Effects of single-session transcranial direct current stimulation in children with cerebral palsy
Bernadette Gillick, PhD, MSPT, PT (Department of Rehabilitative Medicine)
Neurorehabilitation in cases of hemiparesis has primarily focused on intensive motor training to encourage use of the affected extremities in an effort to produce use-dependent neuroplasticity in the brain. Such interventions are effective, but require a burdensome amount of time, 60-90 hours per week, for both the child and therapist. Furthermore, some children do not respond at all to such training.
Neuromodulation is a relatively new field that aims to influence the brain’s neuronal activity through direct application of magnetic (TMS) or electric (tDCS) energy. It is thought the combination of neuromodulation and motor training may reduce the dosage of training needed, and would promote recovery to a greater extent for more individuals. Indeed, previous work in adult stroke demonstrate a benefit of combining repetitive TMS (rTMS) and tDCS with motor training, compared to training alone. These types of synergistic interventions are just beginning to be used in children with UCP, with some preliminary data showing potential benefit.
This study aims to offer insight into the mechanisms of tDCS and lead the field toward a better understanding of how tDCS be implemented in a neurorehabilitation setting for both children and potentially adults.
Mindful breathing and neuromodulation for depression in young people
Kathryn Cullen, MD (Department of Psychiatry)
Bonnie Klimes-Dougan, PhD (Department of Psychology), Kelvin Lim, MD (Department of Psychiatry)
Transcranial direct current stimulation (tDCS) is a non-invasive neuromodulation technique that can modulate neural activity. If paired with Mindful breating training (MBT), tDCS may be able to enhance learning and neural changes associated with MBT. This study will test the efficacy of a novel treatment comprised of MBT and tDCS in adolescent depression. We propose that for patients with depression, where the core feature is persistent negative mood, a training task that engages the DLPFC’s role in regulating emotion may optimally reduce symptoms of depression. Mindful breathing training may be a suitable task to down-regulate negative affect and prime the fronto-limbic circuit. Further, this work will advance our understanding the synergistic effects of combining MBT with tDCS to target the connections between the DLPFC with the default mode network (DMN) and limbic regions. If successful, this study will aid in the development of novel treatments for adolescent depression and improve the ability of neuromodulation to treat depression.
Neuromodulation augmented cognitive remediation to improve executive dysfunction in fetal alcohol spectrum disorder
Jeffrey R. Wozniak, Ph.D., L.P. (Department of Psychiatry)
Christopher J. Boys, Ph.D. (Department of Pediatrics), Kelvin Lim, MD (Department of Psychiatry)
Prenatal alcohol exposure (PAE) has profound detrimental effects on brain development and, as a result, has permanent consequences for cognition, learning, and behavior. Individuals with Fetal Alcohol Spectrum Disorders (FASD) commonly have a range of neurocognitive impairments that directly lead to practical problems with learning, attention, working memory, task planning/execution, and decision making, among other areas of functioning. Despite the profound public health burden posed by FASD, there have been very few treatment studies of any sort in this population. Our group conducted the first randomized controlled trials of the nutrient choline as a neurodevelopmental intervention in 2-5 year old children with FASD, in which we demonstrated effects on sequential memory. For older children, a very different neurodevelopmental target is needed, and for this we have narrowed our focus to “plasticity” (the brain’s ability to adapt). We propose to conduct a novel pilot study to examine the effects of cognitive remediation training augmented with tDCS in children and adolescents with FASD. Functional magnetic resonance imaging will be collected to provide preliminary data of brain circuitry changes created by this intervention.
Perinatal Stroke: Understanding Brain Reorganization through Infant Neuroimaging and Neuromodulation
Bernadette Gillick, PhD, MSPT, PT (Department of Rehabilitation Medicine)
Michael Georgieff, MD (Department of Neonatology), Raghavendra Rao, MD (Department of Neonatology)
The purpose of this study is to use MRI/DTI TMS and electroencephalography (EEG) to comprehensively examine both the CST integrity and cortical excitability in infants following perinatal stroke, and to identify association with sensorimotor outcome as evaluated by clinical behavioral assessments of infants. The results of this study will provide fundamental information as to the feasibility and safety of applying non-sedative/natural sleeping MRI/DTI scanning and TMS in infants. This study will also investigate the relationship between modeled electric field and measured motor threshold across hemispheres. This may help identify anatomical markers that can predict electric field strength and thus could be used for dosing considerations for future neuromodulation interventions. Additionally, sensory stimulation evoked event related potential amplitude will be compared between infants with stroke and typical development to identify whether infants with stroke demonstrate early sensory processing differences compared to typically developing peers.