Transcranial direct current stimulation for children with perinatal stroke and hemiparesis. Kirton A., Ciechanski P., Zewdie E., Andersen J., Nettel-Aguirre A., Carlson H., Carsolio L., Herrero M., Quigley J., Mineyko A., Hodge J., & Hill M. 2017.
Transcranial direct current stimulation for children with perinatal stroke and hemiparesis [link]Paper  abstract   bibtex   
Objective: To determine whether the addition of transcranial direct current stimulation (tDCS) to intensive therapy increases motor function in children with perinatal stroke and hemiparetic cerebral palsy. Methods: This was a randomized, controlled, double-blind clinical trial. Participants were recruited from a population-based cohort with MRI-classified unilateral perinatal stroke, age of 6 to 18 years, and disabling hemiparesis. All completed a goal-directed, peer-supported, 2-week after-school motor learning camp (32 hours of therapy). Participants were randomized 1:1 to 1 mA cathodal tDCS over the contralesional primary motor cortex (M1) for the initial 20 minutes of daily therapy or sham. Primary subjective (Canadian Occupational Performance Measure [COPM]), objective (Assisting Hand Assessment [AHA]), safety, and secondary outcomes were measured at 1 week and 2 months after intervention. Analysis was by intention to treat. Results: Twenty-four participants were randomized (median age 11.8 +/- 2.7 years, range 6.7-17.8). COPM performance and satisfaction scores doubled at 1 week with sustained gains at 2 months (p \textless 0.001). COPM scores increased more with tDCS compared to sham control (p = 0.004). AHA scores demonstrated only mild increases at both time points with no tDCS effects. Procedures were safe and well tolerated with no decrease in either arm function or serious adverse events. Conclusion: TDCS trials appear feasible and safe in hemiparetic children. Lack of change in objective motor function may reflect underdosing of therapy. Marked gains in subjective function with tDCS warrant further study. ClinicalTrials.gov identifier: NCT02170285. Classification of evidence: This study provides Class II evidence that for children with perinatal stroke and hemiparetic cerebral palsy, the addition of tDCS to moderate-dose motor learning therapy does not significantly improve motor function as measured by the AHA. Copyright © 2016 American Academy of Neurology.
@misc{kirton_a._transcranial_2017,
	title = {Transcranial direct current stimulation for children with perinatal stroke and hemiparesis},
	url = {http://www.neurology.org},
	abstract = {Objective: To determine whether the addition of transcranial direct current stimulation (tDCS) to intensive therapy increases motor function in children with perinatal stroke and hemiparetic cerebral palsy. Methods: This was a randomized, controlled, double-blind clinical trial. Participants were recruited from a population-based cohort with MRI-classified unilateral perinatal stroke, age of 6 to 18 years, and disabling hemiparesis. All completed a goal-directed, peer-supported, 2-week after-school motor learning camp (32 hours of therapy). Participants were randomized 1:1 to 1 mA cathodal tDCS over the contralesional primary motor cortex (M1) for the initial 20 minutes of daily therapy or sham. Primary subjective (Canadian Occupational Performance Measure [COPM]), objective (Assisting Hand Assessment [AHA]), safety, and secondary outcomes were measured at 1 week and 2 months after intervention. Analysis was by intention to treat. Results: Twenty-four participants were randomized (median age 11.8 +/- 2.7 years, range 6.7-17.8). COPM performance and satisfaction scores doubled at 1 week with sustained gains at 2 months (p {\textless} 0.001). COPM scores increased more with tDCS compared to sham control (p = 0.004). AHA scores demonstrated only mild increases at both time points with no tDCS effects. Procedures were safe and well tolerated with no decrease in either arm function or serious adverse events. Conclusion: TDCS trials appear feasible and safe in hemiparetic children. Lack of change in objective motor function may reflect underdosing of therapy. Marked gains in subjective function with tDCS warrant further study. ClinicalTrials.gov identifier: NCT02170285. Classification of evidence: This study provides Class II evidence that for children with perinatal stroke and hemiparetic cerebral palsy, the addition of tDCS to moderate-dose motor learning therapy does not significantly improve motor function as measured by the AHA. Copyright © 2016 American Academy of Neurology.},
	journal = {Neurology},
	author = {{Kirton A.} and {Ciechanski P.} and {Zewdie E.} and {Andersen J.} and {Nettel-Aguirre A.} and {Carlson H.} and {Carsolio L.} and {Herrero M.} and {Quigley J.} and {Mineyko A.} and {Hodge J.} and {Hill M.}},
	year = {2017},
	keywords = {*brain ischemia/th [Therapy], *cerebral palsy/th [Therapy], *cerebrovascular accident, *hemiparesis, *hemiparesis/th [Therapy], *perinatal morbidity, *transcranial direct current stimulation, Child, adolescent, adult, adverse drug reaction, adverse outcome, arm movement, article, assisting hand assessment, canadian occupational performance measure, cerebral palsy, classification, clinical article, clinical trial, controlled clinical trial, controlled study, cortical electrode, double blind procedure, female, human, intensive care, intention to treat analysis, male, motor learning, motor performance, neurologic disease assessment, nuclear magnetic resonance imaging, patient safety, peer group, population based case control study, primary motor cortex, priority journal, randomized controlled trial, safety, satisfaction, school child, side effect}
}

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