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Shierk A, Lake A, Haas T. Review of Therapeutic Interventions for the Upper Limb Classified by Manual Ability in Children with Cerebral Palsy. Semin Plast Surg 2016; 30:14-23. [PMID: 26869859 DOI: 10.1055/s-0035-1571256] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The aim of this literature review was to assemble an inventory of intervention strategies utilized for children diagnosed with cerebral palsy (CP) based on the Manual Ability Classification System (MACS). The purpose of the inventory is to guide physicians and therapists in intervention selection aimed at improving upper limb function in children with CP. The following databases were searched: CINAHL (Cumulative Index to Nursing and Allied Health Literature), Cochrane Database of Systematic Reviews, ERIC (Educational Research Information Center), Google Scholar, OTSeeker (Occupational Therapy Systematic Evaluation of Evidence), OVID (Ovid Technologies, Inc.), and PubMed. Inclusion criteria were whether the study (1) identified MACS levels of participants, and (2) addressed the effectiveness of intervention on upper limb function. Overall, 74 articles met the inclusion criteria. The summarized data identified 10 categories of intervention. The majority of participants across studies were MACS level II. The most frequently cited interventions were constraint-induced movement therapy (CIMT), bimanual training, and virtual reality and computer-based training. Multiple interventions demonstrated effectiveness for upper limb improvement at each MACS level. However, there is a need for additional research for interventions appropriate for MACS levels IV and V. To fully develop an intervention inventory based on manual ability, future studies need to report MACS levels of participants, particularly for splinting and therapy interventions used in combination with surgery.
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Affiliation(s)
- Angela Shierk
- Occupational Therapy, Texas Scottish Rite Hospital for Children, Dallas, Texas
| | - Amy Lake
- Occupational Therapy, Texas Scottish Rite Hospital for Children, Dallas, Texas
| | - Tara Haas
- Physical Medicine and Rehabilitation, Texas Children's Hospital, Houston, Texas
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Friel KM, Kuo HC, Fuller J, Ferre CL, Brandão M, Carmel JB, Bleyenheuft Y, Gowatsky JL, Stanford AD, Rowny SB, Luber B, Bassi B, Murphy DLK, Lisanby SH, Gordon AM. Skilled Bimanual Training Drives Motor Cortex Plasticity in Children With Unilateral Cerebral Palsy. Neurorehabil Neural Repair 2016; 30:834-44. [PMID: 26867559 DOI: 10.1177/1545968315625838] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Intensive bimanual therapy can improve hand function in children with unilateral spastic cerebral palsy (USCP). We compared the effects of structured bimanual skill training versus unstructured bimanual practice on motor outcomes and motor map plasticity in children with USCP. Objective We hypothesized that structured skill training would produce greater motor map plasticity than unstructured practice. Methods Twenty children with USCP (average age 9.5; 12 males) received therapy in a day camp setting, 6 h/day, 5 days/week, for 3 weeks. In structured skill training (n = 10), children performed progressively more difficult movements and practiced functional goals. In unstructured practice (n = 10), children engaged in bimanual activities but did not practice skillful movements or functional goals. We used the Assisting Hand Assessment (AHA), Jebsen-Taylor Test of Hand Function (JTTHF), and Canadian Occupational Performance Measure (COPM) to measure hand function. We used single-pulse transcranial magnetic stimulation to map the representation of first dorsal interosseous and flexor carpi radialis muscles bilaterally. Results Both groups showed significant improvements in bimanual hand use (AHA; P < .05) and hand dexterity (JTTHF; P < .001). However, only the structured skill group showed increases in the size of the affected hand motor map and amplitudes of motor evoked potentials (P < .01). Most children who showed the most functional improvements (COPM) had the largest changes in map size. Conclusions These findings uncover a dichotomy of plasticity: the unstructured practice group improved hand function but did not show changes in motor maps. Skill training is important for driving motor cortex plasticity in children with USCP.
