title: Effect of transcranial direct-current stimulation combined with treadmill training on balance and functional performance in children with cerebral palsy: a double-blind randomized controlled trial.
abstract: BACKGROUND
  Cerebral palsy refers to permanent, mutable motor development disorders stemming from a primary brain lesion, causing secondary musculoskeletal problems and limitations in activities of daily living. The aim of the present study was to determine the effects of gait training combined with transcranial direct-current stimulation over the primary motor cortex on balance and functional performance in children with cerebral palsy.
  
  
  METHODS
  A double-blind randomized controlled study was carried out with 24 children aged five to 12 years with cerebral palsy randomly allocated to two intervention groups (blocks of six and stratified based on GMFCS level (levels I-II or level III).The experimental group (12 children) was submitted to treadmill training and anodal stimulation of the primary motor cortex. The control group (12 children) was submitted to treadmill training and placebo transcranial direct-current stimulation. Training was performed in five weekly sessions for 2 weeks. Evaluations consisted of stabilometric analysis as well as the administration of the Pediatric Balance Scale and Pediatric Evaluation of Disability Inventory one week before the intervention, one week after the completion of the intervention and one month after the completion of the intervention. All patients and two examiners were blinded to the allocation of the children to the different groups.
  
  
  RESULTS
  The experimental group exhibited better results in comparison to the control group with regard to anteroposterior sway (eyes open and closed; p<0.05), mediolateral sway (eyes closed; p<0.05) and the Pediatric Balance Scale both one week and one month after the completion of the protocol.
  
  
  CONCLUSIONS
  Gait training on a treadmill combined with anodal stimulation of the primary motor cortex led to improvements in static balance and functional performance in children with cerebral palsy.
  
  
  BACKGROUND
  Ensaiosclinicos.gov.br/RBR-9B5DH7.
authors.affiliation: Master Program in Rehabilitation Sciences, Movement Analysis Lab, University Nove de Julho, São Paulo, São Paulo, Brazil.
authors.forename: Natália de Almeida Carvalho
authors.initials: Nde A
authors.lastname: Duarte
authors.affiliation: Doctoral Program in Rehabilitation Sciences, Movement Analysis Lab, University Nove de Julho, São Paulo, São Paulo, Brazil.
authors.forename: Luanda André Collange
authors.initials: LA
authors.lastname: Grecco
authors.affiliation: Dept. of Electronic Information and Bioengineering, Politecnico di Milano and IRCCS San Raffaele Pisana, Rome.
authors.forename: Manuela
authors.initials: M
authors.lastname: Galli
authors.affiliation: Laboratory of Neuromodulation & Center of Clinical Research Learning, Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America.
authors.forename: Felipe
authors.initials: F
authors.lastname: Fregni
authors.affiliation: Professor, Master and Doctoral Programs in Rehabilitation Sciences, Movement Analysis Lab, University Nove de Julho, São Paulo, São Paulo, Brazil.
authors.forename: Cláudia Santos
authors.initials: CS
authors.lastname: Oliveira
mesh_terms: D000704:Analysis of Variance; D002547:Cerebral Palsy / Q000503:physiopathology* / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D004311:Double-Blind Method; D005080:Exercise Test; D005081:Exercise Therapy / Q000379:methods*; D005684:Gait / Q000502:physiology; D006801:Humans; D009044:Motor Cortex / Q000503:physiopathology; D004856:Postural Balance / Q000502:physiology*; D011597:Psychomotor Performance / Q000502:physiology*; D013997:Time Factors; D065908:Transcranial Direct Current Stimulation / Q000379:methods*; D016896:Treatment Outcome