Home based remotely supervised tDCS in children with acquired brain injury: a feasibility study protocol

Abstract

Abstract Introduction: Traumatic brain injury (TBI) is the most common acquired brain injury (ABI), where 16% of children sustain at least one TBI requiring medical attention, and 25-30% experience chronic problems. Attention and concentration problems are among the most common cognitive symptoms following ABI. Transcranial direct current stimulation (tDCS) may improve cognition after ABI; however, clinic visits can be burdensome. Home-based, remotely-supervised tDCS (rh-tDCS) may improve patient comfort and compliance in multi-day tDCS trials. Methods: We describe a protocol for an open-label feasibility study involving 10 days of rh-tDCS during attention training in 20 children (aged 8-18 years) with ABI. Participants will self-administer tDCS for 10 consecutive weekdays (1mA, 20 minutes, anode: left dorsolateral prefrontal cortex (dlPFC), cathode: right dlPFC) during attention training (gamified Stop Signal Task). The primary outcome is feasibility according to patient compliance and reported tolerability. Attentional inhibition will be measured daily before each tDCS session using flanker reaction time (RT). Stop signal, Go/No-go and flanker RT will be measured prior to and following 10 days of tDCS, and at 1- and 4-weeks post-tDCS. Resting and task-based functional connectivity (fc) will be measured using high-density-EEG (HD-EEG, 128-channel net) before and after the 10-day trial, and 1- and 4-weeks post-tDCS. Results: Preliminary results will be presented, including patient-reported compliance and tolerability, as well as changes in attentional inhibition before and after the 10-day trial and at 1-week and 4-weeks post-tDCS. Finally, changes in HD-EEG fc before and after the 10-day trial, and 1- and 4-weeks post-tDCS will be reported. Conclusion: This study will be the first multi-day tDCS trial in children with ABI, and the first home-based tDCS trial in this population. Our results will provide feasibility data to inform a randomised controlled trial investigating the efficacy of multi-day home-based tDCS to improve attention in children with ABI. Research Category and Technology and Methods Clinical Research: 9. Transcranial Direct Current Stimulation (tDCS) Keywords: tDCS, EEG, acquired brain injury, children