Influence of combined transcranial direct current stimulation and motor training on corticospinal excitability in children with unilateral cerebral palsy

Samuel T. Nemanich; Tonya L. Rich; Chao Ying Chen; Jeremiah Menk; Kyle Rudser; Mo Chen; Gregg Meekins; Bernadette T. Gillick

doi:10.3389/fnhum.2019.00137

Influence of combined transcranial direct current stimulation and motor training on corticospinal excitability in children with unilateral cerebral palsy

Samuel T. Nemanich, Tonya L. Rich, Chao Ying Chen, Jeremiah Menk, Kyle Rudser, Mo Chen, Gregg Meekins, Bernadette T. Gillick

Research output: Contribution to journal › Article › peer-review

19 Scopus citations

Abstract

Combined non-invasive brain stimulation (NIBS) and rehabilitation interventions have the potential to improve function in children with unilateral cerebral palsy (UCP), however their effects on developing brain function are not well understood. In a proof-of-principle study, we used single-pulse transcranial magnetic stimulation (TMS) to measure changes in corticospinal excitability and relationships to motor performance following a randomized controlled trial consisting of 10 days of combined constraint-induced movement therapy (CIMT) and cathodal transcranial direct current stimulation (tDCS) applied to the contralesional motor cortex. Twenty children and young adults (mean age = 12 years, 9 months, range = 7 years, 7 months, 21 years, 7 months) with UCP participated. TMS testing was performed before, after, and 6 months after the intervention to measure motor evoked potential (MEP) amplitude and cortical silent period (CSP) duration. The association between neurophysiologic and motor outcomes and differences in excitability between hemispheres were examined. Contralesional MEP amplitude decreased as hypothesized in five of five participants receiving active tDCS immediately after and 6 months after the intervention, however no statistically significant differences between intervention groups were noted for MEP amplitude [mean difference = −323.9 μV, 95% CI = (−989, 341), p = 0.34] or CSP duration [mean difference = 3.9 ms, 95% CI = (−7.7, 15.5), p = 0.51]. Changes in corticospinal excitability were not statistically associated with improvements in hand function after the intervention. Across all participants, MEP amplitudes measured in the more-affected hand from both contralesional (mean difference = −474.5 μV) and ipsilesional hemispheres (−624.5 μV) were smaller compared to the less-affected hand. Assessing neurophysiologic changes after tDCS in children with UCP provides an understanding of long-term effects on brain excitability to help determine its potential as a therapeutic intervention. Additional investigation into the neurophysiologic effects of tDCS in larger samples of children with UCP are needed to confirm these findings.

Original language	English (US)
Article number	137
Journal	Frontiers in Human Neuroscience
Volume	13
DOIs	https://doi.org/10.3389/fnhum.2019.00137
State	Published - Feb 1 2019

Bibliographical note

Funding Information:
This work was supported by the National Institutes of Health (NIH) Eunice Kennedy Shriver National Institutes of Child Health and Development K01 Award (HD078484-01A1); the Cerebral Palsy Foundation, the Foundation for Physical Therapy Magistro Family Grant; the University of Minnesota’s MnDRIVE (Minnesota’s Discovery, Research, and Innovation Economy) initiative, and University of Minnesota Center for Magnetic Resonance Research (P41 EB015894 and 1S10OD017974-01). The project described was also supported in part by Award UL1 TR000114 and KL2 TR000113. This research was also supported by the National Institutes of Health’s National Center for Advancing Translational Sciences, grant UL1TR002494. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health’s National Center for Advancing Translational Sciences.

Funding Information:
We thank the Center for Neurobehavioral Development and at the University of Minnesota; the therapists, therapy supervisors, study coordinators, and research administration personnel from Gillette Children?s Specialty Healthcare; and Ma?ra Lixandr?o, PhD, PT, and Cec?lia Prudente, PhD, PT for data acquisition efforts. Finally, we are grateful for the energies of the families and children involved in this study. Funding. This work was supported by the National Institutes of Health (NIH) Eunice Kennedy Shriver National Institutes of Child Health and Development K01 Award (HD078484-01A1); the Cerebral Palsy Foundation, the Foundation for Physical Therapy Magistro Family Grant; the University of Minnesota?s MnDRIVE (Minnesota?s Discovery, Research, and Innovation Economy) initiative, and University of Minnesota Center for Magnetic Resonance Research (P41 EB015894 and 1S10OD017974-01). The project described was also supported in part by Award UL1 TR000114 and KL2 TR000113. This research was also supported by the National Institutes of Health?s National Center for Advancing Translational Sciences, grant UL1TR002494. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health?s National Center for Advancing Translational Sciences.

