hemi-stim. tdcs and intensive therapies

Conditions: Infantile Hemiplegia

Summary: application of transcranial direct current or placebo combined with constraint induced movement therapy (cimt) and bimanual intensive therapy (bit) in infantile hemiplegia (4-8 years). before, after the treatment and 3 months after the treatment, the functionality of the affected upper limb will be assessed: spontaneous use, alignment of the affected segment in movement, action of grasping and releasing an object with the wrist in a neutral position, extension and flexion and quality of life. cimt will last 3 hours per day in a period of two weeks (10 days from m-f), and the transcranial direct current or placebo will be combined during the first 20 minutes of it. in addition, 45 minutes of bit will be performed during the third week (3 days). the total time of the therapy will be 33 hours and 45 minutes. cimt and bit will have a playful and group performance model.

objectives: to determine the efficacy of the combined application of transcranial direct current (tdcs) with a restraint-induced movement therapy program and bimanual therapy on quality of life, quality of movement and spontaneous use of the affected upper limb in children. with infantile hemiparesis. design: randomized clinical trial with triple blind placebo control. participants: 30 children between 4 and 8 years old diagnosed with infantile hemiparesis randomized into two groups. intervention: program of 15 sessions (3 weeks) in which 20 minutes of cathodic tdcs (active or placebo) will be applied during the performance of 3 hours of restriction-induced movement therapy (cimt) in the first two weeks and with 45 minutes of bimanual intensive therapy (tib) in the third week. the effective duration of the intervention will be 33 hours and 45 minutes. variables: the outcome variables will be recorded before the intervention program, just after and three months after its completion. analysis: an intention-to-treat analysis will be performed. for the main result variables, a two-factor anova (intervention-time) will be performed with a post-hoc analysis with bonferroni correction.

Eligibility criteria:
inclusion criteria: * children between 4 and 8 years old, with a diagnosis of congenital infantile hemiplegia, with a score between levels i and iii of the manual ability classification system (macs) and a level i-iii of the gross motor function classification system will be included (gmfcs). in addition, children must have a preserved cognitive ability to understand the execution of structured activities exclusion criteria: * having previously been treated with tdcs; having been infiltrated with botulinum toxin 2 months prior to the intervention; surgery of the upper limb the 6 months prior to the intervention; pharmacologically uncontrolled epilepsy or having suffered epileptic seizures in the two years prior to the study (according to international recommendations for tdcs in children, gillick et al., 2018); contraindications of tdcs according to international recommendations. in addition, a withdrawal criterion will be non-attendance for more than 20% of the hours of the program.

Keywords: infantile hemiplegia upper extremity transcranial direct current children