Empowering Exceptional Children

Empowering Exceptional Children

Investigating the Effectiveness of Transcranial Direct Current Stimulation on Working Memory and Psychological Indicators in Children with Cerebral Palsy

Document Type : Original Article

Authors
fereshteh neissari 1
peyman hassani abharian 2
reza rostami 3
1 student Psychology and Education of Exceptional Children, Faculty of Literature, Humanities and Social Sciences, Science and Research Branch, Islamic Azad University, Tehran, Iran.
2 Assistant Professor in Cognitive Rehabilitation Department, Institute for Cognitive Sciences studies (IRICSS), Tehran, Iran.
3 Professor of Psychology Department, University of Tehran, Tehran, Iran.
10.22034/ceciranj.2025.470762.1897
Abstract
The aim of this study was to examine the effectiveness of transcranial direct current stimulation (tDCS) on working memory and psychological indicators in children with cerebral palsy (CP). This quantitative research employed a quasi-experimental, two-group design with pre-test and post-test measures. A total of 24 children aged 7 to 18 years with CP were selected through convenience sampling and randomly assigned to either the tDCS (experimental) group or the control group (12 participants in each). To assess outcomes, the Multidimensional Anxiety Scale for Children, the Children's Depression Inventory, and the Behavior Rating Inventory of Executive Function (BRIEF) were administered. The findings revealed that post-test scores for social anxiety, separation anxiety, harm avoidance, somatic symptoms, and depression in the tDCS group significantly differed from their own pre-test scores, as well as from both pre- and post-test scores of the control group (p < .001). In contrast, the control group’s post-test scores only differed significantly from the tDCS group’s post-test scores. These results indicate a significant improvement in anxiety and depression variables following tDCS intervention; however, no significant difference was observed between the groups in working memory (p ≥ .05). tDCS appears to be a promising intervention in the rehabilitation of children with CP, particularly in enhancing their psychological functioning. This approach offers a novel pathway by leveraging the brain’s neuroplasticity to support the rehabilitation process in this population.
Keywords
cerebral palsy
Direct current electrical stimulation
brief executive functions questionnaire
cognitive functions
Akbar, E., Abutorabi Zarchi, H., Namiranian, N., & Abutorabi Zarchi, M. (2019). The Effect of 8-week Aquatic and Terrestrial Exercises on Functional Balance and Psychological Factors of Spastic Cerebral Palsy Girls. Function and Disability Journal, 2(1), 125–132.
Bartonek, Å., Piccardi, L., & Guariglia, C. (2021). Topographical working memory in children with cerebral palsy. Journal of Motor Behavior, 53(2), 200–208.
Beauchene, C., Abaid, N., Moran, R., Diana, R. A., & Leonessa, A. (2016). The effect of binaural beats on visuospatial working memory and cortical connectivity. PloS One, 11(11), e0166630.
Bjorgaas, H. M., Elgen, I. B., & Hysing, M. (2021). Trajectories of psychiatric disorders in a cohort of children with cerebral palsy across four years. Disability and Health Journal, 14(1), 100992.
Chen, L., Du, B., Li, K., Li, K., Hou, T., Jia, F., & Li, L. (2024). The effect of tDCS on inhibitory control and its transfer effect on sustained attention in children with autism spectrum disorder: An fNIRS study. Brain Stimulation, 17(3), 594–606.
Gallop, L., Westwood, S. J., Lewis, Y., Campbell, I. C., & Schmidt, U. (2023). Effects of transcranial direct current stimulation in children and young people with psychiatric disorders: A systematic review. European Child & Adolescent Psychiatry.
