Brain Stimulation and Hand Training in Children With Hemiparesis
Condition: Pediatric Hemiparesis
MeSH terms: Paresis
Study type: Interventional

Summary: 
      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)
    

Detailed description: 
      We use single-pulse transcranial magnetic stimulation (TMS) to measure the location and
      strength of brain connections that control hand movements.
    

Intervention name(s): Transcranial Direct Current Stimulation (tDCS); Placebo Comparator
Intervention type(s): Device; Device
Intervention description(s): 10 tDCS/CIMT Sessions
Other intervention name(s): tDCS; Brain Stimulation
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Care Provider, Investigator)
Primary purpose: Treatment
Keywords: Cerebral Palsy; Hemiparesis; Stroke; Non-Invasive Brain Stimulation; Transcranial Direct Current Stimulation; Constraint-Induced Movement Therapy; Diffusion Tensor Imaging; Congenital Hemiparesis; Bimanual Therapy