ORIGINAL PAPER
Efficacy of transcranial direct current stimulation and mirror therapy on motor development in children with spastic cerebral palsy: a randomised clinical trial
1
Faculty of Rehabilitation Sciences, Lahore University of Biological and Applied Sciences, Lahore, Pakistan
2
University Institute of Physical Therapy, The University of Lahore, Lahore, Pakistan
3
Department of Health Technologies, Bahiana School of Medicine and Public Health (Escola Bahiana de Medicina e Saúde Pública), Salvador, Bahia, Brazil
4
Department of Biostatistics, Faculty of Medicine, Sakarya University, Sakarya, Turkey
5
Department of Physical Therapy, School of Health Sciences, University of Management and Technology, Lahore, Pakistan
Submission date: 2025-04-24
Acceptance date: 2026-02-23
Online publication date: 2026-11-10
Corresponding author
Shoaib Waqas
Faculty of Rehabilitation Sciences, Lahore University of Biological and Applied Sciences, North Canal Bank, Tulspura, Lahore, Pakistan
Faculty of Rehabilitation Sciences, Lahore University of Biological and Applied Sciences, North Canal Bank, Tulspura, Lahore, Pakistan
KEYWORDS
TOPICS
ABSTRACT
Introduction:
Cerebral palsy (CP) is a neurological disorder caused by a brain injury that severely affects children’s motor development. This study investigates the effects of two non-invasive techniques: transcranial direct current stimulation (tDCS) and mirror therapy (MT), on motor development in children with spastic quadriplegic cerebral palsy.
Methods:
A randomised, double-blind clinical trial was conducted at Ghurki Hospital’s rehabilitation centre in Lahore, which involved 93 diagnosed CP patients divided into three groups. Group A received tDCS, MT, and routine physical therapy (RPT); group B received MT and RPT; and group C received tDCS and RPT. tDCS and MT were applied for 15 min per side over two weeks, while RPT lasted 20 min for ten weeks. Motor development was assessed using three tools: developmental age via the Shoaib sensorimotor development tool, gross motor function through the Gross Motor Function Measure (GMFM) and Time Up and Go test (TUG), and fine motor skills using the Nine-Hole Peg Test (NHPT) and Box and Block Test (BBT). Assessments were conducted at baseline, after two weeks, and after ten weeks.
Results:
Group A showed significant improvements in gross and fine motor development (p < 0.05). Compared with the other groups, effect sizes were η2 = 0.451 for developmental age, η2 = 0.575 for motor development, η2 = 0.575 for GMFM scores, η2 = 0.090 for TUG scores, η2 = 0.085 for NHPT scores, and η2 = 0.139 for BBT scores.
Conclusions:
This trial highlights the effectiveness of combining tDCS, MT, and RPT in enhancing motor skills in cerebral palsy patients.
Cerebral palsy (CP) is a neurological disorder caused by a brain injury that severely affects children’s motor development. This study investigates the effects of two non-invasive techniques: transcranial direct current stimulation (tDCS) and mirror therapy (MT), on motor development in children with spastic quadriplegic cerebral palsy.
Methods:
A randomised, double-blind clinical trial was conducted at Ghurki Hospital’s rehabilitation centre in Lahore, which involved 93 diagnosed CP patients divided into three groups. Group A received tDCS, MT, and routine physical therapy (RPT); group B received MT and RPT; and group C received tDCS and RPT. tDCS and MT were applied for 15 min per side over two weeks, while RPT lasted 20 min for ten weeks. Motor development was assessed using three tools: developmental age via the Shoaib sensorimotor development tool, gross motor function through the Gross Motor Function Measure (GMFM) and Time Up and Go test (TUG), and fine motor skills using the Nine-Hole Peg Test (NHPT) and Box and Block Test (BBT). Assessments were conducted at baseline, after two weeks, and after ten weeks.
Results:
Group A showed significant improvements in gross and fine motor development (p < 0.05). Compared with the other groups, effect sizes were η2 = 0.451 for developmental age, η2 = 0.575 for motor development, η2 = 0.575 for GMFM scores, η2 = 0.090 for TUG scores, η2 = 0.085 for NHPT scores, and η2 = 0.139 for BBT scores.
Conclusions:
This trial highlights the effectiveness of combining tDCS, MT, and RPT in enhancing motor skills in cerebral palsy patients.
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