# Effects of exercise combined with brain stimulation on hand function in children with cerebral palsy: a meta-analysis of randomized controlled trials

## TL;DR

Combining exercise with brain stimulation improves hand function in children with cerebral palsy, especially with more than 16 sessions and using tDCS.

## Contribution

This study is the first meta-analysis to evaluate the combined effects of exercise and brain stimulation on hand function in children with cerebral palsy.

## Key findings

- Exercise with brain stimulation over 16 sessions significantly improves grip strength in children with CP.
- Transcranial direct current stimulation (tDCS) shows greater improvement in fine manual control compared to other brain stimulation methods.
- Fewer than 10 sessions of brain stimulation combined with exercise do not significantly improve hand function.

## Abstract

Cerebral palsy (CP) is a paediatric condition generally characterized by persistent motor disabilities in hand function. This review examined the impact of exercise with and without brain stimulation on hand function in children with CP.

A systematic literature search was conducted from January 2010 to June 2025 across four electronic databases: Web of Science, Scopus, PubMed, and EBSCO. This review established the inclusion criteria as follows: 1. Children with CP; 2. Randomised controlled trial; 3. Exercise with and without brain stimulation; 4. Measurements included gross motor function (GMF), fine manual control (FMC) and grip strength (GS) evaluated at pre- and post-intervention. The quality of the included studies was assessed using the Cochrane Risk of Bias tool. For data analysis, the standardized mean difference (SMD) was selected as the appropriate effect size index, and RevMan 5.4 software was employed to analyze the mean differences in the data extracted from the included articles. (Registration number: CRD420251106181).

The results showed that exercise with brain stimulation comprising more than 16 sessions could notably improve GS (SMD, 1.38 (0.88, 1.88), p < 0.05, I2 = 0%), whereas that comprising fewer than 10 sessions did not demonstrate a statistically significant effect (SMD, 0.19 (−0.29, 0.67), p = 0.44, I2 = 0%). Consequently, brain stimulation intervention could substantially enhance FMC (SMD, 0.46 (0.15, 0.76), p < 0.05, I2 = 47%). Subgroup analysis also presented that exercise with transcranial direct current stimulation (tDCS) resulted in a significant improvement in FMC (SMD, 0.71 (0.29, 1.14), p < 0.05, I2 = 49%) compared to exercise with repetitive transcranial magnetic stimulation (SMD, 0.19 (−0.25, 0.63), p = 0.09, I2 = 47%).

This review demonstrated that exercise with brain stimulation could significantly enhance hand function in children with CP. Specifically, more than 16 sessions has greater benefits for GS, and the tDCS may confer benefits for FMC.