Transcranial Direct Current Stimulation Combined With Virtual Reality for Mobility and Self-Esteem in Children With Spastic Cerebral Palsy: A Three-Arm Randomized Controlled Trial

Introduction:Children with spastic cerebral palsy have reduced mobility, problems with their gait and psychosocial issues. The purpose of this study was to assess the effect of active tDCS versus sham tDCS and traditional therapy (sham + VR) on mobility, walking performance and self-esteem in the context of VR.

Methods:Children aged 8–16 years (Gross Motor Function Classification System levels I–III) were randomly assigned equally to active tDCS plus VR, sham tDCS plus VR, or conventional therapy. There was a total of 18 sessions in 6 weeks for participants. Active and sham tDCS were administered at 1 mA for 20 minutes and 30 seconds, respectively. Outcomes were measured at baseline, session 9 and session 18. Covariate adjustment and Holm correction were included in linear mixed-effects models.

Results:The effects of the group by assessment were significant for Timed Up and Go performance (adjusted p=0.010) and 5-m home mobility (adjusted p=0.015) on the Functional Mobility Scale. Compared with conventional therapy, active tDCS plus VR resulted in greater improvements in Timed Up and Go time (difference in change, −0.507 seconds; 95% CI, −0.784 to −0.231; adjusted p=0.003) and home mobility (0.571 points; 95% CI, 0.277–0.865; adjusted p=0.001) at baseline to post treatment. Neither active nor sham stimulation was superior with respect to either outcome. Omnibus interactions were not significant for walking velocity or Rosenberg self-esteem.

Conclusions:Active tDCS when combined with VR showed some evidence of an improvement in selected mobility outcomes compared to traditional therapy, but not over sham stimulation. The mobility improvements could actually come from VR-based rehabilitation instead of concurrent tDCS. The six-week intervention may not have been enough to bring about psychosocial change. Interpretation is limited by the modest sample and absence of post-intervention follow-up.