Thesis (M.Sc.) - Cairo University - Faculty of Physical Therapy - Department of Growth and Development Disorders in Pediatrics

Purpose: This study systematically reviewed studies of randomized controlled trials (RCTs) involving the use of Transcranial magnetic stimulation (TMS) combined with Constraint induced movement therapy (CIMT) over the primary motor cortex (M1) to probe brain plasticity on upper extremity (UE) function in children with cerebral palsy (CP). Methods: PubMed, ScienceDirect, Physiotherapy Evidence Database (PEDro), and Cochrane library were searched to identify relevant RCTs from 2000 to December 2020 which had to investigate pre/post-intervention changes of TMS with CIMT on UE function. For study quality we use PEDro scale and risk of bias were assessed. Meta-analysis was performed for outcomes on UE (function or activity) using Assisting hand assessment (AHA), Canadian occupational performance measure (COPM) as primary outcome measures, peak force, stereognosis, finger tracking, glutamate and glutamine (Glx), Creatine compounds (Cre), motor evoked potential (MEP), cortical silent duration (CSP), and pediatrics quality of life (PedsQL) as secondary outcomes. Results: Out of 92 papers screened, 11 studies involved (pooled participants = 140; mean ±SD 20 ±2.94 / study) met the selection criteria. This study reported a significant treatment effect of the PedsQL in the real group with a significant decrease in the PedsQL in the sham group in comparison with the pre-treatment baseline values. However, there was no significant change demonstrated by the Assisting Hand Assessment (AHA) between groups at post-test, and 6-months post-treatment evaluations

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