title: Effects of anodal transcranial direct current stimulation combined with virtual reality for improving gait in children with spastic diparetic cerebral palsy: a pilot, randomized, controlled, double-blind, clinical trial.
abstract: OBJECTIVE
  To compare the effects of anodal vs. sham transcranial direct current stimulation combined with virtual reality training for improving gait in children with cerebral palsy.
  
  
  METHODS
  A pilot, randomized, controlled, double-blind, clinical trial.
  
  
  METHODS
  Rehabilitation clinics.
  
  
  METHODS
  A total of 20 children with diparesis owing to cerebral palsy.
  
  
  METHODS
  The experimental group received anodal stimulation and the control group received sham stimulation over the primary motor cortex during virtual reality training. All patients underwent the same training programme involving a virtual reality (10 sessions). Evaluations were performed before and after the intervention as well as at the one-month follow-up and involved gait analysis, the Gross Motor Function Measure, the Pediatric Evaluation Disability Inventory and the determination of motor evoked potentials.
  
  
  RESULTS
  The experimental group had a better performance regarding gait velocity (experimental group: 0.63 ±0.17 to 0.85 ±0.11 m/s; control group: 0.73 ±0.15 to 0.61 ±0.15 m/s), cadence (experimental group: 97.4 ±14.1 to 116.8 ±8.7 steps/minute; control group: 92.6 ±10.4 to 99.7 ±9.7 steps/minute), gross motor function (dimension D experimental group: 59.7 ±12.8 to 74.9 ±13.8; control group: 58.9 ±10.4 to 69.4 ±9.3; dimension E experimental group: 59.0 ±10.9 to 79.1 ±8.5; control group: 60.3 ±10.1 to 67.4 ±11.4) and independent mobility (experimental group: 34.3 ±5.9 to 43.8 ±75.3; control group: 34.4 ±8.3 to 37.7 ±7.7). Moreover, transcranial direct current stimulation led to a significant increase in motor evoked potential (experimental group: 1.4 ±0.7 to 2.6 ±0.4; control group: 1.3 ±0.6 to 1.6 ±0.4).
  
  
  CONCLUSIONS
  These preliminary findings support the hypothesis that anodal transcranial direct current stimulation combined with virtual reality training could be a useful tool for improving gait in children with cerebral palsy.
authors.affiliation: Rehabilitation Sciences, Universidade Nove de Julho, São Paulo, Brazil Pediatric Neurosurgical Center (CENEPE), São Paulo, Brazil Laboratory of Neuromodulation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA luandagrecco@hotmail.com.
authors.forename: Luanda André
authors.initials: LA
authors.lastname: Collange Grecco
authors.affiliation: Rehabilitation Sciences, Universidade Nove de Julho, São Paulo, Brazil.
authors.forename: Natália
authors.initials: N
authors.lastname: de Almeida Carvalho Duarte
authors.affiliation: Neurosciences and Behavior, Psychology Institute, University of Sao Paulo, São Paulo, Brazil.
authors.forename: Mariana E
authors.initials: ME
authors.lastname: Mendonça
authors.affiliation: Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy Gait Analysis Laboratory, IRCCS San Raffaele Pisana, Rome, Italy.
authors.forename: Manuela
authors.initials: M
authors.lastname: Galli
authors.affiliation: Laboratory of Neuromodulation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Felipe
authors.initials: F
authors.lastname: Fregni
authors.affiliation: Rehabilitation Sciences, Universidade Nove de Julho, São Paulo, Brazil.
authors.forename: Claudia Santos
authors.initials: CS
authors.lastname: Oliveira
mesh_terms: D002547:Cerebral Palsy / Q000503:physiopathology* / Q000628:therapy*; D002648:Child; D003131:Combined Modality Therapy; D004311:Double-Blind Method; D005260:Female; D005684:Gait; D006801:Humans; D008297:Male; D010865:Pilot Projects; D065908:Transcranial Direct Current Stimulation; D063367:Virtual Reality Exposure Therapy
keywords: Cerebral palsy; gait; transcranial direct current stimulation; virtual reality therapy