Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Kafrelsheikh University, Kafrelsheikh, Egypt.
Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Cairo, Egypt.
Arch Phys Med Rehabil. 2019 Oct;100(10):1945-1963. doi: 10.1016/j.apmr.2019.04.009. Epub 2019 May 10.
To assess the evidence of the effectiveness of noninvasive brain stimulation (NIBS) for rehabilitation of pediatric motor disorders after brain injury.
Ovid, Cochrane, Science Direct, Web of Science, EBSCOhost, PubMed, and Google Scholar databases were searched up to August 2017 by 2 independent reviewers.
Randomized controlled trials (RCTs) published in English were included if they met the following criteria.
Pediatric patients with motor disorders following brain injury.
NIBS, including transcranial direct current stimulation (tDCS) or repetitive transcranial magnetic stimulation (rTMS).
Measures related to motor disorders (upper limb functional abilities, gait, balance, and spasticity). Fourteen RCTs were included (10 studies used tDCS, while 4 studies used rTMS).
Predefined data were tabulated by 1 reviewer and verified by another reviewer. Methodological quality was assessed using the Physiotherapy Evidence Database (PEDro) scale; also levels of evidence adapted from Sackett were used.
A grouped meta-analysis was performed on balance, gait parameters, and upper limb function. Data were pooled using a random-effects model to assess the immediate effect and 1-month follow-up of NIBS. According to the PEDro scale, 3 studies were excellent, 8 studies were good, and 3 studies were fair. The level of evidence of all of the included studies was 1b, except for 3 studies with grade 2a. There were significant improvements in all upper limb functions (standardized mean differences [SMDs] ranging from 0.94 to 1.83 [P values=.0001]), balance (SMDs ranging between -0.48 to 0.83 [P values<.05]) and some gait variables.
Pediatric patients with brain injury can be safely stimulated by NIBS, and there is evidence for the efficacy of rTMS in improving upper limb function, and tDCS in improving balance and majority of gait variables with persisted effects for 1 month. The efficacy of spasticity is uncertain.
评估非侵入性脑刺激（NIBS）在脑损伤后儿童运动障碍康复中的有效性证据。
两位独立审查员于 2017 年 8 月前在 Ovid、Cochrane、Science Direct、Web of Science、EBSCOhost、PubMed 和 Google Scholar 数据库中进行了检索。
纳入符合以下标准的英语发表的随机对照试验（RCT）。
脑损伤后存在运动障碍的儿科患者。
NIBS，包括经颅直流电刺激（tDCS）或重复经颅磁刺激（rTMS）。
与运动障碍相关的测量（上肢功能、步态、平衡和痉挛）。纳入 14 项 RCT（10 项研究使用 tDCS，4 项研究使用 rTMS）。
1 位评审员制表汇总数据，另 1 位评审员验证。使用物理治疗证据数据库（PEDro）量表评估方法学质量；还使用了 Sackett 改编的证据水平。
使用随机效应模型对平衡、步态参数和上肢功能进行分组荟萃分析。使用随机效应模型对 NIBS 的即时效应和 1 个月随访进行数据汇总。根据 PEDro 量表，3 项研究为优秀，8 项研究为良好，3 项研究为中等。所有纳入研究的证据水平均为 1b，除了 3 项研究为 2a 级。所有上肢功能（标准化均数差 [SMD] 范围为 0.94 至 1.83 [P 值<.0001]）、平衡（SMD 范围为-0.48 至 0.83 [P 值<.05]）和部分步态变量均有显著改善。
脑损伤的儿科患者可以安全地接受 NIBS 刺激，rTMS 改善上肢功能，tDCS 改善平衡和多数步态变量的疗效证据确凿，且 1 个月内疗效持续，rTMS 对痉挛的疗效尚不确定。
