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Safety and efficacy of non-invasive brain stimulation for the upper extremities in children with cerebral palsy: A systematic review

Nicole Metelski, Yu Gu, Lori Quinn, Kathleen M Friel, Andrew M Gordon
Year Published: 
Dev Med Child Neurol . 2023 Aug 1. doi: 10.1111/dmcn.15720. Online ahead of print.
PMID: 37528530 | DOI: 10.1111/dmcn.15720
Full Text on Wiley


Aim: To evaluate available evidence examining safety and efficacy of non-invasive brain stimulation (NIBS) on upper extremity outcomes in children with cerebral palsy (CP).

Method: We electronically searched 12 sources up to May 2023 using JBI and Cochrane guidelines. Two reviewers selected articles with predetermined eligibility criteria, conducted data extraction, and assessed risk of bias using the Cochrane Risk of Bias criteria.

Results: Nineteen studies were included: eight using repetitive transcranial magnetic stimulation (rTMS) and 11 using transcranial direct current stimulation (tDCS). Moderate certainty evidence supports the safety of rTMS and tDCS for children with CP. Very low to moderate certainty evidence suggests that rTMS and tDCS result in little to no difference in upper extremity outcomes.

Interpretation: Evidence indicates that NIBS is a safe and feasible intervention to target upper extremity outcomes in children with CP, although it also indicates little to no significant impact on upper extremity outcomes. These findings are discussed in relation to the heterogeneous participants' characteristics and stimulation parameters. Larger studies of high methodological quality are required to inform future research and protocols for NIBS.

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Worldwide, over 24 million children and adults are living with CP.