Effects of Multimodal Neuro Rehabilitation on Cortical Activity and Muscle Syenergy in Spastic Cerebral Palsy

Effects of Multimodal Neuro Rehabilitation on Cortical Activity and Muscle Syenergy in Spastic Cerebral Palsy

• To determine the effects of tDCS in conjunction with task-oriented training (TOT) and virtual reality (VR) as compared with sham stimulation and conventional physiotherapy on cortical activity and muscle synergy.
• To determine the retention effects of tDCS in conjunction with task-oriented training (TOT) and virtual reality (VR) as compared with sham stimulation and conventional physiotherapy on cortical activity and muscle synergy, one-month follow-up across the five groups.

• To determine the effects of tDCS in conjunction with task-oriented training (TOT) and virtual reality (VR) as compared with sham stimulation and conventional physiotherapy on
• gross motor function, gait, balance, mobility, dexterity, and spasticity.
• executive functions
• self-esteem.

Inclusion Criteria:

• Children aged 6-18 years.
• Neurologist-confirmed spastic cerebral palsy.
• GMFCS Levels I-III (mild to moderate motor impairment).
• Ability to understand and follow simple instructions.
• Medically stable (no planned major surgery; no recent adjustment of medications affecting cortical excitability).
• Parental/guardian written informed consent and child assent.

Exclusion Criteria:

• Active uncontrolled epilepsy or history of seizure in the last year.
• Metal implants in the head or implanted medical/electrical devices (e.g., cochlear implants, ventriculoperitoneal shunts, pacemakers).
• Significant visual or auditory impairments that would interfere with task performance.
• Severe behavioral or cognitive difficulties that would prevent safe application of tDCS or training tasks.
• Currently taking medications known to significantly alter cortical excitability (e.g., benzodiazepines, antiepileptics) if dosage is unstable.
• Participation in other experimental neurorehabilitation or brain stimulation interventions within the last 6 months.