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Targeted transcranial direct current stimulation combined with bimanual training for children with cerebral palsy

Award Number: R01HD076436
ORGANIZATION: NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 09/26/2014
PERIOD OF PERFORMANCE END DATE: 08/31/2025

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Targeted transcranial direct current stimulation combined with bimanual training for children with cerebral palsy - PROJECT SUMMARY/ABSTRACT Unilateral spastic cerebral palsy (USCP) is characterized by movement deficits, particularly upper extremity (UE) impairments on one side of the body. Although strides have been made to improve UE rehabilitation approaches, even the best available therapies fail to fully ameliorate UE impairments, are costly, and require large amounts of time. Thus, there is an urgent need to optimize the effectiveness and cost of UE therapies. Our long-term goal is to develop evidence-based strategies to improve movement in children with USCP. Early damage to the developing brain can result in a re-wiring of the direct corticospinal tract (CST) projections innervating UE function. In many children with USCP, there are no CST connections from the damaged hemisphere, and instead ipsilateral (same-sided) CST pathways control movement of the affected UE. Previously, this type of reorganization was believed to be maladaptive and unresponsive to treatment. However, during the first funding period of this R01, we determined that UE therapy efficacy is independent of CST laterality. Importantly, we found that the hemisphere containing CST connectivity to the affected hand showed neuroplastic changes in response to intensive therapy. Nonetheless, this heterogeneity in the brain connectivity means it is unlikely that a one-size-fits-all rehabilitation approach will be suitable. Therefore, our next goal is to leverage these findings using an individualized approach to obtain the same or greater changes using a fraction of the dosage by enhancing the neuroplastic changes with transcranial direct current stimulation (tDCS). Our preliminary results show that tDCS enhances the efficacy of UE training only if it is targeted to an individual’s CST laterality determined with single-pulse transcranial magnetic stimulation (TMS). The overall objective for this renewal is to vertically extend what has been learned under our prior R01 by determining how to optimally target tDCS to enhance the efficacy of UE training in children with USCP. Our central hypothesis is that bimanual training (BT) combined with a tDCS montage targeting the hemisphere with CST connectivity to the impaired UE muscles will improve UE function more than BT plus sham stimulation. We will test this by conducting a randomized clinical trial (RCT) to determine the efficacy of targeted tDCS/BT for improving UE function and interactions between tDCS/BT and motor cortex physiology in children with USCP. Our working hypotheses are that children who receive targeted anodal tDCS will show the most robust changes in hand function and motor cortex physiology. Determination of the synergistic effects of tDCS and BT may substantially reduce the required rehabilitation time and cost necessary to improve UE function. The proposed work is innovative because it may increase accessibility of treatment, particularly for centers that serve families of lower socio-economic status, due to the reduced cost of therapy.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2025 ( Subtotal = $0 )
2025	2024	THE WINIFRED MASTERSON BURKE MEDICAL RESEARCH INSTITUTE, INC	785 MAMARONECK AVE	WHITE PLAINS	NY	10605	WESTCHESTER	USA	Child Health and Human Development Extramural Research	000	10	11/21/2024	NON-COMPETING CONTINUATION	$0
														Subtotal = $0

Issue Date FY: 2024 ( Subtotal = $609,914 )
2024	2024	THE WINIFRED MASTERSON BURKE MEDICAL RESEARCH INSTITUTE, INC	785 MAMARONECK AVE	WHITE PLAINS	NY	10605	WESTCHESTER	USA	Child Health and Human Development Extramural Research	000	10	8/1/2024	NON-COMPETING CONTINUATION	$609,914
														Subtotal = $609,914

Issue Date FY: 2023 ( Subtotal = $635,632 )
2023	2023	THE WINIFRED MASTERSON BURKE MEDICAL RESEARCH INSTITUTE, INC	785 MAMARONECK AVE	WHITE PLAINS	NY	10605	WESTCHESTER	USA	Child Health and Human Development Extramural Research	000	9	8/16/2023	NON-COMPETING CONTINUATION	$635,632
														Subtotal = $635,632

Issue Date FY: 2022 ( Subtotal = $1,006,058 )
2022	2022	WINIFRED MASTERSON BURKE MEDICAL RESEARCH INSTITUTE, INC, THE	785 MAMARONECK AVE	WHITE PLAINS	NY	10605	WESTCHESTER	USA	Child Health and Human Development Extramural Research	001	8	8/26/2022	NON-COMPETING CONTINUATION	$649,638
2022	2022	WINIFRED MASTERSON BURKE MEDICAL RESEARCH INSTITUTE, INC, THE	785 MAMARONECK AVE	WHITE PLAINS	NY	10605	WESTCHESTER	USA	Child Health and Human Development Extramural Research	002	8	9/1/2022	SUPPLEMENT FOR EXPANSION	$356,420
2022	2018	WINIFRED MASTERSON BURKE MEDICAL RESEARCH INSTITUTE, INC, THE	785 MAMARONECK AVE	WHITE PLAINS	NY	10605	WESTCHESTER	USA	Child Health and Human Development Extramural Research	000	5	11/1/2021	NON-COMPETING CONTINUATION	$0
														Subtotal = $1,006,058

