Transcranial direct current stimulation combined with augmentative and alternative communication for children with cerebral palsy: Preliminary results
Estimulação transcraniana por corrente contínua e comunicação aumentativa e alternativa para crianças com paralisia cerebral: resultados preliminares
Amanda Macedo de Freitas Souza Ramos; Veronica Unzueta; Marcela de Oliveira Araujo; Paula Soares da Silva; Claudia Santos Oliveira; Luanda André Collange-Grecco
Abstract
Keywords
Resumo
Objetivo: investigar os efeitos da estimulação transcraniana por corrente contínua (tDCS) anódica sobre o córtex pré-frontal dorsolateral esquerdo, combinada a intervenções fonoaudiológicas com Comunicação Aumentativa e Alternativa (CAA), no nível de comunicação de crianças com paralisia cerebral (PC) classificadas entre os níveis III e V do Sistema de Classificação da Função de Comunicação (CFCS).
Métodos: seis crianças (6-12 anos) realizaram dez sessões de tDCS (1 mA; 20 min) associadas ao treino de vocabulário essencial via TD Snap®. O nível de comunicação foi avaliado antes e após a intervenção pela Matriz de Comunicação. A segurança foi monitorada por relatos de eventos adversos.
Resultados: todos os participantes concluíram o protocolo, com boa tolerabilidade e ausência de eventos adversos graves. Observou-se tendência de melhora no nível de comunicação, com progressão de pelo menos um nível na Matriz de Comunicação em todos os casos. Sensação de formigamento foi tolerável e a vermelhidão local apresentou-se transitória.
Conclusão: a combinação tDCS + CAA mostrou-se viável, segura e potencialmente eficaz para aprimorar a comunicação em crianças com PC moderada à grave. São necessários estudos controlados, com amostras maiores e seguimento prolongado, para confirmar a efetividade e otimizar os parâmetros de intervenção.
Palavras-chave
References
1. Novak I, Morgan C, Fahey M, Finch-Edmondson M, Galea C, Hines A et al. State of the evidence traffic lights 2019: Systematic review of interventions for preventing and treating children with cerebral palsy. Curr Neurol Neurosci Rep. 2020;20(2):3.
2. Jackman M, Sakzewski L, Morgan C, Boyd RN, Brennan S, Langdon K et al. Interventions to improve physical function for children and young people with cerebral palsy: International clinical practice guideline. Dev Med Child Neurol. 2022;64(5):536-549.
3. Morgan C, Novak I, Dale RC, Guzzetta A, Badawi N. Single-blind randomised controlled trial of GAME (Goals-Activity-Motor Enrichment) in infants at high risk of cerebral palsy. Res Dev Disabil. 2016;55:256-67.
4. Pennington L, Dave M, Rudd J, Hidecker MJC, Caynes K, Pearce MS. Communication disorders in young children with cerebral palsy. Dev Med Child Neurol. 2020;62(10):1161-9.
5. Morgan C, Fetters L, Adde L, Badawi N, Bancali A, Boyd RB et al. Early intervention for children aged 0 to 2 years with or at high risk of cerebral palsy: International clinical practice guideline based on systematic reviews. JAMA Pediatr. 2021;175(8):846-58.
6. Hidecker MJC, Paneth N, Rosenbaum PL, Kent RD, Lillie J, Eulenberg JB et al. Developing and validating the Communication Function Classification System for individuals with cerebral palsy. Dev Med Child Neurol. 2011;53(8):704-10.
7. Cockerill H. Developing the Communication Function Classification System for individuals with cerebral palsy. Dev Med Child Neurol. 2011;53(8):675.
8. McCoy SW, Palisano R, Avery L, Tylkowski C, Gorton G, Novak I et al. Physical, occupational, and speech therapy for children with cerebral palsy. Dev Med Child Neurol. 2020;62(12):140-6.
9. Butt AK, Zubair R, Rathore FA. The role of augmentative and alternative communication in speech and language therapy: A mini review. J Pak Med Assoc. 2022;72(3):581-5.
10. Avagyan A, Mkrtchyan H, Shafa FA, Mathew JA, Petrosyan T. Effectiveness and determinant variables of augmentative and alternative communication interventions in cerebral palsy patients with communication deficit: A systematic review. CoDAS. 2021;33(5):e20200244.
11. Hidecker MJC. Speech and augmentative and alternative communication needs in young children with cerebral palsy. Dev Med Child Neurol. 2022;64(9):1053.