Gupta, M., Bhatia, D., & Rajak, B. L. (2017). Study of available intervention technique to improve cognitive function in cerebral palsy patients. Curr Neurobiol, 8(1), 51–59.
Hameed, M. Q., Damar, U., MacMullin, P., & Rotenberg, A. (2019). Chapter 2—The Developing Brain—Relevance to Pediatric Neurotechnology. In L. M. Oberman & P. G. Enticott (Eds.), Neurotechnology and Brain Stimulation in Pediatric Psychiatric and Neurodevelopmental Disorders (pp. 9–30). Academic Press.
Hill, A. T., Fitzgerald, P. B., & Hoy, K. E. (2016). Effects of Anodal Transcranial Direct Current Stimulation on Working Memory: A Systematic Review and Meta-Analysis of Findings from Healthy and Neuropsychiatric Populations. Brain Stimulation, 9(2), 197–208.
Hou, W., Zhou, F., Wang, Q., Li, H., Qin, X., Ding, Y., Dong, F., Bo, Q., Li, A., Zhang, L., Chen, Z., Wang, Z., Li, X., Lee, J., & Wang, C. (2024). Effect of transcranial direct current stimulation with concurrent cognitive performance targeting posterior parietal cortex vs prefrontal cortex on working memory in schizophrenia: A randomized clinical trial. Translational Psychiatry, 14(1), 1–10.
Ingendoh, R. M., Posny, E. S., & Heine, A. (2023). Binaural beats to entrain the brain? A systematic review of the effects of binaural beat stimulation on brain oscillatory activity, and the implications for psychological research and intervention. PLOS ONE, 18(5), e0286023.
Jazini, F., & Sheikh, M. (2022). Comparison of the Effect of Direct Transcranial Electrical Stimulation of Motor and Vision Cortex on Working Memory and Motor Performance in Children with Developmental Coordination Disorder.
Jiang, S., Jones, M., & von Bastian, C. C. (2024). TDCS over PPC or DLPFC does not improve visual working memory capacity. Communications Psychology, 2(1), 1–10.
Kilcioglu, S., Schiltz, B., Araneda, R., & Bleyenheuft, Y. (2023). Short-to Long-Term Effects of Virtual Reality on Motor Skill Learning in Children with Cerebral Palsy: Systematic Review and Meta-Analysis. JMIR Serious Games, 11(1), e42067.
Kube, T., Schwarting, R., Rozenkrantz, L., Glombiewski, J. A., & Rief, W. (2020). Distorted Cognitive Processes in Major Depression: A Predictive Processing Perspective. Biological Psychiatry, 87(5), 388–398.
LeMoult, J., & Gotlib, I. H. (2019). Depression: A cognitive perspective. Clinical Psychology Review, 69, 51–66.
Li, J., Kung, S., Croarkin, P., & Lapid, M. (2024). Transcranial Direct Current Stimulation (tDCS) for Treatment Resistant Depression (TRD): A Systematic Review. The American Journal of Geriatric Psychiatry, 32(4, Supplement), S99.
Mashhadi, A., Reza, S., Fatemeh, M., & Batol, B. (2014). Psychometric properties of children’s multidimensional anxiety scale. https://www.sid.ir/fa/VEWSSID/J_pdf/30313912105.pdf
Müller, D., Habel, U., Brodkin, E. S., & Weidler, C. (2022). High-definition transcranial direct current stimulation (HD-tDCS) for the enhancement of working memory – A systematic review and meta-analysis of healthy adults. Brain Stimulation, 15(6), 1475–1485.
Narayan, A., Muhit, M., Whitehall, J., Hossain, I., Badawi, N., Khandaker, G., & Jahan, I. (2023). Associated Impairments among Children with Cerebral Palsy in Rural Bangladesh—Findings from the Bangladesh Cerebral Palsy Register. Journal of Clinical Medicine, 12(4), Article 4.
Oliveira, J. F., Zanão, T. A., Valiengo, L., Lotufo, P. A., Benseñor, I. M., Fregni, F., & Brunoni, A. R. (2013). Acute working memory improvement after tDCS in antidepressant-free patients with major depressive disorder. Neuroscience Letters, 537, 60–64.
