Evaluating the Feasibility of Transcranial Direct Current Stimulation as an Adjunct to Physiotherapy in Children and Youth wth Acquired Brain Injury

Abstract

Background: Children and youth with subacute moderate to severe acquired brain injury (ABI) experience plateaus in gross motor recovery toward the end of inpatient rehabilitation. Thus, novel treatment adjuncts may be used to enhance recovery. The primary objective of this dissertation was to evaluate the feasibility of transcranial direct current stimulation (tDCS) as an adjunct to inpatient physiotherapy in school-aged children and youth with ABI. Methods: A chart review was conducted to establish the gross motor change associated with inpatient ABI. A systematic review was undertaken to determine if motor evoked potentials (MEP) are an appropriate neural outcome for tDCS protocols involving motor intervention in healthy individuals. A tDCS feasibility trial was conducted at the author’s pediatric rehabilitation centre where participants were randomized to receive either 20 minutes of sham or active anodal tDCS immediately prior to their existing inpatient physiotherapy sessions for up to 16 sessions. Results: The chart review provided an estimate of gross motor change for inpatient ABI rehabilitation with two of the outcome measures implemented in the feasibility study. The systematic review revealed that MEP outcomes varied considerably across tDCS studies and were therefore not measured in the feasibility study. Feasibility study eligibility and retention were lower than the a priori targets. Over 21 months, six children were eligible for the study, four enrolled in the study, three commenced the study protocol, and one completed all study sessions. Symptom ratings before and after each tDCS session suggest that the participants tolerated tDCS. Physiotherapy session documentation and analysis detailed the motor learning strategies content of the physiotherapy sessions accompanying tDCS. Conclusions: This dissertation established gross motor outcomes associated with inpatient pediatric ABI rehabilitation and identified the limitations of MEPs as a neural outcome. While eligibility and retention were barriers to tDCS study feasibility, our study processes (including differentiating between ABI symptoms and tDCS side effects, analyzing the physiotherapy session content paired with the tDCS, and evaluating gross motor outcomes with a complementary set of outcome measures) were feasible and can be applied in future tDCS research in pediatric ABI.