12. Tang L, Wu Y, Ma J, Lu Y, Wang L, Shan C. Application of tDCS in children with cerebral palsy: A mini-review. Front Pediatr. 2022;10:966650.
13. Duarte NdeAC, Collange Grecco LA, Zanon N, Galli M, Fregni F, Santos Oliveira C. Motor cortex plasticity in children with spastic cerebral palsy: A systematic review. J Mot Behav. 2017;49(6):641-55.
14. Lima VLCC, Cosmo C, Lima KB, Maia MFM, Teixeira LC, Andrade SM et al. Neuromodulation: A combined-therapy protocol for speech rehabilitation in a child with cerebral palsy. J Bodyw Mov Ther. 2022;29:10-5.
15. Lima VLC, Collange Grecco LA, Marques VC, Fregni F, Brandão de Ávila CR. Transcranial direct current stimulation combined with integrative speech therapy in a child with cerebral palsy: A case report. J Bodyw Mov Ther. 2016;20(2):252-7.
16. Ko EJ, Hong MJ, Choi EJ, Yuk JS, Yum MS, Sung IY. Effect of anodal transcranial direct current stimulation combined with cognitive training for improving cognition and language among children with cerebral palsy and cognitive impairment: A pilot randomized, double-blind clinical trial. Front Pediatr. 2021;9:713792.
17. Rowland C. Using the Communication Matrix to assess expressive skills in early communicators. Commun Disord Q. 2011;32(3):190-201.
18. Quinn ED, Rowland C. Exploring expressive communication skills in a cross-sectional sample of children and young adults with Angelman syndrome. Am J Speech Lang Pathol. 2017;26(2):369-82.
19. Rowland C, Fried-Oken M. Communication Matrix: A clinical and research assessment tool targeting children with severe communication disorders. J Pediatr Rehabil Med. 2010;3(4):319-29.
20. Quinn ED, Cook A, Rowland C. An online community of practice to improve intervention for individuals with complex communication needs. Augment Altern Commun. 2019;35(4):311-21.
21. Quinn ED, Cook A, Wiedrick J, Rowland C. An initial investigation into the feasibility of the Communication Matrix Professional Development Program for educational professionals working with students with complex communication needs. Lang Speech Hear Serv Sch. 2021;52(4):1080-94.
22. Homan RW, Herman J, Purdy P. Cerebral location of international 10-20 system electrode placement. Electroencephalogr Clin Neurophysiol. 1987;66(4):376-382.
23. Laubscher E, Light J. Core vocabulary lists for young children and considerations for early language development: A narrative review. Augment Altern Commun. 2020;36(1):43-53.
24. Buchanan D, Bogdanowicz T, Khanna N, Lockman-Dufour G, Robaey P, D'Angiulli A. Systematic review on the safety and tolerability of transcranial direct current stimulation in children and adolescents. Brain Sci. 2021;11(2):212.
25. Zhong M, Zhang Y, Luo J, Li H, Zhou J, Wang Y et al. Safety and effectiveness of non-invasive brain stimulation on mobility and balance function in children with cerebral palsy: A systematic review and meta-analysis. J Neuroeng Rehabil. 2025;22(1):111.
26. Metelski N, Gu Y, Quinn L, Friel KM, Gordon AM. Safety and efficacy of non-invasive brain stimulation for the upper extremities in children with cerebral palsy: A systematic review. Dev Med Child Neurol. 2024;66(5):573-97.
27. Borgestig M, Sandqvist J, Parsons R, Falkmer T, Hemmingsson H. Eye gaze performance for children with severe physical impairments using gaze-based assistive technology: A longitudinal study. Assist Technol. 2016;28(2):93-102.
28. Stevens-Hofer B, Wallen M, McInerney M, Karlsson P. Eyes on communication: Strategies to facilitate uptake of clinical practice guidelines for implementation of eye-gaze control technology by people with cerebral palsy. A mixed-methods study. Disabil Rehabil Assist Technol. 2025;20(8):1128-39.
29. Puttemans F, Copermans E, Karlsson P, Vanreusel B, De Vaan G, Van de Winckel A et al. An intensive eye-tracking intervention in children with dyskinetic cerebral palsy: A multiple case study. Disabil Rehabil Assist Technol. 2025;20(7):867-77.
Submitted date:
08/21/2025
Accepted date:
08/30/2025
Facebook
Twitter
LinkedIn
Mendeley
Email