Publisher Copyright:
© 2019 Nemanich, Rich, Chen, Menk, Rudser, Chen, Meekins and Gillick.

Keywords

Cerebral palsy
Corticospinal excitability
Pediatric hemiparesis
Rehabilitation
Transcranial direct current stimulation

Publisher link

10.3389/fnhum.2019.00137

Find It

Find It at U of M Libraries

Cite this

@article{d86cb1888569432d81c3bfef5cee3782,

title = "Influence of combined transcranial direct current stimulation and motor training on corticospinal excitability in children with unilateral cerebral palsy",

abstract = "Combined non-invasive brain stimulation (NIBS) and rehabilitation interventions have the potential to improve function in children with unilateral cerebral palsy (UCP), however their effects on developing brain function are not well understood. In a proof-of-principle study, we used single-pulse transcranial magnetic stimulation (TMS) to measure changes in corticospinal excitability and relationships to motor performance following a randomized controlled trial consisting of 10 days of combined constraint-induced movement therapy (CIMT) and cathodal transcranial direct current stimulation (tDCS) applied to the contralesional motor cortex. Twenty children and young adults (mean age = 12 years, 9 months, range = 7 years, 7 months, 21 years, 7 months) with UCP participated. TMS testing was performed before, after, and 6 months after the intervention to measure motor evoked potential (MEP) amplitude and cortical silent period (CSP) duration. The association between neurophysiologic and motor outcomes and differences in excitability between hemispheres were examined. Contralesional MEP amplitude decreased as hypothesized in five of five participants receiving active tDCS immediately after and 6 months after the intervention, however no statistically significant differences between intervention groups were noted for MEP amplitude [mean difference = −323.9 μV, 95% CI = (−989, 341), p = 0.34] or CSP duration [mean difference = 3.9 ms, 95% CI = (−7.7, 15.5), p = 0.51]. Changes in corticospinal excitability were not statistically associated with improvements in hand function after the intervention. Across all participants, MEP amplitudes measured in the more-affected hand from both contralesional (mean difference = −474.5 μV) and ipsilesional hemispheres (−624.5 μV) were smaller compared to the less-affected hand. Assessing neurophysiologic changes after tDCS in children with UCP provides an understanding of long-term effects on brain excitability to help determine its potential as a therapeutic intervention. Additional investigation into the neurophysiologic effects of tDCS in larger samples of children with UCP are needed to confirm these findings.",

keywords = "Cerebral palsy, Corticospinal excitability, Pediatric hemiparesis, Rehabilitation, Transcranial direct current stimulation",

author = "Nemanich, {Samuel T.} and Rich, {Tonya L.} and Chen, {Chao Ying} and Jeremiah Menk and Kyle Rudser and Mo Chen and Gregg Meekins and Gillick, {Bernadette T.}",

