Effect of Transcranial Direct Current Stimulation on Hand Recovery and Quality of Life in Hemiparetic Cerebral Palsied Children

Cerebral palsy (CP) refers to a group of diseases characterized by persistent central dyskinesia, postural development disorder, and activity limitation syndromes caused by non-progressive brain injury in the developing fetus or infant. It is often accompanied by sensory, cognitive, and attention disorders. Routine rehabilitation methods for children with CP include physical therapy, occupational therapy, and speech therapy. In recent years, non-invasive brain stimulation (NIBS) techniques have been used to regulate cortical excitability and plasticity.

Transcranial direct current stimulation (tDCS) is a NIBS technique that is easier and more convenient to perform than other methods. It does not require patients to remain stationary for a long time, making it suitable for children. tDCS can be combined with occupational or speech therapy, reducing overall treatment time and avoiding burnout due to long treatment sessions.

This study uses a controlled, blinded, parallel-group, pre- and post-study design. A single trained investigator will evaluate all patients and collect all data to eliminate inter-investigator error. Patients will be divided into two equal groups according to the treatment procedure.

Sixty hemiparetic cerebral palsy children (both sexes, aged 7 to 12 years) will be randomly assigned to the experimental or control group.

• Experimental Group:** Participants receive anodal transcranial direct current stimulation (a-tDCS) applied to the ipsilesional hemisphere at 2mA for 20 minutes, 3 times per week for 1 month (total 12 sessions), combined with 40 minutes of functional task training directed toward hand recovery.
• Control Group:** Participants receive functional task training directed toward hand recovery for 60 minutes, 3 times per week for 1 month (total 12 sessions).

**Assessments:**

• Height and weight scale - for body mass index (BMI) calculation
• Modified Ashworth Scale (MAS) - for spasticity assessment
• Digital hand held dynamometer (Jamar) - for grip strength measurement
• Jebsen Taylor Hand Function Test (JTHFT) - for fine and gross motor hand function
• Pediatric Quality of Life Inventory 4.0 (PedsQL) - for health-related quality of life

The JTHFT consists of seven subsets: writing, simulated page-turning, lifting small objects, simulated feeding, stacking, and lifting large lightweight and heavy objects. The test has good to excellent test-retest reliability and is easy to administer in clinical settings using readily available materials.

The PedsQL 4.0 Generic Core Scales consist of 23 items applicable for healthy school and community populations, as well as pediatric populations with acute and chronic health conditions. It has demonstrated reliability and validity in both healthy and patient populations.

• Study Duration:** 1 month of treatment (12 sessions)
• Follow-up:** No follow-up period beyond the 1-month treatment
• Statistical Analysis:** Data will be analyzed using appropriate statistical methods to compare pre- and post-treatment outcomes within and between groups.

Inclusion criteria

• Age: 7 to 12 years old
• Diagnosis of unilateral spastic hemiparetic cerebral palsy
• Both sexes (male and female)
• Able to understand and follow simple instructions
• Able to maintain a sitting position for at least 60 minutes
• Stable medication regimen for at least 3 months prior to study entry

Exclusion criteria

• Blindness, sickness, or language defects impairing patient cooperation
• Epilepsy or abnormal electroencephalography (EEG)
• Previous brain surgery
• Skin irritation or dysfunction at electrode placement site
• Metallic implants within the brain
• Inability to consent or undergo tDCS therapy
• Presence of cardiac abnormalities
• Received botulinum toxin injections in the upper limb within the past 6 months