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Affiliation(s)
- Kathleen M Friel
- Burke-Cornell Medical Research Institute, White Plains, NY, USA Teachers College, Columbia University, New York, NY, USA Weill Cornell Medical College, New York, NY, USA
| | | | - Jason Fuller
- Burke-Cornell Medical Research Institute, White Plains, NY, USA New York University, New York, NY, USA
| | | | - Marina Brandão
- Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Jason B Carmel
- Burke-Cornell Medical Research Institute, White Plains, NY, USA Weill Cornell Medical College, New York, NY, USA
| | | | | | | | | | | | - Bruce Bassi
- Columbia University Medical Center, New York, NY, USA
| | | | - Sarah H Lisanby
- Division of Translational Research, National Institutes of Health, Bethesda, MD, USA
| | - Andrew M Gordon
- Teachers College, Columbia University, New York, NY, USA Columbia University Medical Center, New York, NY, USA
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Kuo HC, Gordon AM, Henrionnet A, Hautfenne S, Friel KM, Bleyenheuft Y. The effects of intensive bimanual training with and without tactile training on tactile function in children with unilateral spastic cerebral palsy: A pilot study. RESEARCH IN DEVELOPMENTAL DISABILITIES 2016; 49-50:129-139. [PMID: 26698408 PMCID: PMC4871715 DOI: 10.1016/j.ridd.2015.11.024] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 11/23/2015] [Accepted: 11/25/2015] [Indexed: 06/05/2023]
Abstract
Children with unilateral spastic cerebral palsy (USCP) often have tactile impairments. Intensive bimanual training improves the motor abilities, but the effects on the sensory system have not been studied. Here we compare the effects of bimanual training with and without tactile training on tactile impairments. Twenty children with USCP (6-15.5 years; MACS: I-III) were randomized to receive either bimanual therapy (HABIT) or HABIT+tactile training (HABIT+T). All participants received 82 h of standardized HABIT. In addition 8 sessions of 1h were provided to both groups. The HABIT+T group received tactile training (without vision) using materials of varied shapes and textures. The HABIT group received training with the same materials without tactile directed training (full vision). Primary outcomes included grating orientation task/GOT and stereognosis. Secondary outcomes included two-point discrimination/TPD, Semmes-Weinstein monofilaments/SWM. The GOT improved in both groups after training, while stereognosis of the more-affected hand tended to improve (but p=0.063). No changes were found in the TPD and the SWM. There were no group×test interactions for any measure. We conclude tactile spatial resolution can improve after bimanual training. Either intensive bimanual training alone or incorporation of materials with a diversity of shapes/textures may drive these changes.
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Affiliation(s)
- Hsing-Ching Kuo
- Department of Biobehavioral Sciences, Teachers College, Columbia University, 525 West 120th Street, Box 93, New York, NY 10027, USA.
| | - Andrew M Gordon
- Department of Biobehavioral Sciences, Teachers College, Columbia University, 525 West 120th Street, Box 93, New York, NY 10027, USA.
| | - Aline Henrionnet
- Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium.
| | - Sylvie Hautfenne
- Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium.
| | - Kathleen M Friel
- Burke-Cornell Medical Research Institute, 785 Mamaroneck Avenue, White Plains, NY 10605, USA; Brain-Mind Research Institute, Weill Cornell Medical College, 1300 York Ave, New York, NY 10021, USA.
| | - Yannick Bleyenheuft
- Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium.
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Interpreting Intervention Induced Neuroplasticity with fMRI: The Case for Multimodal Imaging Strategies. Neural Plast 2015; 2016:2643491. [PMID: 26839711 PMCID: PMC4709757 DOI: 10.1155/2016/2643491] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 09/27/2015] [Indexed: 12/03/2022] Open
Abstract
Direct measurement of recovery from brain injury is an important goal in neurorehabilitation, and requires reliable, objective, and interpretable measures of changes in brain function, referred to generally as “neuroplasticity.” One popular imaging modality for measuring neuroplasticity is task-based functional magnetic resonance imaging (t-fMRI). In the field of neurorehabilitation, however, assessing neuroplasticity using t-fMRI presents a significant challenge. This commentary reviews t-fMRI changes commonly reported in patients with cerebral palsy or acquired brain injuries, with a focus on studies of motor rehabilitation, and discusses complexities surrounding their interpretations. Specifically, we discuss the difficulties in interpreting t-fMRI changes in terms of their underlying causes, that is, differentiating whether they reflect genuine reorganisation, neurological restoration, compensation, use of preexisting redundancies, changes in strategy, or maladaptive processes. Furthermore, we discuss the impact of heterogeneous disease states and essential t-fMRI processing steps on the interpretability of activation patterns. To better understand therapy-induced neuroplastic changes, we suggest that researchers utilising t-fMRI consider concurrently acquiring information from an additional modality, to quantify, for example, haemodynamic differences or microstructural changes. We outline a variety of such supplementary measures for investigating brain reorganisation and discuss situations in which they may prove beneficial to the interpretation of t-fMRI data.
