# Cognitive Improvement in Children With Cerebral Palsy Following Combined Scalp Acupuncture and High-Frequency Repetitive Transcranial Magnetic Stimulation (rTMS): A Prospective Observational Study

## TL;DR

This study shows that combining scalp acupuncture with high-frequency rTMS improves cognitive function in children with cerebral palsy more effectively than acupuncture alone.

## Contribution

The novel contribution is demonstrating the added benefit of high-frequency rTMS when combined with scalp acupuncture for cognitive improvement in children with cerebral palsy.

## Key findings

- The observation group showed significantly higher total WISC scores after intervention compared to the control group.
- The combination treatment improved Perceptual Reasoning and Working Memory Index scores significantly more than acupuncture alone.
- Mean change scores in the observation group were significantly higher than in the control group.

## Abstract

Objective: To evaluate the clinical efficacy of combining scalp acupuncture and high-frequency repetitive transcranial magnetic stimulation (rTMS) for improving cognitive function in children with cerebral palsy (CP) and cognitive impairment.

Methods: In this prospective observational study, 60 children with CP and cognitive impairment were recruited from January 2023 to June 2024 at a tertiary rehabilitation center. Participants were divided into two groups (n=30 each): the observation group received scalp acupuncture plus high-frequency rTMS (3 sessions/week), while the control group received scalp acupuncture alone (same frequency). Both groups underwent concurrent routine rehabilitation (150 minutes/session, three sessions/week) for 24 weeks. Cognitive function was assessed using WISC-IV before and after intervention. Statistical analyses included t-tests, chi-square tests, and non-parametric tests.

Results: Baseline characteristics (age, gender, and disease duration) showed no differences between the two groups (p>0.05). Pre-intervention, compared with the control group, total WISC scores were higher (64.74±4.00 vs. 60.07±4.54, p＜0.001), and a greater proportion of children with mild cognitive impairment (25/30 vs. 14/30, p=0.037) were in the observation group. Post-intervention, compared with the control group, total WISC scores were higher (75.03±4.72 vs. 65.90±4.81, p＜0.001), 65.90±4.81，p＜0.001), mean change scores were increased (10.57±2.81 vs. 5.83±1.70, p＜0.001), the Perceptual Reasoning Index was higher (82.26±7.62 vs. 74.16±10.31, p＜0.001), and the Working Memory Index was higher (78.90±7.12 vs. 67.33±7.70, p＜0.001) in the observation group.

Conclusion: The combination of scalp acupuncture and high-frequency rTMS significantly enhances cognitive function in children with CP and cognitive impairment compared to scalp acupuncture alone.