Effect of Combined Therapy of Virtual Reality and Transcranial Direct Current Stimulation in Children and Adolescents With Cerebral Palsy: A Study Protocol for a Triple-Blinded Randomized Controlled Crossover Trial

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Background: Transcranial direct current stimulation (tDCS) and therapy-based virtual reality (VR) have been investigated separately. They have shown promise as efficient and engaging new tools in the neurological rehabilitation of individuals with cerebral palsy (CP). However, the recent literature encourages investigation of the combination of therapy tools in order to potentiate clinic effects and its mechanisms.

Methods: A triple-blinded randomised sham-controlled crossover trial will be performed. Thirty-six individuals with gross motor function of levels I to IV (aged 4–14 years old) will be recruited. Individuals will be randomly assigned to Group A (active first) or S (sham first): Group A will start with ten sessions of active tDSC combined with VR tasks. After a 1-month washout, this group will be reallocated to another ten sessions with sham tDCS combined with VR tasks. In contrast, Group S will carry out the opposite protocol, starting with sham tDCS. For the active tDCS the protocol will use low frequency tDCS [intensity of 1 milliampere (mA)] over the primary cortex (M1) area on the dominant side of the brain. Clinical evaluations (reaction times and coincident timing through VR, functional scales: Abilhand-Kids, ACTIVLIM-CP, Paediatric Evaluation of Disability Inventory-PEDI- and heart rate variability-HRV) will be performed at baseline, during, and after active and sham tDCS.

Conclusion: tDCS has produced positive results in treating individuals with CP; thus, its combination with new technologies shows promise as a potential mechanism for improving neurological functioning. The results of this study may provide new insights into motor rehabilitation, thereby contributing to the better use of combined tDCS and VR in people with CP.

Trial Registration: ClinicalTrials.gov, NCT04044677. Registered on 05 August 2019.

Related collections

Most cited references 82

Record: found
Abstract: found
Article: not found

Virtual reality in neuroscience research and therapy.

Corey Bohil, Bradly Alicea, Frank Biocca (2011)

Virtual reality (VR) environments are increasingly being used by neuroscientists to simulate natural events and social interactions. VR creates interactive, multimodal sensory stimuli that offer unique advantages over other approaches to neuroscientific research and applications. VR's compatibility with imaging technologies such as functional MRI allows researchers to present multimodal stimuli with a high degree of ecological validity and control while recording changes in brain activity. Therapists, too, stand to gain from progress in VR technology, which provides a high degree of control over the therapeutic experience. Here we review the latest advances in VR technology and its applications in neuroscience research.

0 comments Cited 282 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Baroreflex sensitivity and heart-rate variability in prediction of total cardiac mortality after myocardial infarction. ATRAMI (Autonomic Tone and Reflexes After Myocardial Infarction) Investigators.

M T La Rovere, J Bigger, F I Marcus … (1998)

Experimental evidence suggests that autonomic markers such as heart-rate variability and baroreflex sensitivity (BRS) may contribute to postinfarction risk stratification. There are clinical data to support this concept for heart-rate variability. The main objective of the ATRAMI study was to provide prospective data on the additional and independent prognostic value for cardiac mortality of heart-rate variability and BRS in patients after myocardial infarction in whom left-ventricular ejection fraction (LVEF) and ventricular arrhythmias were known. This multicentre international prospective study enrolled 1284 patients with a recent ( 105 ms, BRS >6.1 ms per mm Hg). The association of low SDNN or BRS with LVEF below 35% carried a relative risk of 6.7 (3.1-14.6) or 8.7 (4.3-17.6), respectively, compared with patients with LVEF above 35% and less compromised SDNN (> or = 70 ms) and BRS (> or = 3 ms per mm Hg). ATRAMI provides clinical evidence that after myocardial infarction the analysis of vagal reflexes has significant prognostic value independently of LVEF and of ventricular arrhythmias and that it significantly adds to the prognostic value of heart-rate variability.

0 comments Cited 274 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: found

Is Open Access

State of the Evidence Traffic Lights 2019: Systematic Review of Interventions for Preventing and Treating Children with Cerebral Palsy

Iona Novak, Catherine Morgan, Michael Fahey … (2020)

Purpose of Review Cerebral palsy is the most common physical disability of childhood, but the rate is falling, and severity is lessening. We conducted a systematic overview of best available evidence (2012–2019), appraising evidence using GRADE and the Evidence Alert Traffic Light System and then aggregated the new findings with our previous 2013 findings. This article summarizes the best available evidence interventions for preventing and managing cerebral palsy in 2019. Recent Findings Effective prevention strategies include antenatal corticosteroids, magnesium sulfate, caffeine, and neonatal hypothermia. Effective allied health interventions include acceptance and commitment therapy, action observations, bimanual training, casting, constraint-induced movement therapy, environmental enrichment, fitness training, goal-directed training, hippotherapy, home programs, literacy interventions, mobility training, oral sensorimotor, oral sensorimotor plus electrical stimulation, pressure care, stepping stones triple P, strength training, task-specific training, treadmill training, partial body weight support treadmill training, and weight-bearing. Effective medical and surgical interventions include anti-convulsants, bisphosphonates, botulinum toxin, botulinum toxin plus occupational therapy, botulinum toxin plus casting, diazepam, dentistry, hip surveillance, intrathecal baclofen, scoliosis correction, selective dorsal rhizotomy, and umbilical cord blood cell therapy. Summary We have provided guidance about what works and what does not to inform decision-making, and highlighted areas for more research. Electronic supplementary material The online version of this article (10.1007/s11910-020-1022-z) contains supplementary material, which is available to authorized users.