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Chorna O, Heathcock J, Key A, Noritz G, Carey H, Hamm E, Nelin MA, Murray M, Needham A, Slaughter JC, Maitre NL. Early childhood constraint therapy for sensory/motor impairment in cerebral palsy: a randomised clinical trial protocol. BMJ Open 2015; 5:e010212. [PMID: 26644127 PMCID: PMC4679990 DOI: 10.1136/bmjopen-2015-010212] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Cerebral palsy (CP) is the most common physical disability in childhood. It is a disorder resulting from sensory and motor impairments due to perinatal brain injury, with lifetime consequences that range from poor adaptive and social function to communication and emotional disturbances. Infants with CP have a fundamental disadvantage in recovering motor function: they do not receive accurate sensory feedback from their movements, leading to developmental disregard. Constraint-induced movement therapy (CIMT) is one of the few effective neurorehabilitative strategies shown to improve upper extremity motor function in adults and older children with CP, potentially overcoming developmental disregard. METHODS AND ANALYSIS This study is a randomised controlled trial of children 12-24 months corrected age studying the effectiveness of CIMT combined with motor and sensory-motor interventions. The study population will comprise 72 children with CP and 144 typically developing children for a total of N=216 children. All children with CP, regardless of group allocation will continue with their standard of care occupational and physical therapy throughout the study. The research material collected will be in the form of data from high-density array event-related potential scan, standardised assessment scores and motion analysis scores. ETHICS AND DISSEMINATION The study protocol was approved by the Institutional Review Board. The findings of the trial will be disseminated through peer-reviewed journals and scientific conferences. TRIAL REGISTRATION NUMBER NCT02567630.
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Affiliation(s)
- Olena Chorna
- The Perinatal Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Jill Heathcock
- Department of Allied Health and Rehabilitation Sciences, The Ohio State University, Columbus, Ohio, USA
| | - Alexandra Key
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Garey Noritz
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Helen Carey
- The Perinatal Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Ellyn Hamm
- The Perinatal Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Mary Ann Nelin
- The Perinatal Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Micah Murray
- Department of Clinical Neurosciences and Department of Radiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Amy Needham
- Department of Psychology, Vanderbilt University, Nashville, Tennessee, USA
| | - James C Slaughter
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Nathalie L Maitre
- The Perinatal Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
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Cassidy JM, Carey JR, Lu C, Krach LE, Feyma T, Durfee WK, Gillick BT. Ipsilesional motor-evoked potential absence in pediatric hemiparesis impacts tracking accuracy of the less affected hand. RESEARCH IN DEVELOPMENTAL DISABILITIES 2015; 47:154-164. [PMID: 26426515 PMCID: PMC4670029 DOI: 10.1016/j.ridd.2015.09.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 09/01/2015] [Accepted: 09/14/2015] [Indexed: 06/05/2023]
Abstract
This study analyzed the relationship between electrophysiological responses to transcranial magnetic stimulation (TMS), finger tracking accuracy, and volume of neural substrate in children with congenital hemiparesis. Nineteen participants demonstrating an ipsilesional motor-evoked potential (MEP) were compared with eleven participants showing an absent ipsilesional MEP response. Comparisons of finger tracking accuracy from the affected and less affected hands and ipsilesional/contralesional (I/C) volume ratio for the primary motor cortex (M1) and posterior limb of internal capsule (PLIC) were done using two-sample t-tests. Participants showing an ipsilesional MEP response demonstrated superior tracking performance from the less affected hand (p=0.016) and significantly higher I/C volume ratios for M1 (p=0.028) and PLIC (p=0.005) compared to participants without an ipsilesional MEP response. Group differences in finger tracking accuracy from the affected hand were not significant. These results highlight differentiating factors amongst children with congenital hemiparesis showing contrasting MEP responses: less affected hand performance and preserved M1 and PLIC volume. Along with MEP status, these factors pose important clinical implications in pediatric stroke rehabilitation. These findings may also reflect competitive developmental processes associated with the preservation of affected hand function at the expense of some function in the less affected hand.
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Affiliation(s)
- Jessica M Cassidy
- Department of Physical Medicine and Rehabilitation, University of Minnesota, Minneapolis, MN, United States.
| | - James R Carey
- Department of Physical Medicine and Rehabilitation, University of Minnesota, Minneapolis, MN, United States
| | - Chiahao Lu
- Department of Neurology, University of Minnesota, Minneapolis, MN, United States
| | - Linda E Krach
- Courage Kenny Rehabilitation Institute, Minneapolis, MN, United States
| | - Tim Feyma
- Pediatric Neurology, Gillette Children's Specialty Healthcare, Saint Paul, MN, United States
| | - William K Durfee
- Department of Mechanical Engineering, University of Minnesota, Minneapolis, MN, United States
| | - Bernadette T Gillick
- Department of Physical Medicine and Rehabilitation, University of Minnesota, Minneapolis, MN, United States
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Schertz M, Shiran SI, Myers V, Weinstein M, Fattal-Valevski A, Artzi M, Ben Bashat D, Gordon AM, Green D. Imaging Predictors of Improvement From a Motor Learning-Based Intervention for Children With Unilateral Cerebral Palsy. Neurorehabil Neural Repair 2015; 30:647-60. [PMID: 26564999 DOI: 10.1177/1545968315613446] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Motor-learning interventions may improve hand function in children with unilateral cerebral palsy (UCP) but with inconsistent outcomes across participants. Objective To examine if pre-intervention brain imaging predicts benefit from bimanual intervention. Method Twenty children with UCP with Manual Ability Classification System levels I to III, aged 7-16 years, participated in an intensive bimanual intervention. Assessments included the Assisting Hand Assessment (AHA), Jebsen Taylor Test of Hand Function (JTTHF) and Children's Hand Experience Questionnaire (CHEQ) at baseline (T1), completion (T2) and 8-10 weeks post-intervention (T3). Imaging at baseline included conventional structural (radiological score), functional (fMRI) and diffusion tensor imaging (DTI). Results Improvements were seen across assessments; AHA (P = 0.04), JTTHF (P < .001) and CHEQ (P < 0.001). Radiological score significantly correlated with improvement at T2; AHA (r = .475) and CHEQ (r = .632), but negatively with improvement on unimanual measures at T3 (JTTFH r = -.514). fMRI showed negative correlations between contralesional brain activation when moving the affected hand and AHA improvements (T2: r = -.562, T3: r = -0.479). Fractional Anisotropy in the affected posterior limb of the internal capsule correlated negatively with increased bimanual use on CHEQ at T2 (r = -547) and AHA at T3 (r = -.656). Conclusions Children with greater structural, functional and connective brain damage showed enhanced responses to bimanual intervention. Baseline imaging may identify parameters predicting response to intervention in children with UCP.
