Abstract Details

Title Protocol-specific Efficacy of Non-invasive Brain Stimulation and Peripheral Electrical Stimulation for Walking Speed in Cerebral Palsy: A Network Meta-analysis of Randomized Controlled Trials

Topic Child Neurology and Developmental Neurology

Presentation(s) S19 - Emerging Therapies in Child Neurology (5:18 PM-5:30 PM)

Poster/Presentation
Number 010

Objective To assess the protocol-specific and overall comparative efficacy of non-invasive brain stimulation (NIBS) and peripheral electrical stimulation (PES) on walking speed in patients with cerebral palsy (CP) using network meta-analysis (NMA).

Background Cerebral palsy, the leading childhood physical disability, often impairs walking speed; while transcranial direct current stimulation (tDCS), neuromuscular electrical stimulation (NMES), and functional electrical stimulation (FES) show promise for gait improvement, their comparative efficacy and parameter-specific effects remain unclear.

Design/Methods We systematically searched PubMed, Embase, Scopus, and ClinicalTrials.gov to July 2025 for randomized controlled trials (RCTs) reporting walking speed or equivalent gait outcomes in CP. Twenty RCTs (591 patients) were included. A frequentist random-effects NMA estimated mean differences (MDs) versus sham, with ranking assessed by P-scores. Subanalyses were conducted by stimulation modality and protocol parameters.

Results The overall NMA demonstrated that all active interventions significantly outperformed sham. tDCS showed the largest effect (MD = 0.22, 95% CI 0.14–0.29, p < 0.0001), followed by FES (MD = 0.16, 95% CI 0.06–0.26, p = 0.0015) and NMES (MD = 0.11, 95% CI 0.05–0.18, p = 0.0010). Protocol-specific analyses revealed that tDCS over the primary motor cortex (M1) at 1 mA for 20 minutes combined with treadmill training yielded the greatest improvement (MD = 0.29, 95% CI 0.22–0.36). Quadriceps-targeted NMES for one hour also showed robust benefits (MD = 0.27, 95% CI 0.16–0.37). FES of the common peroneal nerve for 4–8 hours produced significant gains (MD range 0.19–0.27). Other NMES protocols, including gluteus maximus or gastrocnemius stimulation, did not differ from sham. Heterogeneity was minimal (I² = 0.4%), and no inconsistency was detected.

Conclusions Both overall and protocol-specific analyses confirm that NIBS and PES enhance walking speed in CP, with tDCS over M1 and quadriceps-targeted NMES demonstrating the strongest effects. Tailoring stimulation parameters may optimize motor rehabilitation strategies for this population.

Authors/Disclosures
Apeksha Pokalkar, MBBS ("Dharm Villa") PRESENTER	Dr. Pokalkar has nothing to disclose.
Muneeb Ahmad Muneer (Allama Iqbal Medical College)	Mr. Muneer has nothing to disclose.
Amatul Aala, MBBS	Miss Aala has nothing to disclose.
Rania naqrashi, MBBS	Miss naqrashi has nothing to disclose.
Zainab A. Memon, MBBS	Dr. Memon has nothing to disclose.
Aima Muzaffar, MBBS	Dr. Muzaffar has nothing to disclose.
Mohammad Burhanuddin, MBBS	Dr. Burhanuddin has nothing to disclose.
Abdur Rehman, MBBS	Dr. Rehman has nothing to disclose.
Zainab Awan, MBBS	Miss Awan has nothing to disclose.
Affan Tasleem, MBBS	Dr. Tasleem has nothing to disclose.
Ashan S. Fareed, MBBS	Mr. Fareed has nothing to disclose.
Sami Asif	Mr. Asif has nothing to disclose.
Zonaira Mushahid, MBBS	Dr. Mushahid has nothing to disclose.
Dabbara V. Ramana	Mr. Ramana has nothing to disclose.

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