0 comments Cited 163 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Contributors

Talita Dias da Silva: URI : http://loop.frontiersin.org/people/609716/overview

Anne Michelli Gomes Gonçalves Fontes: URI : http://loop.frontiersin.org/people/1063726/overview

Tatiane Tedeschi Roque: URI : http://loop.frontiersin.org/people/1061937/overview

Camila Aparecida de Oliveira Alberissi: URI : http://loop.frontiersin.org/people/1041457/overview

Ana Clara Silveira: URI : http://loop.frontiersin.org/people/1061742/overview

Íbis Ariana Peña de Moraes: URI : http://loop.frontiersin.org/people/1040620/overview

Johnny Collett: URI : http://loop.frontiersin.org/people/628761/overview

Roger Pereira Silva: URI : http://loop.frontiersin.org/people/1046102/overview

Marina Junqueira Airoldi: URI : http://loop.frontiersin.org/people/1061814/overview

Denise Cardoso Ribeiro-Papa: URI : http://loop.frontiersin.org/people/1040769/overview

Helen Dawes: URI : http://loop.frontiersin.org/people/49836/overview

Carlos Bandeira de Mello Monteiro: URI : http://loop.frontiersin.org/people/177598/overview

Journal

Journal ID (nlm-ta): Front Neurol

Journal ID (iso-abbrev): Front Neurol

Journal ID (publisher-id): Front. Neurol.

Title: Frontiers in Neurology

Publisher: Frontiers Media S.A.

ISSN (Electronic): 1664-2295

Publication date (Electronic): 02 September 2020

Publication date Collection: 2020

Volume: 11

Electronic Location Identifier: 953

Affiliations

[1] ¹Programa de Pós-Graduação em Ciências da Reabilitação, Faculdade de Medicina da Universidade de São Paulo (FMUSP) , São Paulo, Brazil

[2] ²Departamento de Medicina (Cardiologia), Universidade Federal de São Paulo (UNIFESP) , São Paulo, Brazil

[3] ³Grupo de Pesquisa e Aplicações Tecnológicas em Reabilitação (PATER), Escola de Artes, Ciências e Humanidades, Universidade de São Paulo (EACH-USP) , São Paulo, Brazil

[4] ⁴Faculdade de Medicina, Universidade Cidade de São Paulo (UNICID) , São Paulo, Brazil

[5] ⁵Institute of Nursing and Allied Health Research, Oxford Brookes University , Oxford, United Kingdom

[6] ⁶Department of Clinical Neurology, University of Oxford , Oxford, United Kingdom

Author notes

Edited by: Stefano Tamburin, University of Verona, Italy

Reviewed by: Marta Matamala-Gomez, University of Milano-Bicocca, Italy; Eman M. Khedr, Faculty of Medicine, Assiut University, Egypt

*Correspondence: Talita Dias da Silva ft.talitadias@ 123456gmail.com

This article was submitted to Neurorehabilitation, a section of the journal Frontiers in Neurology

†These authors share first authorship

Article

DOI: 10.3389/fneur.2020.00953

PMC ID: 7492207

PubMed ID: 32982950

SO-VID: 25e995d0-94c0-4127-a3f2-bee9768e1581

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

History

Date received : 20 April 2020

Date accepted : 23 July 2020

Page count

Figures: 6, Tables: 1, Equations: 0, References: 90, Pages: 14, Words: 10945

Funding

Funded by: Coordenação de Aperfeiçoamento de Pessoal de Nível Superior 10.13039/501100002322

Funded by: Fundação de Amparo à Pesquisa do Estado de São Paulo 10.13039/501100001807

Funded by: Conselho Nacional de Desenvolvimento Científico e Tecnológico 10.13039/501100003593

Effect of Combined Therapy of Virtual Reality and Transcranial Direct Current Stimulation in Children and Adolescents With Cerebral Palsy: A Study Protocol for a Triple-Blinded Randomized Controlled Crossover Trial

Read this article at

Abstract

Related collections

Karger: Neurology and Neuroscience

Most cited references 82

Virtual reality in neuroscience research and therapy.

Baroreflex sensitivity and heart-rate variability in prediction of total cardiac mortality after myocardial infarction. ATRAMI (Autonomic Tone and Reflexes After Myocardial Infarction) Investigators.

State of the Evidence Traffic Lights 2019: Systematic Review of Interventions for Preventing and Treating Children with Cerebral Palsy

Author and article information

Contributors

Journal

Affiliations

Author notes

Article

History

Page count

Funding

Categories

Comments

Comment on this article

Similar content 100

Cited by 10

Most referenced authors 1,187