UMN research may benefit kids with cerebral palsy

The researchers are the first to combine physical therapy and brain stimulation.

Wesley Hortenbach

Non-invasive brain stimulation combined with movement therapy could be a safe and effective intervention for children with cerebral palsy, according to new research from the University of Minnesota.

The study was published in the European Journal of Pediatric Neurology last month. The researchers are the first to combine interventions for cerebral palsy and hope to eventually use the findings to improve health outcomes for infants and toddlers.

Right now, the most common treatment for people with cerebral palsy — a disorder that leads to varying degrees of movement impairment — is an intensive rehabilitation regime that requires placing a patient’s stronger arm in a sling to encourage use of their weaker arm, said Bernadette Gillick, lead author of the study and assistant professor in the University Medical School’s Division of Physical Therapy.

However, this method isn’t effective for all children, and researchers aren’t certain of its usefulness or how long the improvements last, Gillick said.

Medical care for cerebral palsy is also extremely expensive, costing about $1 million over a person’s lifetime, said Maureen Boxrud, research study coordinator in the Division of Physical Therapy. Researchers hope new interventions, like this combined treatment, could decrease the cost of care.

The University researchers studied transcranial direct current stimulation (tDCS), which uses a small electrical current from two sponges placed on specific regions of a patient’s head. The currents target the area of the brain that controls movement, and during the 20-minute session, study participants are involved in hand activities such as playing a game of Jenga, said Sam Nemanich, a postdoctoral associate in Dr. Gillick’s lab, who also works on the study.

This tDCS brain stimulation influences the brain cells’ ability to communicate with each other and produce movement. In individuals with cerebral palsy, these brain cells may be dormant and stimulation may allow improved contributions to movement, Boxrud said.

Though the study showed the method was safe and feasible in participants, the small sample size and lengthy research process means the methods won’t be available to the public for quite some time, Boxrud said.

“So many at a young age recognize that [this study] might not change anything for them. It might, but it’s research, not a treatment at this point,” Boxrud said. “They understand that the knowledge we are gaining from their participation in the future could impact other children which is amazing when you are talking to a 10-year-old.”

The research team developed the idea for using brain stimulation to treat children with cerebral palsy after noticing the success of similar studies on adults.

“A lot of this technology and combining these therapies has been done with adults with stroke, and we knew a lot about that from studies,” Nemanich said. “So the thought was, can we apply that to kids who’ve had a stroke and improve their outcomes. That was the rationale that hadn’t really been explored before.”

Until recently, researchers hadn’t been able to use these therapies with young children because of U.S. Food and Drug Administration regulations, but over the course of this 11-year project, they’ve earned permission by supporting the safety and feasibility of its application.

Working with younger children, infants and even newborns could mean the team’s research will have a greater lifespan impact by helping patients sooner, meaning it could dampen cerebral palsy’s effects, Gillick said.

In the future, the team wants to provide intervention for cerebral palsy at an even earlier age.

“The study just published involved patients between the ages of seven and 21 which is relatively old in terms of neurodevelopment,” Nemanich said. “There is another study in the works involving infants under a year [of age] who have had the same incident of a stroke occurring at birth.”