Transcranial stimulation by direct current: a promising tool for people with cerebral palsy

Cerebral palsy (CP) is caused by non-progressive lesion of the developing brain in the pre-, peri- or postnatal periods. Clinical manifestations include disorders of tonus, posture and movement, and can undergo intense transformations throughout life. In the most severely affected children, motor gains may decline during adolescence and adulthood, further reducing functional independence¹. Considering that the life expectancy of adults with mild or moderate CP is slightly lower, when compared to that of the neurotypical population, throughout the life of these individuals the costs for health services can exceed 800 million dollars per year².

Advances in neuroscience originated non-invasive techniques to treat individuals with lesions in the nervous system, improving their functionality even when there are severe disabilities of active and independent movement, or great limitations to carry out daily activities. Transcranial direct current stimulation (tDCS) is one of the main forms of non-invasive brain stimulation, being easy to manipulate, low-cost and capable of inducing regional changes in cortical excitability, activating new neural networks and strengthening the effects of motor training^{3), (4}.

Recent studies have shown that the tDCS, combined with motor exercises, significantly improves short- and medium-term mobility of children with mild to moderate motor impairment CP (Gross Motor function Classification System, levels I, II and III) ⁽⁴. In adults and older adults with neurological dysfunctions, tDCS combined with kinesiotherapy also showed very promising results, but without the same level of evidence in cases of CP with stagnation or decline of motor gains, as in the most severely affected individuals (Gross Motor function Classification System, levels IV and V).

Therefore, the question remains about the tDCS being a possible tool that will provide hope for motor recovery and improvement of functional independence of children, adolescents and adults with major motor impairments caused by cerebral palsy and other brain injuries acquired in childhood.

REFERÊNCIAS

• ¹
  Palisano RJ, Chiarello LA, Avery L, Hanna S, On Track Study Team. Self-care trajectories and reference percentiles for children with cerebral palsy. Phys Occup Ther Pediatr. 2020;40(1)62-78. doi: 10.1080/01942638.2019.1642288
  » https://doi.org/10.1080/01942638.2019.1642288
• ²
  Amankwah N, Oskoui M, Garner R, Bancej C, Manuel DG, Wall R, et al. Cerebral palsy in Canada, 2011-2031: results of a microsimulation modelling study of epidemiological and cost impacts. Health Promot Chronic Dis Prev Can. 2020;40(2):25-37. doi: 10.24095/hpcdp.40.2.01
  » https://doi.org/10.24095/hpcdp.40.2.01
• ³
  Lefaucheur JP, Antal A, Ayache SS, Benninger DH, Brunelin J, Cogiamanian F, et al. Evidence-based guidelines on the therapeutic use of transcranial direct current stimulation (tDCS). Clin Neurophysiol. 2017;128(1):56-92. doi: 10.1016/j.clinph.2016.10.087
  » https://doi.org/10.1016/j.clinph.2016.10.087
• ⁴
  Fleming MK, Theologis T, Buckingham R, Johansen-Berg H. Transcranial direct current stimulation for promoting motor function in cerebral palsy: a review. J Neuroeng Rehabil. 2018;15:121. doi: 10.1186/s12984-018-0476-6
  » https://doi.org/10.1186/s12984-018-0476-6

Publication Dates

• Publication in this collection
  02 Apr 2021
• Date of issue
  Oct-Dec 2020