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

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. Design: A pilot, randomized, controlled, double-blind, clinical trial. Setting: Rehabilitation clinics. Subjects: A total of 20 children with diparesis owing to cerebral palsy. Interventions: 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 +/- 0.11m/s; control group: 0.73 +/- 0.15 to 0.61 +/- 0.15m/s), cadence (experimental group: 97.4 +/- 14.1 to 116.8 +/- 8.7steps/minute; control group: 92.6 +/- 10.4 to 99.7 +/- 9.7steps/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). Conclusion: 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.