Robotic Rehabilitation and Transcranial Direct Current Stimulation in Children With Bilateral Cerebral Palsy.

The study had no control group and was not blinded, so any change in scores cannot be credited to robotic arm training plus transcranial direct current stimulation. Only eight families consented and five children completed the full protocol; three stopped because of reduced energy and appetite, dyskinetic movement with limited cooperation, or insufficient cognitive ability. The sample was very small and young, so findings cannot be generalised to older children or to children with severe cognitive, communication, or dyskinetic movement problems. The intensive 10 consecutive weekday schedule was hard for families and participants: five families declined consent, training time decreased as children became bored, and breaks were needed in 20 of 51 sessions. Some outcome measures were not completed or were too difficult, including the robot task for two children and the Box and Block Test for one child. The authors said they could not tell whether arm function measures reflected daily variation or real change.

The study was funded by the Swiss Foundation for Children with Cerebral Palsy, the Alumni-Organization of the Faculty of Medicine at the University of Zurich, and a Thrasher Research Fund Early Career Award. One author reported consulting payments from Promethus Medical, Sinntaxis, and Ipsen, plus operating grants from the Heart and Stroke Foundation, Canadian Institutes of Health Research, and University of Calgary. The other authors reported no commercial or financial conflicts.

Do not conclude that robotic arm training plus transcranial direct current stimulation improves arm function in children with bilateral cerebral palsy. The study had no comparison group, only five children completed it, and the authors said they could not tell whether scores reflected daily variation or real change.