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Affiliation(s)
- Mitchell Schertz
- Child Development and Pediatric Neurology Service, Meuhedet-Northern Region, Haifa, Israel Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | | - Vicki Myers
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Maya Weinstein
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel Bar Ilan University, Ramat Gan, Israel
| | | | - Moran Artzi
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Dafna Ben Bashat
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel Tel Aviv University, Tel Aviv, Israel
| | | | - Dido Green
- Tel Aviv University, Tel Aviv, Israel Oxford Brookes University, Oxford, UK
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Brain Plasticity following Intensive Bimanual Therapy in Children with Hemiparesis: Preliminary Evidence. Neural Plast 2015; 2015:798481. [PMID: 26640717 PMCID: PMC4657087 DOI: 10.1155/2015/798481] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 06/10/2015] [Accepted: 06/11/2015] [Indexed: 11/17/2022] Open
Abstract
Neuroplasticity studies examining children with hemiparesis (CH) have focused predominantly on unilateral interventions. CH also have bimanual coordination impairments with bimanual interventions showing benefits. We explored neuroplasticity following hand-arm bimanual intensive therapy (HABIT) of 60 hours in twelve CH (6 females, mean age 11 ± 3.6 y). Serial behavioral evaluations and MR imaging including diffusion tensor (DTI) and functional (fMRI) imaging were performed before, immediately after, and at 6-week follow-up. Manual skills were assessed repeatedly with the Assisting Hand Assessment, Children's Hand Experience Questionnaire, and Jebsen-Taylor Test of Hand Function. Beta values, indicating the level of activation, and lateralization index (LI), indicating the pattern of brain activation, were computed from fMRI. White matter integrity of major fibers was assessed using DTI. 11/12 children showed improvement after intervention in at least one measure, with 8/12 improving on two or more tests. Changes were retained in 6/8 children at follow-up. Beta activation in the affected hemisphere increased at follow-up, and LI increased both after intervention and at follow-up. Correlations between LI and motor function emerged after intervention. Increased white matter integrity was detected in the corpus callosum and corticospinal tract after intervention in about half of the participants. Results provide first evidence for neuroplasticity changes following bimanual intervention in CH.
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Adler C, Berweck S, Lidzba K, Becher T, Staudt M. Mirror movements in unilateral spastic cerebral palsy: Specific negative impact on bimanual activities of daily living. Eur J Paediatr Neurol 2015; 19:504-9. [PMID: 26004994 DOI: 10.1016/j.ejpn.2015.03.007] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Revised: 03/15/2015] [Accepted: 03/16/2015] [Indexed: 11/24/2022]
Abstract
AIM Mirror movements are involuntary movements of the other hand during voluntary unimanual movements. Some, but not all children with unilateral spastic cerebral palsy (USCP) show this phenomenon. In this observational study, we investigated whether these mirror movements have a specific negative impact on bimanual activities of daily living. METHODS Eighteen children (six girls; age range, 6-16 years; mean age, 12 years 1 month; SD, 3 years 3 month) with USCP, nine with and nine without mirror movements, underwent the Jebsen Taylor Hand Function Test (unimanual capacity) and the Assisting Hand Assessment (bimanual performance). In addition, we measured the time the participants needed for the completion of five activities we had identified as particularly difficult for children with mirror movements. RESULTS Multivariate analysis demonstrated that mirror movements indeed have a specific negative impact on bimanual performance (Assisting Hand Assessment) and on the time needed for the completion of these five particularly difficult activities. This effect was independent from unimanual capacity. CONCLUSION Functional therapies in children with USCP and mirror movements should address this phenomenon.
