Brain stimulation and constraint for perinatal stroke hemiparesis: The PLASTIC CHAMPS Trial.

Abstract

OBJECTIVE:

To determine whether the addition of repetitive transcranial magnetic stimulation (rTMS) and/or constraint-induced movement therapy (CIMT) to intensive therapy increases motor function in children with perinatal stroke and hemiparesis.

METHODS:

A factorial-design, blinded, randomized controlled trial (clinicaltrials.gov/NCT01189058) assessed rTMS and CIMT effects in hemiparetic children (aged 6-19 years) with MRI-confirmed perinatal stroke. All completed a 2-week, goal-directed, peer-supported motor learning camp randomized to daily rTMS, CIMT, both, or neither. Primary outcomes were the Assisting Hand Assessment and the Canadian Occupational Performance Measure at baseline, and 1 week, 2 and 6 months postintervention. Outcome assessors were blinded to treatment. Interim safety analyses occurred after 12 and 24 participants. Intention-to-treat analysis examined treatment effects over time (linear mixed effects model).

RESULTS:

All 45 participants completed the trial. Addition of rTMS, CIMT, or both doubled the chances of clinically significant improvement. Assisting Hand Assessment gains at 6 months were additive and largest with rTMS + CIMT (β coefficient = 5.54 [2.57-8.51], p = 0.0004). The camp alone produced large improvements in Canadian Occupational Performance Measure scores, maximal at 6 months (Cohen d = 1.6, p = 0.002). Quality-of-life scores improved. Interventions were well tolerated and safe with no decrease in function of either hand.

CONCLUSIONS:

Hemiparetic children participating in intensive, psychosocial rehabilitation programs can achieve sustained functional gains. Addition of CIMT and rTMS increases the chances of improvement.

CLASSIFICATION OF EVIDENCE:

This study provides Class II evidence that combined rTMS and CIMT enhance therapy-induced functional motor gains in children with stroke-induced hemiparetic cerebral palsy.

• Authors: Adam Kirton, John Andersen, Mia Herrero, Alberto Nettel-Aguirre, Lisa Carsolio, Omar Damji, Jamie Keess, Aleksandra Mineyko, Jacquie Hodge, Michael D Hill
• Journal: Neurology (Neurology) Vol. 86 Issue 18 Pg. 1659-67 (May 03 2016) ISSN: 1526-632X [Electronic] United States
• PMID: 27029628 (Publication Type: Journal Article, Randomized Controlled Trial)
• Copyright: © 2016 American Academy of Neurology.

Topics

• Adolescent
• Child
• Combined Modality Therapy (adverse effects, methods)
• Female
• Hand (physiopathology)
• Humans
• Male
• Paresis (etiology, physiopathology, rehabilitation)
• Patient Selection
• Physical Therapy Modalities (adverse effects)
• Psychiatric Rehabilitation (methods)
• Quality of Life
• Recovery of Function
• Restraint, Physical
• Single-Blind Method
• Stroke (complications, physiopathology)
• Stroke Rehabilitation (adverse effects, methods)
• Transcranial Magnetic Stimulation (adverse effects, methods)
• Treatment Outcome
• Young Adult