Zhong Mengru, Zhang Yage, Luo Jie, Chen Tingting, Zhang Jingbo, Peng Tingting, Han Mingshan, Le Wen, Peng Tingting, Xu Kaishou
Department of Rehabilitation, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510120, China.
Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai, 200438, China.
J Neuroeng Rehabil. 2025 May 18;22(1):111. doi: 10.1186/s12984-025-01619-7.
BACKGROUND: Children with cerebral palsy (CP) experience significant mobility and balance impairments. Non-invasive brain stimulation (NIBS), including transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS), has emerged as a potential therapeutic intervention. Nevertheless, the safety and effectiveness of NIBS in children with CP remain uncertain and require further investigation. This study aimed to evaluate the safety and effectiveness of NIBS in improving mobility and balance function in children with CP. METHODS: Randomized controlled trials written in English were searched in five databases (PubMed, Embase, Scopus, Web of Science, and ProQuest), from the first available records in each database to April 2024. Statistical analysis focused on outcomes related to mobility and balance function immediately following intervention and one-month follow-up. RESULTS: A total of 16 studies encompassing 346 children with CP, aged 3-14 years, were included. The meta-analysis indicated that NIBS is safe and well-tolerated [Risk Difference = 0.16, 95% CI - 0.01-0.33], with a low incidence of adverse events. Significant improvements were observed in mobility post-intervention and at one-month follow-up, particularly in Gross Motor Function Measure scores [standard mean difference (SMD) = 0.47 to 0.63, P < 0.05]. Gait parameters, including gait velocity (SMD = 1.28, P < 0.01) and stride length (SMD = 0.70, P = 0.01) showed immediate improvements. However, no significant improvements were found in balance post-tDCS or at follow-up. CONCLUSIONS: Our findings support the use of NIBS as a safe and feasible tool for enhancing mobility in children with CP, demonstrating both immediate and sustained improvements in gait parameters such as velocity and stride length. However, the impact on balance remains inconclusive. Future research should focus on extending follow-up periods, increasing sample sizes, and exploring tailored stimulation protocols to better understand the long-term efficacy and optimal application of NIBS in pediatric populations.
背景：脑瘫（CP）患儿存在明显的运动和平衡障碍。非侵入性脑刺激（NIBS），包括经颅直流电刺激（tDCS）和重复经颅磁刺激（rTMS），已成为一种潜在的治疗干预手段。然而，NIBS对CP患儿的安全性和有效性仍不确定，需要进一步研究。本研究旨在评估NIBS改善CP患儿运动和平衡功能的安全性和有效性。 方法：在五个数据库（PubMed、Embase、Scopus、科学网和ProQuest）中检索从每个数据库的首个可用记录到2024年4月以英文撰写的随机对照试验。统计分析集中于干预后及随访1个月时与运动和平衡功能相关的结果。 结果：共纳入16项研究，涉及346例3至14岁的CP患儿。荟萃分析表明，NIBS是安全且耐受性良好的[风险差异=0.16，95%可信区间-0.01至0.33]，不良事件发生率较低。干预后及随访1个月时，运动功能有显著改善，尤其是在粗大运动功能测量评分方面[标准平均差（SMD）=0.47至0.63，P<0.05]。步态参数，包括步速（SMD=1.28，P<0.01）和步长（SMD=0.70，P=0.01）即刻改善。然而，tDCS后及随访时平衡功能未见显著改善。 结论：我们的研究结果支持将NIBS作为增强CP患儿运动能力的一种安全可行的工具，在步速和步长等步态参数方面显示出即刻和持续的改善。然而，对平衡的影响仍不明确。未来的研究应侧重于延长随访时间、增加样本量以及探索个性化的刺激方案，以更好地了解NIBS在儿科人群中的长期疗效和最佳应用。
Cochrane Database Syst Rev. 2018-3-16
Dev Med Child Neurol. 2022-12
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