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Affiliation(s)
- Caroline Adler
- Clinic for Neuropediatrics and Neurorehabilitation, Epilepsy Center for Children and Adolescents, Schön Klinik Vogtareuth, Germany; Dept. Pediatric Neurology and Developmental Medicine, University Children's Hospital, Tübingen, Germany
| | - Steffen Berweck
- Clinic for Neuropediatrics and Neurorehabilitation, Epilepsy Center for Children and Adolescents, Schön Klinik Vogtareuth, Germany; Dr. von Hauners Children's Hospital, Ludwig-Maximilians-University Munich, Germany
| | - Karen Lidzba
- Dept. Pediatric Neurology and Developmental Medicine, University Children's Hospital, Tübingen, Germany
| | - Thomas Becher
- Center for Child Neurology, Sana Klinik Düsseldorf, Germany
| | - Martin Staudt
- Clinic for Neuropediatrics and Neurorehabilitation, Epilepsy Center for Children and Adolescents, Schön Klinik Vogtareuth, Germany; Dept. Pediatric Neurology and Developmental Medicine, University Children's Hospital, Tübingen, Germany.
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Bleyenheuft Y, Dricot L, Gilis N, Kuo HC, Grandin C, Bleyenheuft C, Gordon AM, Friel KM. Capturing neuroplastic changes after bimanual intensive rehabilitation in children with unilateral spastic cerebral palsy: A combined DTI, TMS and fMRI pilot study. RESEARCH IN DEVELOPMENTAL DISABILITIES 2015; 43-44:136-49. [PMID: 26183338 PMCID: PMC4871716 DOI: 10.1016/j.ridd.2015.06.014] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 06/25/2015] [Accepted: 06/29/2015] [Indexed: 05/25/2023]
Abstract
Intensive rehabilitation interventions have been shown to be efficacious in improving upper extremity function in children with unilateral spastic cerebral palsy (USCP). These interventions are based on motor learning principles and engage children in skillful movements. Improvements in upper extremity function are believed to be associated with neuroplastic changes. However, these neuroplastic changes have not been well-described in children with cerebral palsy, likely due to challenges in defining and implementing the optimal tools and tests in children. Here we documented the implementation of three different neurological assessments (diffusion tensor imaging-DTI, transcranial magnetic stimulation-TMS and functional magnetic resonance imaging-fMRI) before and after a bimanual intensive treatment (HABIT-ILE) in two children with USCP presenting differential corticospinal developmental reorganization (ipsilateral and contralateral). The aim of the study was to capture neurophysiological changes and to document the complementary relationship between these measures, the potential measurable changes and the feasibility of applying these techniques in children with USCP. Independent of cortical reorganization, both children showed increases in activation and size of the motor areas controlling the affected hand, quantified with different techniques. In addition, fMRI provided additional unexpected changes in the reward circuit while using the affected hand.
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Affiliation(s)
- Yannick Bleyenheuft
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium.
| | - Laurence Dricot
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
| | - Nathalie Gilis
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
| | - Hsing-Ching Kuo
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, USA
| | - Cécile Grandin
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium; Radioloy Service, Clinques Universitaires Saint-Luc, Brussels, Belgium
| | - Corinne Bleyenheuft
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium; Physical Medicine and Rehabilitation Service, CHU Mont-Godinne, Yvoir, Belgium
| | - Andrew M Gordon
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, USA
| | - Kathleen M Friel
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, USA; Burke-Cornell Medical Research Institute, White Plains, NY, USA
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Panteliadis CP, Hagel C, Karch D, Heinemann K. Cerebral Palsy: A Lifelong Challenge Asks for Early Intervention. Open Neurol J 2015; 9:45-52. [PMID: 26191093 PMCID: PMC4503828 DOI: 10.2174/1874205x01509010045] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 03/09/2015] [Accepted: 04/05/2015] [Indexed: 01/03/2023] Open
Abstract
One of the oldest and probably well-known examples of cerebral palsy is the mummy of the Pharaoh Siptah about 1196-1190 B.C., and a letter from Hippocrates (460-390 B.C.). Cerebral palsy (CP) is one of the most common congenital or acquired neurological impairments in paediatric patients, and refers to a group of children with motor disability and related functional defects. The visible core of CP is characterized by abnormal coordination of movements and/or muscle tone which manifest very early in the development. Resulting from pre- or perinatal brain damage CP is not a progressive condition per se. However, without systematic medical and physiotherapeutic support the dystonia leads to muscle contractions and to deterioration of the handicap. Here we review the three general spastic manifestations of CP hemiplegia, diplegia and tetraplegia, describe the diagnostic procedures and delineate a time schedule for an early intervention.
