Chen (2021) Combined effect of hydrotherapy and transcranial direct-current stimulation on children with cerebral palsy

Introduction to Cerebral Palsy and Treatment Modalities

Cerebral palsy (CP) is a widespread neurodevelopmental disorder caused by brain injury, leading to coordination and motor control deficits. It’s one of the most common physical disabilities in children, imposing a heavy burden on families and society. Conventional treatments, including medical and physical therapies, occupational therapy, and others, aim to improve patient activity and functional participation. However, they do not offer a complete cure for CP​​.

Hydrotherapy and Transcranial Direct Current Stimulation (tDCS)

Hydrotherapy and tDCS have shown positive therapeutic effects in children with CP when used separately. Aquatic herapy enhances voluntary and passive movement, improves blood circulation, reduces muscle tension, and expands joint range of motion. tDCS, a form of noninvasive brain stimulation, modulates cortical excitability and has been beneficial in various pediatric neurological conditions, including CP​​.

Study Aim and Design

This study aims to investigate the combined effect of hydrotherapy and tDCS in children with CP. The hypothesis is that tDCS, combined with hydrotherapy, would result in more significant and long-lasting improvements in motor function. It is a blinded, randomized controlled superiority trial conducted at the Second Affiliated Hospital of Qiqihar Medical University, with a sample size of 150 children with CP. Participants are randomized into two groups: one receiving hydrotherapy plus tDCS, and the control group receiving usual care. The treatment spans 30 sessions over 10 weeks​​.

Outcome Measures

Primary outcomes include Gross Motor Function Assessment and Pediatric Balance Scale, measuring changes in motor function and balance. Secondary outcomes focus on the Pediatric Evaluation Disability Inventory, assessing self-care, mobility, social function, and adverse effects experienced during the treatment​​.

Intervention Specifics

The treatment group undergoes hydrotherapy and tDCS sessions, while the control group receives standard care. The hydrotherapy exercises consist of manual passive stretching and functional training at different levels based on each child’s dysfunction level. tDCS sessions involve applying electrical currents to the brain via scalp electrodes, aiming to promote behavioral changes and neural network development conducive to motor function improvement​​.

Statistical Analysis

An experienced statistician will conduct the data analysis using intention-to-treat analysis when necessary. The Kolmogorov-Smirnov test will be used to demonstrate normal data distribution, and the effect size will be calculated based on the pre- and post-intervention evaluations. The independent t test and chi-square tests will assess baseline characteristics, and ANOVA or Kruskal-Wallis test for the statistical analysis of the control and treatment groups​​.

Conclusion and Clinical Significance

This research could significantly impact clinical practice for treating CP. It aims to determine if a combined application of tDCS and hydrotherapy results in greater and longer-lasting improvement in motor function for children with CP​​.

download article