Neuromodulation: A combined-therapy protocol for speech rehabilitation in a child with cerebral palsy.

INTRODUCTION: Transcranial direct current stimulation (tDCS) modulates cortical activity and potentiates functional gains achieved during therapeutic protocols. The aim of Integrative Speech Therapy Protocol is to rehabilitate speech in patients with impairments regarding neuropyschomotor development by combining oral motor stimuli, specific articulatory production, and the stimulation of phonological aspects of language. OBJECTIVE: Investigate the effect of transcranial direct current stimulation combined to integrative speech therapy in a child with cerebral palsy. METHODS: We performed a case study with tDCS and speech therapy in a patient with cerebral palsy and apraxia of speech. To assess the patient's speech, we used a parameterized test for the Brazilian Portuguese speech - ABFW. The CFCS and Vicking Speech Scales presented level IV and III, respectively. The patient underwent two periods with ten stimulation sessions each: first with anodal stimulation over Broca's area; and second over the left dorsolateral prefrontal cortex. Two indices were calculated: the percentage of consonants correct; and percentage of consonants correct-revised. Descriptive statistics were employed for the clinical data. For the outcomes, changes in each score were calculated as the difference in pre-intervention and post-intervention using Wilcoxon-Mann-Whitney test. RESULTS: Increases were found in percentage of correct consonants indices as well as to produce two-syllable and three-syllable words after both types of stimulation, characterized mainly by correct vowels that marked the presence of the syllable. Number of phonemes increased 0 to 4 at first the stimulation and 4 to 10 at the second. CONCLUSION: The combined-therapy program contributed to improve the speech rehabilitation results in a patient with cerebral palsy.

Transcranial direct current stimulation combined with integrative speech therapy in a child with cerebral palsy: A case report.

The aim of this study was to describe the results of the first case combining integrative speech therapy with anodal transcranial direct current stimulation (tDCS) over Broca's area in a child with cerebral palsy. The ABFW phonology test was used to analyze speech based on the Percentage of Correct Consonants (PCC) and Percentage of Correct Consonants - Revised (PCC-R). After treatment, increases were found in both PCC (Imitation: 53.63%-78.10%; Nomination: 53.19%-70.21%) and PPC-R (Imitation: 64.54%-83.63%; Nomination: 61.70%-77.65%). Moreover, reductions occurred in distortions, substitutions and improvement was found in oral performance, especially tongue mobility (AMIOFE-mobility before = 4 after = 7). The child demonstrated a clinically important improvement in speech fluency as shown in results of imitation number of correct consonants and phonemes acquire. Based on these promising findings, continuing research in this field should be conducted with controlled clinical trials.