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Affiliation(s)
- Christos P Panteliadis
- Paediatric, Division of Paediatric Neurology and Developmental Medicine, Aristotle University of Thessaloniki, Greece
| | - Christian Hagel
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Germany
| | - Dieter Karch
- Clinic of Paediatric Neurology and Social Paediatrics, Children Centre Maulbronn, Germany
| | - Karl Heinemann
- Clinic of Paediatric Neurology and Social Paediatrics, Children Centre Maulbronn, Germany
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Cao J, Khan B, Hervey N, Tian F, Delgado MR, Clegg NJ, Smith L, Roberts H, Tulchin-Francis K, Shierk A, Shagman L, MacFarlane D, Liu H, Alexandrakis G. Evaluation of cortical plasticity in children with cerebral palsy undergoing constraint-induced movement therapy based on functional near-infrared spectroscopy. JOURNAL OF BIOMEDICAL OPTICS 2015; 20:046009. [PMID: 25900145 PMCID: PMC4479242 DOI: 10.1117/1.jbo.20.4.046009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 03/30/2015] [Indexed: 05/04/2023]
Abstract
Sensorimotor cortex plasticity induced by constraint-induced movement therapy (CIMT) in six children (10.2±2.1 years old) with hemiplegic cerebral palsy was assessed by functional near-infrared spectroscopy (fNIRS). The activation laterality index and time-to-peak/duration during a finger-tapping task and the resting-state functional connectivity were quantified before, immediately after, and 6 months after CIMT. These fNIRS-based metrics were used to help explain changes in clinical scores of manual performance obtained concurrently with imaging time points. Five age-matched healthy children (9.8±1.3 years old) were also imaged to provide comparative activation metrics for normal controls. Interestingly, the activation time-to-peak/duration for all sensorimotor centers displayed significant normalization immediately after CIMT that persisted 6 months later. In contrast to this improved localized activation response, the laterality index and resting-state connectivity metrics that depended on communication between sensorimotor centers improved immediately after CIMT, but relapsed 6 months later. In addition, for the subjects measured in this work, there was either a trade-off between improving unimanual versus bimanual performance when sensorimotor activation patterns normalized after CIMT, or an improvement occurred in both unimanual and bimanual performance but at the cost of very abnormal plastic changes in sensorimotor activity.
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Affiliation(s)
- Jianwei Cao
- University of Texas at Arlington and University of Texas Southwestern Medical Center at Dallas, Joint Graduate Program in Biomedical Engineering, Arlington, Texas 76010, United States
| | - Bilal Khan
- University of Texas at Arlington and University of Texas Southwestern Medical Center at Dallas, Joint Graduate Program in Biomedical Engineering, Arlington, Texas 76010, United States
| | - Nathan Hervey
- University of Texas at Arlington and University of Texas Southwestern Medical Center at Dallas, Joint Graduate Program in Biomedical Engineering, Arlington, Texas 76010, United States
| | - Fenghua Tian
- University of Texas at Arlington and University of Texas Southwestern Medical Center at Dallas, Joint Graduate Program in Biomedical Engineering, Arlington, Texas 76010, United States
| | - Mauricio R. Delgado
- Texas Scottish Rite Hospital for Children, Department of Neurology, Dallas, Texas 75219, United States
- University of Texas Southwestern Medical Center at Dallas, Department of Neurology, Dallas, Texas 75235, United States
| | - Nancy J. Clegg
- Texas Scottish Rite Hospital for Children, Department of Neurology, Dallas, Texas 75219, United States
| | - Linsley Smith
- Texas Scottish Rite Hospital for Children, Department of Neurology, Dallas, Texas 75219, United States
| | - Heather Roberts
- Texas Scottish Rite Hospital for Children, Department of Neurology, Dallas, Texas 75219, United States
| | - Kirsten Tulchin-Francis
- Texas Scottish Rite Hospital for Children, Department of Neurology, Dallas, Texas 75219, United States
| | - Angela Shierk
- Texas Scottish Rite Hospital for Children, Department of Neurology, Dallas, Texas 75219, United States
| | - Laura Shagman
- University of Texas at Dallas, Department of Electrical Engineering, Richardson, Texas 75080, United States
| | - Duncan MacFarlane
- University of Texas at Dallas, Department of Electrical Engineering, Richardson, Texas 75080, United States
| | - Hanli Liu
- University of Texas at Arlington and University of Texas Southwestern Medical Center at Dallas, Joint Graduate Program in Biomedical Engineering, Arlington, Texas 76010, United States
| | - George Alexandrakis
- University of Texas at Arlington and University of Texas Southwestern Medical Center at Dallas, Joint Graduate Program in Biomedical Engineering, Arlington, Texas 76010, United States
- Address all correspondence to: George Alexandrakis, E-mail:
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Jaspers E, Byblow WD, Feys H, Wenderoth N. The Corticospinal Tract: A Biomarker to Categorize Upper Limb Functional Potential in Unilateral Cerebral Palsy. Front Pediatr 2015; 3:112. [PMID: 26779464 PMCID: PMC4701904 DOI: 10.3389/fped.2015.00112] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 12/07/2015] [Indexed: 11/13/2022] Open
Abstract
Children with unilateral cerebral palsy (CP) typically present with largely divergent upper limb sensorimotor deficits and individual differences in response to upper limb rehabilitation. This review summarizes how early brain damage can cause dramatic deviations from the normal anatomy of sensory and motor tracts, resulting in unique "wiring patterns" of the sensorimotor system in CP. Based on the existing literature, we suggest that corticospinal tract (CST) anatomy and integrity constrains sensorimotor function of the upper limb and potentially also the response to treatment. However, it is not possible to infer CST (re)organization from clinical presentation alone and conventional biomarkers, such as time of insult, location, and lesion extent seem to have limited clinical utility. Here, we propose a theoretical framework based on a detailed examination of the motor system using behavioral, neurophysiological, and magnetic resonance imaging measures, akin to those used to predict potential for upper limb recovery of adults after stroke. This theoretical framework might prove useful because it provides testable hypotheses for future research with the goal to develop and validate a clinical assessment flowchart to categorize children with unilateral CP.
