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Asan Medical Center, University of Ulsan College of Medicine, Department of Rehabilitation Medicine1, Ulsan University Hospital, University of Ulsan College of Medicine, Department of Physical Medicine and Rehabilitation2, Konyang Medical Center, University of Konyang College of Medicine, Department of Rehabilitation Medicine3, Asan Medical Center, Department of Rehabilitation Medicine4 |
Introduction: There have been studies about noninvasive brain stimulation in cognitive development in recent 30 years, however, there are not many studies discussing the effect of transcranial direct current stimulation (tDCS) in children. Furthermore, studies of tDCS in children with cerebral palsy (CP) were targeting at motor function, not cognition nor language. Therefore, the aim of this study was to evaluate the effect of tDCS on cognition, activities of daily living (ADL), and language in children with CP associated with cognitive impairment.
Method: This is a preliminary report of prospective, randomized, double blinded study. Thirteen children with CP whose cognitive age under 42 months were randomly assigned to tDCS (n = 8, active tDCS and cognitive training, DC-Stimulator Plus (neuroConn, Germany), 1mA, 20 min/session, total 20 sessions, anode electrode placed over the more involved side of the dorsolateral prefrontal cortex, cathode electrode placed over the contralateral supraorbital region) and control (n = 5, sham tDCS and cognitive training) groups. Mental scale of Bayley Scales of Infant Development II (BSID II), Pediatric Evaluation of Disability Inventory (PEDI), interest/persistence domain of the Laboratory Temperament Assessment Battery (Lab-TAB), Early Childhood Behavior Questionnaire (ECBQ), Korean version of MacArther-Bates Communicative Development Inventories (M-B CDI-K), and the Sequenced Language Scale for Infants (SELSI) or the Preschool Receptive-Expressive Language Scale (PRES) were evaluated.
Results: There was no significant difference between the two groups when comparing the baseline characteristics, including age, sex, GMFCS level, side of anodal stimulation, and all outcome measurements (Table 1). After 12 weeks of intervention, the tDCS group showed significant improvements in all measurements (p<0.05) except grammar domain of M-B CDI-K, whereas the control group only showed significant improvements in manipulation domain of LAP-TAB, attentional shifting domain of ECBQ, and comprehension domain of M-B CDI-K (Table 2). When comparing the degree of improvements after intervention, the differences was not statistically significant (p>0.05) (Table 3). Total 13 caregivers of the children participated in the questionnaire regarding symptoms and side effects after tDCS. Only one caregiver replied that the child had a moderate degree of mood change after tDCS, and the rest of the 12 caregivers replied that there was no symptoms or side effects after tDCS.
Conclusion: Application of tDCS showed improvements in cognitive function, ADL, and language in children with CP associated with cognitive dysfunction. |
