Article

The aim of this study was to determine the feasibility and efficacy of five
treatments of 6 Hz primed, low-frequency, repetitive transcranial magnetic
stimulation (rTMS) combined with constraint-induced movement therapy (CIMT) to
promote recovery of the paretic hand in children with congenital hemiparesis.
METHOD: Nineteen children with congenital hemiparesis aged between 8 and 17 years
(10 males, nine females; mean age 10 years 10 months, SD 2 years 10 months;
Manual Ability Classification Scale levels I-III) underwent five sessions of
either real rTMS (n=10) or sham rTMS (n=9) alternated daily with CIMT. CIMT
consisted of 13 days of continuous long-arm casting with five skin-check
sessions. Each child received a total of 10 hours of one-to-one therapy. The
primary outcome measure was the Assisting Hand Assessment (AHA) and the secondary
outcome variables were the Canadian Occupational Performance Measure (COPM) and
stereognosis. A Wilcoxon signed-rank sum test was used to analyze differences
between pre- and post-test scores within the groups. Analysis of covariance was
used to compute mean differences between groups adjusting for baseline. Fisher's
exact test was used to compare individual change in AHA raw scores with the
smallest detectable difference (SDD) of 4 points. RESULTS: All participants
receiving treatment finished the study. Improvement in AHA differed significantly
between groups (p=0.007). No significant differences in the secondary outcome
measures were found. Eight out of 10 participants in the rTMS/CIMT group showed
improvement greater than the SDD, but only two out of nine in the sham rTMS/CIMT
group showed such improvement (p=0.023). No serious adverse events occurred.
INTERPRETATION: Primed, low-frequency rTMS combined with CIMT appears to be safe,
feasible, and efficacious in pediatric hemiparesis. Larger clinical trials are
now indicated.
CI - (c) 2013 Mac Keith Press.

Langue : ANGLAIS