note = "Funding Information: This work was supported by the National Institutes of Health (NIH) Eunice Kennedy Shriver National Institutes of Child Health and Development K01 Award (HD078484-01A1); the Cerebral Palsy Foundation, the Foundation for Physical Therapy Magistro Family Grant; the University of Minnesota{\textquoteright}s MnDRIVE (Minnesota{\textquoteright}s Discovery, Research, and Innovation Economy) initiative, and University of Minnesota Center for Magnetic Resonance Research (P41 EB015894 and 1S10OD017974-01). The project described was also supported in part by Award UL1 TR000114 and KL2 TR000113. This research was also supported by the National Institutes of Health{\textquoteright}s National Center for Advancing Translational Sciences, grant UL1TR002494. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health{\textquoteright}s National Center for Advancing Translational Sciences. Funding Information: We thank the Center for Neurobehavioral Development and at the University of Minnesota; the therapists, therapy supervisors, study coordinators, and research administration personnel from Gillette Children?s Specialty Healthcare; and Ma?ra Lixandr?o, PhD, PT, and Cec?lia Prudente, PhD, PT for data acquisition efforts. Finally, we are grateful for the energies of the families and children involved in this study. Funding. This work was supported by the National Institutes of Health (NIH) Eunice Kennedy Shriver National Institutes of Child Health and Development K01 Award (HD078484-01A1); the Cerebral Palsy Foundation, the Foundation for Physical Therapy Magistro Family Grant; the University of Minnesota?s MnDRIVE (Minnesota?s Discovery, Research, and Innovation Economy) initiative, and University of Minnesota Center for Magnetic Resonance Research (P41 EB015894 and 1S10OD017974-01). The project described was also supported in part by Award UL1 TR000114 and KL2 TR000113. This research was also supported by the National Institutes of Health?s National Center for Advancing Translational Sciences, grant UL1TR002494. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health?s National Center for Advancing Translational Sciences. Publisher Copyright: {\textcopyright} 2019 Nemanich, Rich, Chen, Menk, Rudser, Chen, Meekins and Gillick.",

year = "2019",

month = feb,

day = "1",

doi = "10.3389/fnhum.2019.00137",

language = "English (US)",

volume = "13",

journal = "Frontiers in Human Neuroscience",

issn = "1662-5161",

publisher = "Frontiers Media SA",

}

TY - JOUR

T1 - Influence of combined transcranial direct current stimulation and motor training on corticospinal excitability in children with unilateral cerebral palsy

AU - Nemanich, Samuel T.

AU - Rich, Tonya L.

AU - Chen, Chao Ying

AU - Menk, Jeremiah

AU - Rudser, Kyle

AU - Chen, Mo

AU - Meekins, Gregg

AU - Gillick, Bernadette T.

N1 - Funding Information: This work was supported by the National Institutes of Health (NIH) Eunice Kennedy Shriver National Institutes of Child Health and Development K01 Award (HD078484-01A1); the Cerebral Palsy Foundation, the Foundation for Physical Therapy Magistro Family Grant; the University of Minnesota’s MnDRIVE (Minnesota’s Discovery, Research, and Innovation Economy) initiative, and University of Minnesota Center for Magnetic Resonance Research (P41 EB015894 and 1S10OD017974-01). The project described was also supported in part by Award UL1 TR000114 and KL2 TR000113. This research was also supported by the National Institutes of Health’s National Center for Advancing Translational Sciences, grant UL1TR002494. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health’s National Center for Advancing Translational Sciences. Funding Information: We thank the Center for Neurobehavioral Development and at the University of Minnesota; the therapists, therapy supervisors, study coordinators, and research administration personnel from Gillette Children?s Specialty Healthcare; and Ma?ra Lixandr?o, PhD, PT, and Cec?lia Prudente, PhD, PT for data acquisition efforts. Finally, we are grateful for the energies of the families and children involved in this study. Funding. This work was supported by the National Institutes of Health (NIH) Eunice Kennedy Shriver National Institutes of Child Health and Development K01 Award (HD078484-01A1); the Cerebral Palsy Foundation, the Foundation for Physical Therapy Magistro Family Grant; the University of Minnesota?s MnDRIVE (Minnesota?s Discovery, Research, and Innovation Economy) initiative, and University of Minnesota Center for Magnetic Resonance Research (P41 EB015894 and 1S10OD017974-01). The project described was also supported in part by Award UL1 TR000114 and KL2 TR000113. This research was also supported by the National Institutes of Health?s National Center for Advancing Translational Sciences, grant UL1TR002494. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health?s National Center for Advancing Translational Sciences. Publisher Copyright: © 2019 Nemanich, Rich, Chen, Menk, Rudser, Chen, Meekins and Gillick.

