By Emily Leclerc, Waisman Science Writer
A non-invasive brain stimulation technique that may improve neuroplasticity has recently been shown to be possible and safe for children with cerebral palsy when remotely instructed and conducted in a person’s home. This could be an important step toward increasing accessibility to this treatment and laying the foundation for larger-scale clinical trials.
A new study from the laboratory of Bernadette Gillick, PhD, MSPT Waisman investigator and associate professor of pediatrics, developmental pediatrics, and rehabilitation medicine, published in the journal Brain Stimulation shows that the rehabilitation technique transcranial direct current stimulation (tDCS) is safe, tolerable, and feasible to be used remotely in an individual’s home. tDCS is a safe, non-invasive brain stimulation that uses an electrical current applied to the scalp through two sponge electrodes. tDCS is used to help improve neuroplasticity – the brain’s ability to rewire itself.
Cerebral palsy (CP) is the most common motor disability in the U.S. One in 500 children are diagnosed with CP, with the most common cause being an early brain injury such as a brain bleed or stroke. Some symptoms of CP can be treated and may improve with rehabilitation techniques including physical therapy, occupational therapy, speech therapy among others. Accessing these therapies can be a struggle. “These approaches are often restricted to a clinic setting,” says Preston Christopher, research coordinator within the Pediatric Neuromodulation Laboratory, and first author of the study. “We wanted to implement an intervention that can address this and other concerns, especially inequitable access to health care and being restricted to the clinic, because about 15% of Americans reside in rural areas where they are more likely to report barriers to health care services.”
Neuroplasticity is the brain’s ability to reorganize and rewire itself. “It’s like finding a detour when the usual roadway is closed,” Christopher says. “The brain builds new pathways to get around a part or pathway that might be injured.” Improving neuroplasticity may help individuals regain some loss of function or help the brain heal after an injury. For individuals with CP, when you pair improved neuroplasticity with other rehabilitation techniques, it can lead to more impactful progress and better outcomes. Previously, tDCS was only offered in a clinic setting. This study showcases that it can safely be offered remotely in a home setting where individuals with CP can more readily access it.
Similar to other rehabilitation approaches, tDCS is often used multiple times over long periods. Traveling to and from the lab several times a week to receive this can consume a lot of resources for a family and place an unnecessary burden on them. With other rehab techniques being more frequently offered remotely now, being able to pair them with remote tDCS could have an important impact. “By being able to offer completely remote intervention, participants will be able to receive this intervention in the comfort of their own homes while also enhancing therapy efficacy, improving access, and lowering cost and burdens for these families,” Christopher adds.
The study worked with 10 people with CP between the ages of 8 and 21 with a caregiver present. The pairs were instructed on how to set up and use the tDCS device via Zoom by a study team member. All 10 pairs were able to easily set up and use the device. As anticipated, no serious adverse events were reported. The majority of individuals said wearing the device was comfortable. As expected, some individuals reported mild tingling or mild itchiness around the electrodes. All of the sensations were self-limiting and ceased immediately after stimulation ended.
This was a small study to show that employing tDCS remotely is potentially possible. But this small study opens several important doors. It lays crucial foundation work for larger clinical trials in the future. “We need large trial studies looking at individualizing this treatment for each person,” Christopher says. “Our study will help toward recruitment and retention efforts required for those large clinical trials.”
Setting the foundation with this remote home-based study allows for further research into how to individualize tDCS treatment which Gillick and Christopher are hoping to work on in the future. “Cerebral palsy resulting from early brain injuries looks completely different from child to child. We need to take into consideration the individual organization of the brain and anatomy when deciding where to place the device and electrodes and when deciding stimulation intensity and duration,” Christopher says. “The next step for this research is addressing this individuality.”
Gillick’s goal is that this work will start a fruitful line of research into the best ways to improve rehabilitation efforts and care for individuals with CP. “The importance of this research is not only to enhance motor function in children with cerebral palsy but also to revolutionize access to healthcare for children with CP. By investigating remotely-instructed tDCS, we aim to break down geographical and financial barriers, ensuring equitable access to this innovative intervention for both urban and rural families,” says Gillick. “Our study could lead to a reduction in the overall cost of rehabilitation. Through this research, we strive not only to advance the quality of care but also to foster inclusivity in healthcare, ultimately transforming the lives of children affected by CP.”
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