Please use this identifier to cite or link to this item: http://hdl.handle.net/10397/81536
Title: Influence of combined transcranial direct current stimulation and motor training on corticospinal excitability in children with unilateral cerebral palsy
Authors: Nemanich, ST
Rich, TL
Chen, CY 
Menk, J
Rudser, K
Chen, M
Meekins, G
Gillick, BT
Keywords: Cerebral palsy
Corticospinal excitability
Pediatric hemiparesis
Rehabilitation
Transcranial direct current stimulation
Issue Date: 2019
Publisher: Frontiers Research Foundation
Source: Frontiers in human neuroscience, 2019, v. 13, 137 How to cite?
Journal: Frontiers in human neuroscience 
Abstract: Combined non-invasive brain stimulation (NIBS) and rehabilitation interventions have the potential to improve function in children with unilateral cerebral palsy (UCP), however their effects on developing brain function are not well understood. In a proof-of-principle study, we used single-pulse transcranial magnetic stimulation (TMS) to measure changes in corticospinal excitability and relationships to motor performance following a randomized controlled trial consisting of 10 days of combined constraint-induced movement therapy (CIMT) and cathodal transcranial direct current stimulation (tDCS) applied to the contralesional motor cortex. Twenty children and young adults (mean age = 12 years, 9 months, range = 7 years, 7 months, 21 years, 7 months) with UCP participated. TMS testing was performed before, after, and 6 months after the intervention to measure motor evoked potential (MEP) amplitude and cortical silent period (CSP) duration. The association between neurophysiologic and motor outcomes and differences in excitability between hemispheres were examined. Contralesional MEP amplitude decreased as hypothesized in five of five participants receiving active tDCS immediately after and 6 months after the intervention, however no statistically significant differences between intervention groups were noted for MEP amplitude [mean difference = −323.9 μV, 95% CI = (−989, 341), p = 0.34] or CSP duration [mean difference = 3.9 ms, 95% CI = (−7.7, 15.5), p = 0.51]. Changes in corticospinal excitability were not statistically associated with improvements in hand function after the intervention. Across all participants, MEP amplitudes measured in the more-affected hand from both contralesional (mean difference = −474.5 μV) and ipsilesional hemispheres (−624.5 μV) were smaller compared to the less-affected hand. Assessing neurophysiologic changes after tDCS in children with UCP provides an understanding of long-term effects on brain excitability to help determine its potential as a therapeutic intervention. Additional investigation into the neurophysiologic effects of tDCS in larger samples of children with UCP are needed to confirm these findings.
URI: http://hdl.handle.net/10397/81536
EISSN: 1662-5161
DOI: 10.3389/fnhum.2019.00137
Rights: Copyright © 2019 Nemanich, Rich, Chen, Menk, Rudser, Chen, Meekins and Gillick. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
The following publication Nemanich ST, Rich TL, Chen C-Y, Menk J, Rudser K, Chen M, Meekins G and Gillick BT (2019) Influence of Combined Transcranial Direct Current Stimulation and Motor Training on Corticospinal Excitability in Children With Unilateral Cerebral Palsy. Front. Hum. Neurosci. 13:137, is available at https://doi.org/10.3389/fnhum.2019.00137
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