Rakhshan, V., Hassani-Abharian, P., Joghataei, M., Nasehi, M., & Khosrowabadi, R. (2022). Effects of the Alpha, Beta, and Gamma Binaural Beat Brain Stimulation and Short-Term Training on Simultaneously Assessed Visuospatial and Verbal Working Memories, Signal Detection Measures, Response Times, and Intrasubject Response Time Variabilities: A Within-Subject Randomized Placebo-Controlled Clinical Trial. BioMed Research International, 2022, 1–42.
Saeidmanesha, M., Shabanzadehb, R., Shabanzadeha, M., Abedini, M., Demheria, F., Yeganehfard, E., Aghaei, E., Haghighi, M. M., Alizadeh, A., & Fazeli, Z. (2023). The effect of transcranial Direct Current Stimulation on working memory and depression in mothers with deaf children. Journal of Clinical Physiotherapy Research, 8(1), e79.
Salehinejad, M. A., Vicario, C. M., Vila-Rodriguez, F., Kadosh, R. C., & Nitsche, M. A. (2021). tDCS in Child and Adolescent Psychiatry. In A. R. Brunoni, M. A. Nitsche, & C. K. Loo (Eds.), Transcranial Direct Current Stimulation in Neuropsychiatric Disorders: Clinical Principles and Management (pp. 283–312). Springer International Publishing.
Smith, K. J., Peterson, M. D., O’Connell, N. E., Victor, C., Liverani, S., Anokye, N., & Ryan, J. M. (2019). Risk of depression and anxiety in adults with cerebral palsy. JAMA Neurology, 76(3), 294–300.
Soldini, A., Vogelmann, U., Aust, S., Goerigk, S., Plewnia, C., Fallgatter, A., Normann, C., Frase, L., Zwanzger, P., Kammer, T., Schönfeldt-Lecuona, C., Vural, G., Bajbouj, M., Padberg, F., & Burkhardt, G. (2024). Neurocognitive function as outcome and predictor for prefrontal transcranial direct current stimulation in major depressive disorder: An analysis from the DepressionDC trial. European Archives of Psychiatry and Clinical Neuroscience.
Tajadini, S., Farpour, H., & Farpour, S. (2019). The Relationship Between Working Memory and Acquisition of Mathematical Strategies in Children with Cerebral Palsy: A Review of Literature. Journal of Rehabilitation Sciences & Research, 6(3), 103–108.
The Impact of Affective Information on Working Memory: A Pair of Meta-Analytic Reviews of Behavioral and Neuroimaging Evidence., 145 Psychological bulletin 566 (American Psychological Association 2019).
Tian, H., Wang, Z., Meng, Y., Geng, L., Lian, H., Shi, Z., Zhuang, Z., Cai, W., & He, M. (2025). Neural mechanisms underlying cognitive impairment in depression and cognitive benefits of exercise intervention. Behavioural Brain Research, 476, 115218.
Vöckel, J., Spitznagel, N., Markser, A., Sigrist, C., & Koenig, J. (2024). A paucity of evidence in youth: The curious case of transcranial direct current stimulation for depression. Asian Journal of Psychiatry, 91, 103838.
Wang, J., Yao, X., Ji, Y., & Li, H. (2024). Cognitive potency and safety of tDCS treatment for major depressive disorder: A systematic review and meta-analysis. Frontiers in Human Neuroscience, 18.
Warren, S. L., Heller, W., & Miller, G. A. (2021). The Structure of Executive Dysfunction in Depression and Anxiety. Journal of Affective Disorders, 279, 208–216.
Yang, S., Suh, J. H., Kwon, S., & Chang, M. C. (2022). The effect of neurologic music therapy in patients with cerebral palsy: A systematic narrative review. Frontiers in Neurology, 13.
Zhao, Q., Wang, X., Li, S.-F., Wang, P., Wang, X., Xin, X., Yin, S.-W., Yin, Z.-S., & Mao, L.-J. (2024). Relationship between physical activity and specific working memory indicators of depressive symptoms in university students. World Journal of Psychiatry, 14(1), 148–158.
Zheng, E. Z., Wong, N. M. L., Yang, A. S. Y., & Lee, T. M. C. (2024). Evaluating the effects of tDCS on depressive and anxiety symptoms from a transdiagnostic perspective: A systematic review and meta-analysis of randomized controlled trials. Translational Psychiatry, 14(1), 1–15.

  • Receive Date 21 August 2024
  • Revise Date 09 May 2025
  • Accept Date 24 May 2025