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Affiliation(s)
- Ellen Jaspers
- Neural Control of Movement Laboratory, Department of Health Sciences and Technology, ETH Zurich , Zurich , Switzerland
| | - Winston D Byblow
- Movement Neuroscience Laboratory, Department of Sport and Exercise Science, University of Auckland , Auckland , New Zealand
| | - Hilde Feys
- KU Leuven, Department of Rehabilitation Sciences, Research Group of Neuromotor Rehabilitation , Leuven , Belgium
| | - Nicole Wenderoth
- Neural Control of Movement Laboratory, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland; KU Leuven, Department of Kinesiology, Movement Control and Neuroplasticity Research Group, Leuven, Belgium
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Forsyth R, Basu A. The promotion of recovery through rehabilitation after acquired brain injury in children. Dev Med Child Neurol 2015; 57:16-22. [PMID: 25200439 DOI: 10.1111/dmcn.12575] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/15/2014] [Indexed: 12/12/2022]
Abstract
A degree of motor recovery is typically seen after acquired brain injury in children. The extent to which rehabilitation efforts can claim credit for this is disputed. Strong correlations between late impairment outcomes and early severity and impairment indices are seen both in adults and children. These correlations have been interpreted by some as evidence that recovery is largely intrinsic and that any additional rehabilitation effects are small. Such views are belied by published animal studies demonstrating the possibility of large rehabilitation effects. Animal models suggest that to achieve similar rehabilitation treatment effect sizes in clinical practice, rehabilitation 'doses' should be greater, rehabilitation efforts should start sooner, and premature accommodation of impairment should be avoided.
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Affiliation(s)
- Rob Forsyth
- Institute of Neuroscience, Sir James Spence Institute, Royal Victoria Infirmary, Newcastle University, Newcastle upon Tyne, Newcastle, UK
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Noninvasive brain stimulation: the potential for use in the rehabilitation of pediatric acquired brain injury. Arch Phys Med Rehabil 2014; 96:S129-37. [PMID: 25448248 DOI: 10.1016/j.apmr.2014.10.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 10/12/2014] [Accepted: 10/16/2014] [Indexed: 02/03/2023]
Abstract
Noninvasive brain stimulation (NIBS) offers the potential to modulate neural activity and recovery after acquired brain injury. There are few studies of NIBS in children, but a survey of those studies might provide insight into the potential for NIBS to modulate motor rehabilitation, seizures, and behavior in children. We surveyed the published literature prior to July 2014 for articles pertaining to children and NIBS with a focus on case series or trials. We also reviewed selected articles involving adults to illustrate specific points where the literature in children is lacking. A limited number of articles suggest that NIBS can transiently improve motor function. The evidence for an effect on seizures is mixed. Two open-label studies reported improvement of mood in adolescents with depression. NIBS may serve as a tool for pediatric neurorehabilitation, but many gaps in our knowledge must be filled before NIBS can be adopted as a clinical intervention. To move forward, the field needs adequately powered trials that can answer these questions. Such trials will be challenging to perform, will likely require multicenter collaboration, and may need to adopt novel trial designs that have been used with rare disorders.
