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Effects of transcranial direct current stimulation combined with functional upper limb training in a child with hemiparetic spastic cerebral palsy: A case report
Gait & Posture 49S (2016) 226
Contents lists available at ScienceDirect
Gait & Posture journal homepage: www.elsevier.com/locate/gaitpost
P82 presented in PS03: Poster teaser: CP
Effects of transcranial direct current stimulation combined with functional upper limb training in a child with hemiparetic spastic cerebral palsy: A case report Renata Calhes Franco de Moura 1,*, Cibele Almeida Santos 1, Jamile Benite Palma Lopes 1, Isabela Miziara 3, Veronica Cimolin 2, Claudia Santos Oliveira 1 1
Master and Doctoral Program Rehabilitation Science, University Nove de Julho, Sa˜o Paulo, Brazil Associate Professor of ‘‘Luigi Divieti’’ motion analysis lab, Dipartimento di Bioingegnaria, [1_TD$IF]Politecnico [2_TD$IF]Di [3_TD$IF]Milano, Milano, Brazil 3 University Federal of Uberlaˆndia, UFU, Minas Gerais, Brazil 2
Introduction: Hemiparetic spastic cerebral palsy (CP) accounts for 15.3–40% of cases of CP and is characterized by unilateral motor deficiency contralateral to the brain damage, leading to abnormalities in the biomechanics of the body [1]. In the realm of novel practical therapies, transcranial direct current stimulation (tDCS) is a promising resource for the treatment of children with CP [2].
EMG (RMS – mV) flexion BB/TB*(R) extension BB/TB* (R) flexion BB/TB* (L) extension BB/TB* (L) PEDI (self-care domain) Box and Blocks (R/L) Quest (total)** Ashworth MACS
in the supraorbital region on the contralateral side. A current of 1 mA was administered for 20 min during each training session, which involved reaching exercises with elbow extension. Evaluations were performed before the intervention protocol, immediately after the first session, after ten sessions and one month after the end of the protocol.
Pre
After 1 sess.
After 10 sess.
1 month after
0.094/0.060 0.096/0.061 0.009/0.010 0.008/0.012 62 43/58 85.3 1 1
0.078/0.052 0.096/0.050 0.006/0.017 0.005/0.019 62 43/58 85.3 1 1
0.025/0.005 0.028/0.005 0.025/0.003 0.017/0.004 69 42/59 92.7 1 1
0.004/0.030 0.004/0.033 0.024/0.012 0.018/0.012 68 47/65 92.2 1 1
R, right; L, left; *BB, biceps brachii; TB, triceps brachii; **Total score resulting from mean of A, B, C and D components.
Research question: What are the effects of tDCS over the primary motor cortex combined with functional upper limb training in hemiparetic spastic CP? Materials and methods: This study received approval from the Human Research Ethics Committee of University Nove de Julho (Brazil) under process number 525935/2014. A nine-year-old child with right-side hemiparetic spastic CP was submitted to 10 sessions of functional upper limb training combined with tDCS. The anodal electrode was positioned over the primary motor cortex of the damaged hemisphere, following the 10–20 International System of Electrode Placement [3], and the cathode was placed
* Corresponding author. http://dx.doi.org/10.1016/j.gaitpost.2016.07.279 0966-6362/
Discussion: Studies involving the use of tDCS in the rehabilitation of patients with CP suggest that this method is safe and clinically relevant [4]. Based on the present results, tDCS over the primary cortex of a child with hemiparetic spastic CP combined with upper limb motor training led to improvements in muscle synergy and the quality of dexterity, providing more precise, adjusted movements. References [1] [2] [3] [4]
Hoare BJ, et al. BMC Neurol. 2010;10:58. Muceli S, et al. J. Neurophysiol. 2010;103:1532–42. Jasper HH. J. Neurophysiol. 1958;10:370–5. Grecco LA, et al. Braz. J. Phys. Ther. 2014;18(5):419–27.
Contents lists available at ScienceDirect
Gait & Posture journal homepage: www.elsevier.com/locate/gaitpost
P82 presented in PS03: Poster teaser: CP
Effects of transcranial direct current stimulation combined with functional upper limb training in a child with hemiparetic spastic cerebral palsy: A case report Renata Calhes Franco de Moura 1,*, Cibele Almeida Santos 1, Jamile Benite Palma Lopes 1, Isabela Miziara 3, Veronica Cimolin 2, Claudia Santos Oliveira 1 1
Master and Doctoral Program Rehabilitation Science, University Nove de Julho, Sa˜o Paulo, Brazil Associate Professor of ‘‘Luigi Divieti’’ motion analysis lab, Dipartimento di Bioingegnaria, [1_TD$IF]Politecnico [2_TD$IF]Di [3_TD$IF]Milano, Milano, Brazil 3 University Federal of Uberlaˆndia, UFU, Minas Gerais, Brazil 2
Introduction: Hemiparetic spastic cerebral palsy (CP) accounts for 15.3–40% of cases of CP and is characterized by unilateral motor deficiency contralateral to the brain damage, leading to abnormalities in the biomechanics of the body [1]. In the realm of novel practical therapies, transcranial direct current stimulation (tDCS) is a promising resource for the treatment of children with CP [2].
EMG (RMS – mV) flexion BB/TB*(R) extension BB/TB* (R) flexion BB/TB* (L) extension BB/TB* (L) PEDI (self-care domain) Box and Blocks (R/L) Quest (total)** Ashworth MACS
in the supraorbital region on the contralateral side. A current of 1 mA was administered for 20 min during each training session, which involved reaching exercises with elbow extension. Evaluations were performed before the intervention protocol, immediately after the first session, after ten sessions and one month after the end of the protocol.
Pre
After 1 sess.
After 10 sess.
1 month after
0.094/0.060 0.096/0.061 0.009/0.010 0.008/0.012 62 43/58 85.3 1 1
0.078/0.052 0.096/0.050 0.006/0.017 0.005/0.019 62 43/58 85.3 1 1
0.025/0.005 0.028/0.005 0.025/0.003 0.017/0.004 69 42/59 92.7 1 1
0.004/0.030 0.004/0.033 0.024/0.012 0.018/0.012 68 47/65 92.2 1 1
R, right; L, left; *BB, biceps brachii; TB, triceps brachii; **Total score resulting from mean of A, B, C and D components.
Research question: What are the effects of tDCS over the primary motor cortex combined with functional upper limb training in hemiparetic spastic CP? Materials and methods: This study received approval from the Human Research Ethics Committee of University Nove de Julho (Brazil) under process number 525935/2014. A nine-year-old child with right-side hemiparetic spastic CP was submitted to 10 sessions of functional upper limb training combined with tDCS. The anodal electrode was positioned over the primary motor cortex of the damaged hemisphere, following the 10–20 International System of Electrode Placement [3], and the cathode was placed
* Corresponding author. http://dx.doi.org/10.1016/j.gaitpost.2016.07.279 0966-6362/
Discussion: Studies involving the use of tDCS in the rehabilitation of patients with CP suggest that this method is safe and clinically relevant [4]. Based on the present results, tDCS over the primary cortex of a child with hemiparetic spastic CP combined with upper limb motor training led to improvements in muscle synergy and the quality of dexterity, providing more precise, adjusted movements. References [1] [2] [3] [4]
Hoare BJ, et al. BMC Neurol. 2010;10:58. Muceli S, et al. J. Neurophysiol. 2010;103:1532–42. Jasper HH. J. Neurophysiol. 1958;10:370–5. Grecco LA, et al. Braz. J. Phys. Ther. 2014;18(5):419–27.