Pediatric Hemiparesis Clinical Trial
Official title:
Synergistic Effect of Combined Transcranial Direct Current Stimulation/Constraint Induced Movement Therapy in Children With Hemiparesis
Hemiparetic cerebral palsy influences motor function in children during development and
throughout their lifetime. The deficits one sees are the result both of the congenitally
induced brain lesion and the subsequent plasticity that can impair function of the surviving
neurons in the damaged brain.
Many current treatments have limited influence on children's neurorecovery.
Constraint-induced movement therapy (CIMT) involving constraining the unaffected limb to
encourage use of the affected limb has shown promise, yet with new technology revealing the
potential to directly influence the brain, there is an urgent need to study the synergy of
combined techniques.
Non-invasive brain stimulation (NIBS) as a direct neuromodulatory intervention has the
potential to act synergistically with CIMT to influence neurorecovery.
Combining behavioral therapies, constraint-induced movement therapy (CIMT), with a novel form
of neuromodulation, transcranial direct current stimulation (tDCS), we investigated the
influence of this intervention on improved motor outcomes in children with cerebral palsy.
The study hypotheses surround the safety, feasibility and efficacy of combined CIMT and tDCS
wherein those children who receive the combined intervention will reveal no major adverse
events, yet improved hand function and cortical excitability.
To Note: In addition to the combination of NIBS with CIMT, we also investigated the
combination of NIBS with another form of motor intervention, bimanual, or two-handed,
training. During bimanual training, children engage both hands in movements. The goal of
bimanual training is to teach children how to most effectively use their hands cooperatively.
During bimanual training, children play with games and toys that require the use of both
hands. Children also practice activities of daily living that require the use of both hands,
such as putting hair in a ponytail, tying shoes, and buttoning clothing. N=8 for this pilot
study and no randomization. (Burke Medical Research Institute partnered with Columbia
University and did a parallel pilot study. N=8 (PIs Friel and Gordon; Protocol BRC449)
We use single-pulse transcranial magnetic stimulation (TMS) to measure the location and strength of brain connections that control hand movements. ;