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A.K. Srivastav1, S. Chatterjee2
1Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar (Deemed to be University), Neurological Physiotherapy, Ambala, India, 2Nopany Institute of Health Sciences, Neurological Physiotherapy, Kolkata, India
Background: Developmental dyscalculia (DD) deals with impaired mathematical performance and affects the educational and day-to-day activities of children. There is a scarcity of evidence that transcranial direct current stimulation (tDCS) applied to the posterior parietal cortex facilitate the hypoactive neuronal structure and improve mathematical performance in individuals with DD. The study aimed at investigating whether tDCS adjuvant with conventional numeracy training would enhance the mathematical abilities of school-going children affected with DD. The findings of this study help us to establish the rehabilitative protocol for mathematical enhancement of developmental dyscalculic children.
Purpose: To find out the effectiveness of tDCS adjuvant with conventional numeracy training to enhance mathematical performance.
Methods: Forty-five school-going children diagnosed with DD based on the DSM-5 criteria (American Psychiatric Association) were screened by the purposive sampling method. Thirty participants were selected based on the inclusion criteria to participate in a single-blinded two-group pre-test post-test randomized clinical trial. Participants aged between 8 to 17 years right-handed children diagnosed with DD as per clinicians and neuropsychologist included in the study. None of the participants had any history of neurological disease, seizures, and surgical history, or metal implantation. Participants were randomized into two groups experimental group and control group by using computer-generated randomization. Participants were allotted into one of the two groups based on concealment by random numbers. Fifteen participants were assigned to each group—participants in the study blinded during the entire process. The experimental group received, active tDCS stimulation (left anodal at P3, right cathodal at P4) with 2mA intensity up to 30 minutes, and conventional numeracy training and control group consists of sham-tDCS and conventional numeracy training. Conventional numeracy training consisted of six domains forward counting (from 01 to 50), backward counting (from 100), identification of numbers, breakdown numeracy into tens elements, counting objects, and simple calculations. To evaluate mathematical performance learning disability diagnostic inventory (LDDI) was used, at baseline, end of the 2-week post-intervention period. Lower the score higher the disability.
Results: Data represented in median and inter-quartile range as data did not follow normal distribution. The mean with 95% CI of age was 13.4 (12.7 to 14.1) years. There was no drop out in the study. Participants in experimental group had significant improvement [(31 (24, 34) - 69 (67,75)), p=0.01, effect size= 0.8] and in control group [(38 (31,43)- 65 (49,74)), p=0.01, effect size= 0.8]. Between-group comparison of experimental group and control group shows non-significant difference [(31 (24, 34) – 38 (31, 43), p=0.018, effect size=0.43), (69 (67, 75) -65 (49, 74), p=0.077, effect size= 0.32)] at the end of the 2-week intervention. Post hoc power analysis revealed that the power of the study is > 90%. Data were analyzed by the intention to treat analysis.
Conclusion(s): The result of this study suggests that tDCS adjuvant with conventional numeracy training might be beneficial in improving mathematical performance in school going DD children.
Implications: This treatment protocol can be incorporated with other therapies to improve mathematical performance. Studies should be carried out to investigate the long-term effect of interventions on different age groups.
Funding, acknowledgements: None
Keywords: Dyscalculia, Transcranial direct current stimulation, Child
Topic: Neurology
Did this work require ethics approval? Yes
Institution: Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation
Committee: IEC of MMIMS&R, Maharishi Markandeshwar (Deemed to be University)
Ethics number: IEC/MMU/2018/118, Clinical Trial Registration: CTRI/2018/07/014834
All authors, affiliations and abstracts have been published as submitted.
