Noninvasive Brain Stimulation for Rehabilitation of Pediatric Motor Disorders Following Brain Injury: Systematic Review of Randomized Controlled Trials

Abstract

Objective: To assess the evidence of the effectiveness of noninvasive brain stimulation (NIBS) for rehabilitation of pediatric motor disorders after brain injury.

Data sources: Ovid, Cochrane, Science Direct, Web of Science, EBSCOhost, PubMed, and Google Scholar databases were searched up to August 2017 by 2 independent reviewers.

Study selection: Randomized controlled trials (RCTs) published in English were included if they met the following criteria.

Population: Pediatric patients with motor disorders following brain injury.

Intervention: NIBS, including transcranial direct current stimulation (tDCS) or repetitive transcranial magnetic stimulation (rTMS).

Outcomes: Measures related to motor disorders (upper limb functional abilities, gait, balance, and spasticity). Fourteen RCTs were included (10 studies used tDCS, while 4 studies used rTMS).

Data extraction: Predefined data were tabulated by 1 reviewer and verified by another reviewer. Methodological quality was assessed using the Physiotherapy Evidence Database (PEDro) scale; also levels of evidence adapted from Sackett were used.

Data synthesis: A grouped meta-analysis was performed on balance, gait parameters, and upper limb function. Data were pooled using a random-effects model to assess the immediate effect and 1-month follow-up of NIBS. According to the PEDro scale, 3 studies were excellent, 8 studies were good, and 3 studies were fair. The level of evidence of all of the included studies was 1b, except for 3 studies with grade 2a. There were significant improvements in all upper limb functions (standardized mean differences [SMDs] ranging from 0.94 to 1.83 [P values=.0001]), balance (SMDs ranging between -0.48 to 0.83 [P values<.05]) and some gait variables.

Conclusion: Pediatric patients with brain injury can be safely stimulated by NIBS, and there is evidence for the efficacy of rTMS in improving upper limb function, and tDCS in improving balance and majority of gait variables with persisted effects for 1 month. The efficacy of spasticity is uncertain.

Keywords: Cerebral palsy; Motor disorders; Rehabilitation; Transcranial direct current stimulation; Transcranial magnetic stimulation.