PY - 2019/2/1

Y1 - 2019/2/1

N2 - Combined non-invasive brain stimulation (NIBS) and rehabilitation interventions have the potential to improve function in children with unilateral cerebral palsy (UCP), however their effects on developing brain function are not well understood. In a proof-of-principle study, we used single-pulse transcranial magnetic stimulation (TMS) to measure changes in corticospinal excitability and relationships to motor performance following a randomized controlled trial consisting of 10 days of combined constraint-induced movement therapy (CIMT) and cathodal transcranial direct current stimulation (tDCS) applied to the contralesional motor cortex. Twenty children and young adults (mean age = 12 years, 9 months, range = 7 years, 7 months, 21 years, 7 months) with UCP participated. TMS testing was performed before, after, and 6 months after the intervention to measure motor evoked potential (MEP) amplitude and cortical silent period (CSP) duration. The association between neurophysiologic and motor outcomes and differences in excitability between hemispheres were examined. Contralesional MEP amplitude decreased as hypothesized in five of five participants receiving active tDCS immediately after and 6 months after the intervention, however no statistically significant differences between intervention groups were noted for MEP amplitude [mean difference = −323.9 μV, 95% CI = (−989, 341), p = 0.34] or CSP duration [mean difference = 3.9 ms, 95% CI = (−7.7, 15.5), p = 0.51]. Changes in corticospinal excitability were not statistically associated with improvements in hand function after the intervention. Across all participants, MEP amplitudes measured in the more-affected hand from both contralesional (mean difference = −474.5 μV) and ipsilesional hemispheres (−624.5 μV) were smaller compared to the less-affected hand. Assessing neurophysiologic changes after tDCS in children with UCP provides an understanding of long-term effects on brain excitability to help determine its potential as a therapeutic intervention. Additional investigation into the neurophysiologic effects of tDCS in larger samples of children with UCP are needed to confirm these findings.

AB - Combined non-invasive brain stimulation (NIBS) and rehabilitation interventions have the potential to improve function in children with unilateral cerebral palsy (UCP), however their effects on developing brain function are not well understood. In a proof-of-principle study, we used single-pulse transcranial magnetic stimulation (TMS) to measure changes in corticospinal excitability and relationships to motor performance following a randomized controlled trial consisting of 10 days of combined constraint-induced movement therapy (CIMT) and cathodal transcranial direct current stimulation (tDCS) applied to the contralesional motor cortex. Twenty children and young adults (mean age = 12 years, 9 months, range = 7 years, 7 months, 21 years, 7 months) with UCP participated. TMS testing was performed before, after, and 6 months after the intervention to measure motor evoked potential (MEP) amplitude and cortical silent period (CSP) duration. The association between neurophysiologic and motor outcomes and differences in excitability between hemispheres were examined. Contralesional MEP amplitude decreased as hypothesized in five of five participants receiving active tDCS immediately after and 6 months after the intervention, however no statistically significant differences between intervention groups were noted for MEP amplitude [mean difference = −323.9 μV, 95% CI = (−989, 341), p = 0.34] or CSP duration [mean difference = 3.9 ms, 95% CI = (−7.7, 15.5), p = 0.51]. Changes in corticospinal excitability were not statistically associated with improvements in hand function after the intervention. Across all participants, MEP amplitudes measured in the more-affected hand from both contralesional (mean difference = −474.5 μV) and ipsilesional hemispheres (−624.5 μV) were smaller compared to the less-affected hand. Assessing neurophysiologic changes after tDCS in children with UCP provides an understanding of long-term effects on brain excitability to help determine its potential as a therapeutic intervention. Additional investigation into the neurophysiologic effects of tDCS in larger samples of children with UCP are needed to confirm these findings.

KW - Cerebral palsy

KW - Corticospinal excitability

KW - Pediatric hemiparesis

KW - Rehabilitation

KW - Transcranial direct current stimulation

UR - http://www.scopus.com/inward/record.url?scp=85069539313&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85069539313&partnerID=8YFLogxK

U2 - 10.3389/fnhum.2019.00137

DO - 10.3389/fnhum.2019.00137

M3 - Article

C2 - 31105541

AN - SCOPUS:85069539313

SN - 1662-5161

VL - 13

JO - Frontiers in Human Neuroscience

JF - Frontiers in Human Neuroscience

M1 - 137

ER -

Influence of combined transcranial direct current stimulation and motor training on corticospinal excitability in children with unilateral cerebral palsy

Abstract

Bibliographical note

Keywords

Publisher link

Find It

Other files and links

Fingerprint

Cite this