tDCS in Pediatric Acquired Brain Injury

Safety and Feasibility of Transcranial Direct Current Stimulation in Pediatric Acquired Brain Injury (tDCS in Pediatric ABI)

In this preliminary study, we will examine the safety, tolerability, and feasibility of transcranial direct current stimulation (tDCS), in the setting of dosage escalation, as a candidate intervention for children with Acquired Brain Injury (ABI).

Previous studies have demonstrated that transcranial direct current stimulation (tDCS) is safe and effective in adults with chronic Acquired Brain Injury. Limited data have established the safety of tDCS in children with neuropsychiatric and neuromotor disorders. However, these tDCS safety paradigms may not be relevant to children with ABI due to their abnormal brain structure and function, decreased ability to communicate, variable symptomology, and time-consuming care needs that exist in this population.

In this open-label, single-group, dosage escalation study, investigators aim to assess the safety, tolerability, and feasibility of incrementally higher tDCS currents in 10 pediatric patients with ABI on an inpatient rehabilitation unit. The study will include up to three sessions of tDCS (sham, 1mA, and then 2 mA) either over the left dorsolateral prefrontal cortex or over the primary motor cortex based on the goal to evaluate change in either cognitive or motor function. We will also explore whether tDCS improves consciousness in pediatric DOC. Mozart classical music, as a concurrent intervention, will be played during sham, 1 mA, and 2 mA tDCS applications.

Inclusion Criteria:

• Age 5 through 17 years
• History of acquired brain injury.
• Currently inpatient at the Kennedy Krieger Rehabilitation Unit.
• Parent and child proficient in English.

Exclusion Criteria:

• Patients with extensive focal lesions in the left dorsolateral prefrontal cortex (DLPFC) and bilateral primary motor cortex as determined by review of imaging and/or imaging reports obtained as part of clinical care.
• Youth with known seizures in the month prior to study enrollment.
• Participants with non-convulsive seizures and/or interictal epileptiform discharges observed on study screening extended EEG.
• Females with confirmed pregnancy on urine test.
• Youth with history of craniotomy surgery, metallic cerebral, cochlear or electronic implant in the head or neck area, or ventricular shunt or pacemaker.
• Patients requiring daytime mechanical ventilation.
• Children with head circumference less than 43 cm
• Bilateral severe or profound hearing loss
• Presence of hairstyle interfering with tDCS application and/or high quality EEG signal
• Youth in foster care.