Issue Date FY: 2021 ( Subtotal = $660,190 )
2021	2021	WINIFRED MASTERSON BURKE MEDICAL RESEARCH INSTITUTE, INC, THE	785 MAMARONECK AVE	WHITE PLAINS	NY	10605	WESTCHESTER	USA	Child Health and Human Development Extramural Research	000	7	8/1/2021	NON-COMPETING CONTINUATION	$660,190
														Subtotal = $660,190

Issue Date FY: 2020 ( Subtotal = $709,481 )
2020	2020	WINIFRED MASTERSON BURKE MEDICAL RESEARCH INSTITUTE, INC, THE	785 MAMARONECK AVE	WHITE PLAINS	NY	10605	WESTCHESTER	USA	Child Health and Human Development Extramural Research	003	6	6/23/2020	COMPETING CONTINUATION	$709,481
2020	2018	WINIFRED MASTERSON BURKE MEDICAL RESEARCH INSTITUTE, INC, THE	785 MAMARONECK AVE	WHITE PLAINS	NY	10605	WESTCHESTER	USA	Child Health and Human Development Extramural Research	001	5	3/5/2020	NON-COMPETING CONTINUATION	$0
2020	2018	WINIFRED MASTERSON BURKE MEDICAL RESEARCH INSTITUTE, INC, THE	785 MAMARONECK AVE	WHITE PLAINS	NY	10605	WESTCHESTER	USA	Child Health and Human Development Extramural Research	002	5	6/16/2020	NON-COMPETING CONTINUATION	$0
2020	2018	WINIFRED MASTERSON BURKE MEDICAL RESEARCH INSTITUTE, INC, THE	785 MAMARONECK AVE	WHITE PLAINS	NY	10605	WESTCHESTER	USA	Child Health and Human Development Extramural Research	000	5	1/23/2020	NON-COMPETING CONTINUATION	$0
														Subtotal = $709,481

Issue Date FY: 2018 ( Subtotal = $380,940 )
2018	2018	WINIFRED MASTERSON BURKE MEDICAL RESEARCH INSTITUTE, INC, THE	785 MAMARONECK AVE	WHITE PLAINS	NY	10605	WESTCHESTER	USA	Child Health and Human Development Extramural Research	000	5	7/10/2018	NON-COMPETING CONTINUATION	$380,940
														Subtotal = $380,940

Issue Date FY: 2017 ( Subtotal = $379,787 )
2017	2017	WINIFRED MASTERSON BURKE MEDICAL RESEARCH INSTITUTE, INC, THE	785 MAMARONECK AVE	WHITE PLAINS	NY	10605	WESTCHESTER	USA	Child Health and Human Development Extramural Research	000	4	7/14/2017	NON-COMPETING CONTINUATION	$379,787
														Subtotal = $379,787

Issue Date FY: 2016 ( Subtotal = $371,377 )
2016	2016	WINIFRED MASTERSON BURKE MEDICAL RESCH INSTITUTE, INC	785 MAMARONECK AVENUE	WHITE PLAINS	NY	10605	WESTCHESTER	USA	Child Health and Human Development Extramural Research	000	3	6/14/2016	NON-COMPETING CONTINUATION	$371,377
														Subtotal = $371,377

Issue Date FY: 2015 ( Subtotal = $365,750 )
2015	2015	WINIFRED MASTERSON BURKE MEDICAL RESCH INSTITUTE, INC	785 MAMARONECK AVENUE	WHITE PLAINS	NY	10605	WESTCHESTER	USA	Child Health and Human Development Extramural Research	000	2	6/18/2015	NON-COMPETING CONTINUATION	$365,750
														Subtotal = $365,750

Issue Date FY: 2014 ( Subtotal = $398,879 )
2014	2014	WINIFRED MASTERSON BURKE MEDICAL RESCH INSTITUTE, INC	785 MAMARONECK AVENUE	WHITE PLAINS	NY	10605	WESTCHESTER	USA	Child Health and Human Development Extramural Research	000	1	9/22/2014	NEW	$398,879
														Subtotal = $398,879

Grand Total All Awards = $5,518,008

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Targeted transcranial direct current stimulation combined with bimanual training for children with cerebral palsy

Award Number: R01HD076436

ORGANIZATION: NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

PERIOD OF PERFORMANCE START DATE: 09/26/2014

PERIOD OF PERFORMANCE END DATE: 08/31/2025

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