Effects of non-invasive brain stimulation on gait and corticospinal plasticity in children and adolescents with cerebral palsy: A systematic review

INTRODUCTION: Cerebral palsy (CP) is the main cause of neuromotor disorders in children and is frequently associated with altered corticospinal excitability, contributing to abnormal gait patterns that limit mobility and quality of life. Therefore, gait training is central to pediatric rehabilitation. Non-invasive brain stimulation (NIBS) has emerged as a complementary modality, although evidence regarding its effects on locomotor function in children remains scarce. This review examined NIBS effects on locomotion and corticospinal excitability in pediatric populations, and mapped stimulation parameters in intervention protocols. METHODS: Following PROSPERO protocol CRD42024626430, seven databases were searched (CDSR, CENTRAL, CINAHL, Embase, MEDLINE, SPORTDiscus, and Web of Science). RESULTS: Twenty-four studies involving 725 children with CP met inclusion criteria. NIBS (mostly repetitive transcranial magnetic stimulation (rTMS), and transcranial direct current stimulation (tDCS)) may improve gait parameters (speed, cadence) and functional mobility (endurance, mobility scores). Static balance appeared to improve, whereas dynamic balance findings were inconsistent, and spasticity tended to decrease. NIBS may also enhance corticospinal excitability. tDCS follow-up studies (n=10) suggested potential long-term benefits for walking speed, balance, and mobility. Protocol heterogeneity persisted for rTMS, while tDCS protocols showed consistency (1mA, anode on primary motor cortex). CONCLUSION: Combined with lower-limb training, NIBS may improve gait speed, endurance, static balance, and functional mobility, and increase corticospinal excitability, potentially reflecting neuromodulatory effects that support functional gains. However, optimal stimulation parameters remain undetermined, particularly for rTMS, and current research is restricted to children with CP. Future studies require long-term follow-ups and neurophysiological evaluations to strengthen evidence for clinical applications.