Robotic Rehabilitation and Brain Stimulation for Children with Hemiparetic Cerebral Palsy
Rachel Hawe, DPT, PhD
BACKGROUND: Hemiparetic cerebral palsy, commonly caused by a perinatal stroke, causes motor and sensory deficits in the arm and leg on one side of the body. We currently lack evidence-based interventions to address the motor impairments that will impact a child throughout their life. GAP: This study will determine if robotic therapy combined with transcranial direct current stimulation (tDCS), a form of non-invasive brain stimulation, can improve motor performance in children with hemiparetic cerebral palsy. We will also determine the feasibility of robotic therapy and tDCS in children with bilateral cerebral palsy. HYPOTHESIS: We hypothesize that children with cerebral palsy will show significant improvements in motor function after completing a 10-day trial or robotic rehabilitation, and that tDCS will augment robotic rehabilitation and lead to further improvements in motor function. METHODS: This study is a pilot double-blind randomized controlled trial of children ages 6-19 with hemiparetic cerebral palsy. Children will complete 10 sessions of robotic rehabilitation targeting motor and sensory impairments in the arm, with children randomized to receive concurrent tDCS or sham tDCS. An open label pilot trial of robotic therapy and tDCS in children with bilateral therapy will also be conducted to determine if it is feasible to apply these therapeutic approaches to a wider population on children with cerebral palsy. RESULTS: Results of the primary study in children with hemiparetic cerebral palsy are still pending. In the related project on eight children with bilateral cerebral palsy, robotic therapy and tDCS was found to be safe, feasible, and well tolerated. IMPACT: Cerebral palsy causes a lifetime of disability, with novel approaches to treatment needed to improve motor deficits. Robotic rehabilitation and non-invasive brain stimulation have the potential to improve motor performance in a child-friendly manner without creating a large burden on the health care system.