Transcranial direct current stimulation for upper and lower limb motor function in young people with Cerebral Palsy: a randomised controlled pilot study

Abstract

Purpose: Cerebral Palsy (CP) is the commonest cause of childhood motor disability. Transcranial direct current stimulation (tDCS) is a promising adjuvant therapy, but research targeting upper and lower limbs simultaneously is needed. We aimed to pilot tDCS with upper/lower limb motor training, estimate the potential effect on motor function, and investigate brain imaging correlates of function.

Materials and methods: Participants (10–16 years) with CP affecting upper and/or lower limbs were randomised (online software) to 10 sessions of active (n = 14) or sham (n = 13) tDCS combined with motor training. The primary outcomes were upper and lower limb function assessed at 1-week post-intervention using the Jebson Taylor hand function (JTT) and Timed Up and Go (TUG) tests. Secondary, imaging outcomes included baseline tractography, grey matter volume, and resting state connectivity.

Results: Adherence was good: 74% completed all intervention sessions, 100% completed the primary outcome assessment. There were no between-group differences (1-week post-intervention, intention-to-treat; group-by-time JTT: F(1,25)=1.189,p = 0.286, partial-eta-squared = 0.05; TUG: F(1,25)=1.605,p = 0.217, partial-eta-squared = 0.06). Imaging showed subtle associations between better JTT at baseline and higher grey matter volume (caudate nucleus) and stronger sensorimotor resting state connectivity.

Conclusions: The trial was well tolerated, but effect sizes were small. Larger studies are needed to further explore tDCS for CP.

IMPLICATIONS FOR REHABILITATION: • Cerebral Palsy (CP) commonly affects upper and lower limb motor function in children.

• Transcranial direct current stimulation (tDCS) is a promising adjunct therapy, but research combining tDCS with both upper and lower limb training in CP is needed.

• We found that 10 sessions of combined tDCS and training was well tolerated in children aged 10–16 with CP.

• There was no clear indication of motor improvements following tDCS compared to sham.

• Brain imaging revealed subtle associations between brain structure/function and baseline function, but no clear relationship with intervention response

• Further research and evidence is needed before tDCS can be recommended clinically for children with CP.