Abstract
Objective
To assess the evidence of the effectiveness of noninvasive brain stimulation (NIBS)
for rehabilitation of pediatric motor disorders after brain injury.
Data Sources
Ovid, Cochrane, Science Direct, Web of Science, EBSCOhost, PubMed, and Google Scholar
databases were searched up to August 2017 by 2 independent reviewers.
Study Selection
Randomized controlled trials (RCTs) published in English were included if they met
the following criteria. Population: Pediatric patients with motor disorders following
brain injury. Intervention: NIBS, including transcranial direct current stimulation
(tDCS) or repetitive transcranial magnetic stimulation (rTMS). Outcomes: Measures
related to motor disorders (upper limb functional abilities, gait, balance, and spasticity).
Fourteen RCTs were included (10 studies used tDCS, while 4 studies used rTMS).
Data Extraction
Predefined data were tabulated by 1 reviewer and verified by another reviewer. Methodological
quality was assessed using the Physiotherapy Evidence Database (PEDro) scale; also
levels of evidence adapted from Sackett were used.
Data Synthesis
A grouped meta-analysis was performed on balance, gait parameters, and upper limb
function. Data were pooled using a random-effects model to assess the immediate effect
and 1-month follow-up of NIBS. According to the PEDro scale, 3 studies were excellent,
8 studies were good, and 3 studies were fair. The level of evidence of all of the
included studies was 1b, except for 3 studies with grade 2a. There were significant
improvements in all upper limb functions (standardized mean differences [SMDs] ranging
from 0.94 to 1.83 [P values=.0001]), balance (SMDs ranging between -0.48 to 0.83 [P values<.05]) and some gait variables.
Conclusion
Pediatric patients with brain injury can be safely stimulated by NIBS, and there is
evidence for the efficacy of rTMS in improving upper limb function, and tDCS in improving
balance and majority of gait variables with persisted effects for 1 month. The efficacy
of spasticity is uncertain.
Keywords
List of abbreviations:
AHA (Assisting Hand Assessment), AP (anteroposterior), CI (confidence interval), CIMT (constraint-induced movement therapy), COP (center of pressure), COPM (Canadian Occupational Performance Measure), CP (cerebral palsy), GMFM (Gross Motor Function Measure), MA (Melbourne Assessment of Upper Extremity Function), ML (mediolateral), NIBS (noninvasive brain stimulation), PBS (Pediatric Balance Scale), PEDro (Physiotherapy Evidence Database), PEDI (Pediatric Evaluation of Disability Inventory), RCT (randomized controlled trial), rTMS (repetitive transcranial magnetic stimulation), SMD (standardized mean difference), tDCS (transcranial direct current stimulation)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: May 09, 2019
Footnotes
Disclosures: none.
Clinical Trial Registration No.: CRD42017078513.
Identification
Copyright
© 2019 by the American Congress of Rehabilitation Medicine
