Acquired Brain Injury, Disorders of Consciousness
Conditions
Keywords
Acquired Brain Injury, Transcranial Direct Current Stimulation, Pediatric, Safety, Feasibility
Brief summary
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).
Detailed description
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.
Interventions
DEVICEtDCS
Real and sham tDCS/Mozart piano sonata (K.448)
Sponsors
Johns Hopkins University
Hugo W. Moser Research Institute at Kennedy Krieger, Inc.
Study design
Allocation
NON_RANDOMIZED
Intervention model
SEQUENTIAL
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
Dosage-escalation study
Eligibility
Sex/Gender
ALL
Age
5 Years to 17 Years
Healthy volunteers
No
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.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Changes in adverse events (skin problems and/or seizures) as a measure of safety | Baseline (1-7 days), post-stimulation (within 30-minutes), follow-up (24 hours, 48 hours, 5 days) | Adverse Event Form Questionnaire: Assessment of change from baseline and post-sham stimulation to post- stimulation (1 mA, 2 mA) and follow-up using a detailed assessment of participant's symptoms (skin problems and/or seizures) as related to transcranial direct current stimulation (tDCS) intervention. |
| Changes in pain and discomfort as a measure of safety and tolerability | Baseline (1-7 days), pre-during-post stimulation (pre-stimulation: within 30 minutes, during: within 20 minutes, post-stimulation: within 30-minutes) | Face, Legs, Activity, Cry and Consolability Scale (FLACC) Questionnaire: Assessment of change from baseline and post-sham stimulation to pre-during-post stimulation (1 mA, 2 mA) using an observation tool that will measure pain and discomfort as related to transcranial direct current stimulation (tDCS) in children with decreased communication and cognitive impairment. |
| Disruption of Care Form | Up to 26 Days | Questionnaire: Assessment of interruption of inpatient care due to child's participation in the study. |
| Family Feedback Form | 5 days after the end of the last stimulation session. | Questionnaire: Assessment to receive feedback about the satisfaction in the study from the parent/guardian/caregiver of the participant. |
| Number of participants with adverse events as related to tDCS | Up to 26 Days | The information on number of participants with adverse events will be collected from the beginning of sham tDCS until the end of the last tDCS session. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Changes in Neurobehavioral functioning | Up to 4 months | Modified Functional Reach Task, Grooved Pegboard, Digit Span, or Coma-Recovery Scale Revised: Task chosen based on child's functional status and assessment of change from baseline, post-sham stimulation, and pre-stimulations (1 mA, 2 mA). |
Countries
United States
Outcome results
None listed