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Background. Transcranial direct current stimulation (tDCS) is a form of noninvasive brain stimulation that has shown improved adult stroke outcomes. Applying tDCS in children with congenital hemiparesis has not yet been explored. Objective. The primary objective of this study was to explore the safety and feasibility of single-session tDCS through an adverse events profile and symptom assessment within a double-blind, randomized placebo-controlled preliminary study in children with congenital hemiparesis. A secondary objective was to assess the stability of hand and cognitive function. Design. A double-blind, randomized placebo-controlled pretest/posttest/ follow-up study was conducted. Setting. The study was conducted in a university pediatric research laboratory. Participants. Thirteen children, ages 7 to 18 years, with congenital hemiparesis participated. Measurements. Adverse events/safety assessment and hand function were measured. Intervention. Participants were randomly assigned to either an intervention group or a control group, with safety and functional assessments at pretest, at posttest on the same day, and at a 1-week follow-up session. An intervention of 10 minutes of 0.7 mA tDCS was applied to bilateral primary motor cortices. The tDCS intervention was considered safe if there was no individual decline of 25% or group decline of 2 standard deviations for motor evoked potentials (MEPs) and behavioral data and no report of adverse events. Results. No major adverse events were found, including no seizures. Two participants did not complete the study due to lack of MEP and discomfort. For the 11 participants who completed the study, group differences in MEPs and behavioral data did not exceed 2 standard deviations in those who received the tDCS (n= 5) and those in the control group (n=6). The study was completed without the need for stopping per medical monitor and biostatisticial analysis. Limitations. A limitation of the study was the small sample size, with data available for 11 participants. Conclusions. Based on the results of this study, tDCS appears to be safe, feasible, and well tolerated in most children with hemiparesis. Future investigations of serial sessions of tDCS in conjunction with rehabilitation in pediatric hemiparesis are indicated to explore the benefit of a synergistic approach to improving hand function., Noninvasive brain stimulation (NIBS) has been investigated for benefits in recovery of motor function in adults (1,2) and more recently in children. (3-5) One form, transcranial magnetic stimulation (TMS), can [...]

Adults with cerebral palsy (CP) have unique healthcare needs and risks, including high risk of functional decline. Understanding functional decline is an area of priority for CP research.

Mirror movements (MM) can be a clinical manifestation of unilateral cerebral palsy (UCP) causing involuntary movements when attempting to use either hand for functional activities. Atypical development of the corticospinal tract (CST) contributes to impairments in observed motor movements and functional activities. However, little is known about the underlying neurophysiology and contribution of the CST to MM. The current case study characterizes MM in 13 children and young adults with UCP ranging in age from 7 to 19 years and includes clinical and neurophysiologic variables. Clinical profiles included MM of each hand (ie, Woods and Teuber), bimanual coordination and hand use (Assisting Hand Assessment [AHA]), and perception of performance (Canadian Occupational Performance Measure [COPM]). We measured the strength of motor-evoked potentials (MEP) elicited from single-pulse transcranial magnetic stimulation (TMS) of each hemisphere to create a ratio of hemispheric responses. Our sample included three types of CST circuitry: ipsilateral (n = 5), bilateral (n = 3), and contralateral (n = 4). The MEP ratio ranged from 0 to 1.45 (median 0.11) with greater MM observed in participants with ratios greater than 0.5. We observed a positive relationship between the MEP ratio and the more-affected MM score, meaning participants with larger ipsilateral responses from contralesional stimulation (eg, the contralesional hemisphere was stimulated with TMS resulting in an ipsilateral MEP response), as compared with contralateral responses, displayed greater MM than those that did not. There was no relationship between MM and function as measured by the AHA or COPM. These findings suggest a role of the contralesional hemisphere to MM, which could serve as a therapeutic target for interventions.

The formation of a patient-reported outcomes registry to provide information about functional changes and pain among adults with cerebral palsy (CP) was identified as a priority to address the gap in knowledge and practice about aging and CP. The Cerebral Palsy Research Network collaborated with consumers, clinicians, and researchers to create an interactive internet platform, MyCP, to host a Community Registry. MyCP also provides educational programming, access to webinars and community forums, and fitness opportunities. The registry hosts surveys on function and pain for adults with CP, which provide cross-sectional and longitudinal data about these important issues. Surveys include previously validated measures with normative values that have been used with other populations and investigator developed questions. Enrollment in the registry is growing but needs to reflect the population of adults with CP, which limits generalizability. Future initiatives involve strategies to increase consumer engagement and enrollment.

Retrospective, case-matched review.

Chronic pain is common among adults with cerebral palsy (CP) and an area of priority for research and treatment.

This study describes the characteristics of children who had central autonomic dys function (CAD) after acquired brain injury. CAD was defined as an unexplained increase in body temperature, blood pressure, or respiratory rate. We surveyed a con secutive series of 220 children who had been unconscious for 24 or more hours after acquired brain injury. Thirty-one children met criteria for CAD by chart review. The development of CAD carried with it serious implications as those children were uncon scious longer (median 150 vs. 28 days), had worse cognitive and motor outcomes, and were more likely to die (16 vs. 3.6%). Follow-up neuroimaging studies most com monly showed moderate to severe atrophy and ventricular enlargement. The onset of CAD was usually seen within one month of injury and frequently within one week. All patients required medication to control the symptoms of CAD; nine still required intervention six or more months after injury. CAD is commonly seen in children with severe brain injury. It complicates the management of these patients, reflects more severe injury, is usually associated with less favorable outcome, and can seriously inter fere with rehabilitation programs. Key Words: Central autonomic dysfunction— Dysautonomia—Central fever—Acquired pediatric brain injury.

The regaining of language skills in thirty children unconscious for ninety days or more following acquired brain injury is reported. Although language skills were limited in twenty-six children, four children with closed head injuries were sufficiently function al to be placed in mainstream classes. The recovery of language was correlated with cause of injury—children with closed head injuries were much more likely to regain lan guage. Ten children acquired language more than one year after injury, two at nearly four years after injury. In the four children who were most functional, initial language attempts were observed within 96 to 133 days after injury. Only children with closed head injuries regained higher language skills.