Estimulação transcraniana por corrente contínua associada ao treino funcional de membro superior para crianças com paralisia cerebral hemiparética espástica: ensaio clínico controlado aleatorizado e duplo cego

Abstract

Objective: Perform a comparative analysis of the effects of functional training of the paretic upper limb with and without simultaneous transcranial direct current stimulation (tDCS) in children with spastic hemiparetic cerebral palsy (CP). Material and Methods: Study I: Detailed description of the protocol of the study. Study II: A systematic review was conducted with searches of five databases for randomized controlled trials involving kinematic analysis of the upper limbs of individuals with CP published between 2010 and 2015. Study III: A single session of tDCS with a current of 1 mA over the primary motor cortex (M1) of the hemisphere ipsilateral to the injury in a sample of 20 children with spastic hemiparetic CP randomly allocated to an experimental (active tDCS) and control (sham tDCS) group. Pre-stimulation and post-stimulation spatiotemporal variables of a reaching movement were compared. Study IV: Anodal tDCS was administered with a current of 1 mA over M1 of the hemisphere ipsilateral to the injury in a sample of 30 children with spastic hemiparetic CP randomly allocated to two groups: active and sham tDCS. Stimulation was performed in five weekly sessions for two weeks. Evaluations were performed on four occasions (before the protocol, after the protocol, at one-month follow up and at three-month follow up) and involved three-dimensional movement analysis of the reaching movement, the quality of manual skills, degree of spasticity of the biceps brachii of the paretic limb and functional performance. Results: Study I: Article published in the journal TRIALS. Study II: Five clinical trials with adequate methodological quality (5 or more points on PEDro scale) were found. Review published in Journal of Physical Therapy Science. Study III: The experimental group demonstrated a significant reduction in execution time of the reaching movement in the comparison between the pre-intervention evaluation and immediately after tDCS (p < 0.05) with regard to total duration of movement and returning movement for both the paretic and non-paretic limbs. Study IV: The experimental group demonstrated a significant reduction in execution time of the reaching movement of the paretic limb (p < 0.05) with regard to total movement duration at three-month evaluation, going phase at both one-month and three-month evaluations and returning phase at three-month evaluation. For the non-paretic limb, a reduction in retorn velocity was found at the one-month and three-month evaluations. Regarding the measures QUEST and PEDI, the experimental group demonstrated a significant improvement in function of the paretic upper limb. No significant improvement was found regarding spasticity of the biceps brachii muscle, as demonstrated using the modified Ashworth scale. Conclusion: The results of Studies III and IV suggest that anodal transcranial direct current stimulation has a positive effect on the potentiation and maintenance of physiotherapeutic effects on kinematic and manual function of the upper limbs in children with spastic hemiparetic cerebral palsy.