At-home tDCS in children with acquired brain injury: a dose-controlled feasibility study

Abstract

Symposium title At-home brain stimulation in complex clinical populations: Practical, clinical, and scientific considerations Abstract Following acquired brain injury (ABI), 25% of children experience chronic attention difficulties. Repeated transcranial direct current stimulation (tDCS) may improve attention, however daily clinic visits are burdensome due to concurrent therapy, ongoing school commitments, and caregiver schedules. Home-based treatment increases accessibility but requires several practical and safety considerations in this complex population. We examined the safety, feasibility, and tolerability of supervised at-home tDCS during gamified attention training to improve attention following pediatric ABI. We conducted a randomized, single-blind, dose-controlled clinical trial of at home-tDCS in Brisbane, Australia (10 tDCS sessions; 20min; 1mA / 2mA; bilateral dorsolateral prefrontal cortex). Participants attended our clinic at baseline for clinical assessments, personalized tDCS cap fitting, and training in tDCS usage. All remote sessions were supervised over videoconference. As a primary outcome, we assessed feasibility and tolerability of the at-home tDCS and our customized, personalized at-home tDCS headband. As secondary outcomes, we assessed functional connectivity (fc) changes. Over six months, 73 participants were contacted (January-August 2023) and 10 were enrolled (5 [50%] males; mean age 12.13y [SD 2.90]), satisfying a priori recruitment timelines. All families successfully set up tDCS and training tasks with excellent protocol adherence and no serious adverse events (100 sessions). Nine participants completed all stimulation sessions (1mA:n=5, 2mA:n=4). The 2mA group reported greater tingling, itching and pain (all p <0.05). One participant in the 1mA group did not complete full sessions due to tolerance but was able to gradually increase stimulation duration with additional coaching and support. Daily home-based tDCS overall is safe, feasible and tolerable following pediatric ABI, which supports larger, sham-controlled efficacy trials. Gamified attention tasks may improve adherence. Our results pave the way for the development of safe and effective at-home stimulation therapeutics that may offer targeted improvement of neurocognitive symptoms in children. Research Category and Technology and Methods Clinical Research: 9. Transcranial Direct Current Stimulation (tDCS) Keywords at-home, tDCS, pediatric, brain injury