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Brain stimulation and constraint for perinatal stroke hemiparesis: The PLASTIC CHAMPS Trial.
- Source :
-
Neurology [Neurology] 2016 May 03; Vol. 86 (18), pp. 1659-67. Date of Electronic Publication: 2016 Mar 30. - Publication Year :
- 2016
-
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.<br />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).<br />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.<br />Conclusions: Hemiparetic children participating in intensive, psychosocial rehabilitation programs can achieve sustained functional gains. Addition of CIMT and rTMS increases the chances of improvement.<br />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.<br /> (© 2016 American Academy of Neurology.)
- Subjects :
- Adolescent
Child
Combined Modality Therapy adverse effects
Combined Modality Therapy methods
Female
Hand physiopathology
Humans
Male
Paresis physiopathology
Patient Selection
Psychiatric Rehabilitation methods
Quality of Life
Recovery of Function
Restraint, Physical
Single-Blind Method
Stroke physiopathology
Stroke Rehabilitation adverse effects
Treatment Outcome
Young Adult
Paresis etiology
Paresis rehabilitation
Physical Therapy Modalities adverse effects
Stroke complications
Stroke Rehabilitation methods
Transcranial Magnetic Stimulation adverse effects
Transcranial Magnetic Stimulation methods
Subjects
Details
- Language :
- English
- ISSN :
- 1526-632X
- Volume :
- 86
- Issue :
- 18
- Database :
- MEDLINE
- Journal :
- Neurology
- Publication Type :
- Academic Journal
- Accession number :
- 27029628
- Full Text :
- https://doi.org/10.1212/WNL.0000000000002646