Conjunct effects of transcranial direct current stimulation with mirror therapy on motor control and muscle performance in spastic quadriplegic cerebral palsy children: a randomized clinical trial

Abstract

Background: Cerebral palsy (CP) is a birth-related non-progressive neuromotor brain disorder characterized by abnormalities of muscular tonicity, gross and fine motor skills, gait, and posture. It impacts motor control and muscle performance, which are emergent rehabilitation challenges in cerebral palsy children. Mirror therapy (MT) and transcranial direct current stimulation (tDCS) are novel treatment strategies to enhance muscle performance and motor control. Methods: A randomized clinical trial was conducted at Ghurki Hospital Lahore, Pakistan. One hundred and five spastic quadriplegic CP (SQCP) children aged three to seven years were included. Randomization was carried out using Version 1.0 of Randomized Allocation Software. Allocation was done to three groups (35 in each group) with a 1:1:1 ratio with a unique identity number. Group I (tDCS+MT+Routine Physical Therapy (RPT), Group II (MT+RPT), and Group III (tDCS + RPT). Each patient received ten sessions of tDCS and MT, lasting for 15 minutes per side along with 20 minutes of RPT five days a week for ten weeks. Motor control was assessed by the Fugl-Meyer assessment tool, and muscle performance was measured using an isokinetic dynamometer and assessed at baseline, the 2nd, and the 10th week of follow-up and was analyzed using SPSS version 26. Results: The results indicated a significant improvement after 10 weeks in the mean scores of motor control upper extremities, lower extremities, and trunk) with P-values of 0.04, 0.01, 0.02, 0.02, 0.03, 0.05, 0.05, and 0.02, respectively. Similarly, muscle performance (isokinetic power) for these muscle groups also demonstrated significant changes, with P-values of 0.04, 0.01, 0.04, 0.02, 0.03, 0.05, 0.05, and 0.02, respectively. Conclusion: tDCS and MT in combination significantly impacted motor control and muscle performance, enhancing elbow and knee musculature strength and power among SQCP patients.