0,05 indicativo de significância estatística. Resultados: Os dados foram expressos em média e desvio padrão. No grupo controle, o tem...

Virtual reality and non-invasive brain stimulation for rehabilitation applications: a systematic review

“…The article mainly studies: Stroke rehabilitation (i) [ 25 ] [ 30 ] The effects of NIBS, VR and its combination on therapy for upper limb training in patients with subacute stroke. The effects of combining NIBS with VR-based motor skill training in patients with subacute stroke (ii) [ 31 ] The effect of adding NIBS to VR therapy, for upper limb training in unilateral stroke [ 29 ] Whether combining NIBS with VR training could improve upper limb function in subacute stroke patients [ 28 ] The effects of adding NIBS to a VR-BCI therapy for motor recovery after stroke [ 32 ] The effects of adding NIBS in VR therapy to improve upper limb motor function after stroke (iii) [ 33 ] The effects of NIBS-VR paradigm for upper limb rehabilitation in a stroke survivor with severe hemiparesis Phobia and PTSD (ii) [ 34 ] [ 35 ] The effects on acute anxiety of adding NIBS to a VR experience for patients with spider phobia The impact on emotion regulation of adding NIBS to a VR experience for patients with spider phobia [ 36 ] The use of NIBS during VR experience to reduce psychophysiological arousal and symptoms in veterans with PTSD Cerebral palsy (ii) [ 37 ] The effects of a single session of NIBS combined with VR training on functional mobility in children with cerebral palsy [ 26 ] The effects of a single session of NIBS combined with VR training on the balance of children with cerebral palsy [ 38 ] ...…”

“…The reviewed studies reported different blinding approaches to prevent both participant and/or experimenter biases [ 44 ]. Six studies, [ 26 , 29 , 31 , 37 – 39 ], reported double blinding (patients and therapists); single blinding on the patient side was reported in seven studies [ 28 , 30 , 32 , 34 – 36 , 41 ]; and the remaining three studies reported single blinding only in the therapist side.…”

“…The interaction was carried out with an eye-tracking device and armband capable of measuring EMG and position. Patient was seated in a comfortable chair 1PP 20 min [ 32 ] The VE was presented in a large screen and consisted of a game in which the patient had to hit a target object with a virtual ball through the movement of a mechanical handle N/R 20 min [ 26 , 37 , 38 ] The patient (child) was instructed to stand in front of a large screen measuring 200 × 150 cm and played a Kinect-controlled Xbox game that consisted of aerobic exercise (walking and walking with obstacles) games Depends on the game 20 min [ 39 , 40 ] A screen-mirror setup was used to induce a walking visual illusion in the patient. The mirror reflected the upper body of the subject, while the screen showed patient-matched legs walking in a treadmill machine The interaction was performed by the mirror part of the setup.…”

“…The three studies in this category made use of the same VR-tDCS protocol, with the main difference being the number of sessions administered, namely, one-session protocol was used in [ 26 , 37 ] and ten-session protocol in [ 38 ]. Regarding outcome, the one-session studies in this category reported inconclusive outcomes, while the ten-session protocol reported positive outcomes with the use of the VR-tDCS protocol for children with cerebral palsy.…”

“…More studies are needed to define specific VR and NIBS protocols for each therapeutic application, and to corroborate the reported findings in larger populations. Four of the seven articles with neutral effects, [ 26 , 34 , 35 , 37 ], used a single-session approach for the VR-NIBS therapy. For the four studies using the VR-TMS protocol, only [ 29 ] reported positive outcomes with a TMS protocol of 30 min in 24 sessions, while the other three studies used a TMS-protocol for 10 or less minutes in 1 or 10 sessions.…”