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Juenger H, Koerte IK, Muehlmann M, Mayinger M, Mall V, Krägeloh-Mann I, Shenton ME, Berweck S, Staudt M, Heinen F. Microstructure of transcallosal motor fibers reflects type of cortical (re-)organization in congenital hemiparesis. Eur J Paediatr Neurol 2014; 18:691-7. [PMID: 24993149 DOI: 10.1016/j.ejpn.2014.05.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 05/08/2014] [Accepted: 05/18/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Early unilateral brain lesions can lead to different types of corticospinal (re-)organization of motor networks. In one group of patients, the contralesional hemisphere exerts motor control not only over the contralateral non-paretic hand but also over the (ipsilateral) paretic hand, as the primary motor cortex is (re-)organized in the contralesional hemisphere. Another group of patients with early unilateral lesions shows "normal" contralateral motor projections starting in the lesioned hemisphere. AIM We investigated how these different patterns of cortical (re-)organization affect interhemispheric transcallosal connectivity in patients with congenital hemiparesis. METHOD Eight patients with ipsilateral motor projections (group IPSI) versus 7 patients with contralateral motor projections (group CONTRA) underwent magnetic resonance diffusion tensor imaging (DTI). The corpus callosum (CC) was subdivided in 5 areas (I-V) in the mid-sagittal slice and volumetric information. The following diffusion parameters were calculated: fractional anisotropy (FA), trace, radial diffusivity (RD), and axial diffusivity (AD). RESULTS DTI revealed significantly lower FA, increased trace and RD for group IPSI compared to group CONTRA in area III of the corpus callosum, where transcallosal motor fibers cross the CC. In the directly neighboring area IV, where transcallosal somatosensory fibers cross the CC, no differences were found for these DTI parameters between IPSI and CONTRA. Volume of callosal subsections showed significant differences for area II (connecting premotor cortices) and III, where group IPSI had lower volume. INTERPRETATION The results of this study demonstrate that the callosal microstructure in patients with congenital hemiparesis reflects the type of cortical (re-)organization. Early lesions disrupting corticospinal motor projections to the paretic hand consecutively affect the development or maintenance of transcallosal motor fibers.
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Affiliation(s)
- Hendrik Juenger
- Department of Pediatrics, Klinikum rechts der Isar, Technical University Munich, Koelner Platz 1, 80804 Munich, Germany; Department of Pediatric Neurology and Developmental Medicine, University Children's Hospital, Tübingen, Germany.
| | - Inga K Koerte
- Psychiatry Neuroimaging Laboratory, Department of Radiology and Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, USA; Institute for Clinical Radiology, Ludwig-Maximilian-University, Munich, Germany; Department of Child and Adolescent Psychiatry, Psychosomatic and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Marc Muehlmann
- Institute for Clinical Radiology, Ludwig-Maximilian-University, Munich, Germany; Psychiatry Neuroimaging Laboratory, Department of Radiology and Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, USA; Department of Child and Adolescent Psychiatry, Psychosomatic and Psychotherapy, Ludwig-Maximilian-University, Munich, Germany
| | - Michael Mayinger
- Institute for Clinical Radiology, Ludwig-Maximilian-University, Munich, Germany; Psychiatry Neuroimaging Laboratory, Department of Radiology and Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Volker Mall
- Social Pediatrics and Developmental Medicine, Klinikum rechts der Isar, Technical University Munich, Koelner Platz 1, 80804 Munich, Germany
| | - Ingeborg Krägeloh-Mann
- Department of Pediatric Neurology and Developmental Medicine, University Children's Hospital, Tübingen, Germany
| | - Martha E Shenton
- Psychiatry Neuroimaging Laboratory, Department of Radiology and Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, USA; Veterans Affairs (VA) Boston Healthcare System, Brockton, MA, USA
| | - Steffen Berweck
- Clinic for Neuropediatrics and Neurorehabilitation, Epilepsy Center for Children and Adolescents, Krankenhausstr. 20, 83569 Vogtareuth, Germany
| | - Martin Staudt
- Department of Pediatric Neurology and Developmental Medicine, University Children's Hospital, Tübingen, Germany; Clinic for Neuropediatrics and Neurorehabilitation, Epilepsy Center for Children and Adolescents, Krankenhausstr. 20, 83569 Vogtareuth, Germany
| | - Florian Heinen
- Department of Pediatric Neurology and Developmental Medicine, Hauner Children's Hospital, Ludwig-Maximilian-University, Munich, Germany; German Center for Vertigo and Balance Disorders, University of Munich, Munich, Germany
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Intraoperative brain mapping to identify corticospinal projections during resective epilepsy surgery in children with congenital hemiparesis. Childs Nerv Syst 2014; 30:1559-64. [PMID: 24825575 DOI: 10.1007/s00381-014-2436-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Accepted: 05/05/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE The purpose of the study is to determine corticospinal organization using intraoperative neurophysiologic monitoring (IONM) during resective epilepsy surgery for patients with congenital hemiparesis and intractable epilepsy. METHODS Ten patients, aged 3-17, with intractable epilepsy underwent resective surgery. Transcranial stimulation (TCS) was achieved using a pair of cork screws at Cz and C3/C4, respectively. A 1 × 4 stimulating electrode strip was placed on the presumed motor cortex of the affected hemisphere for direct cortical stimulation (DCS) after craniotomy. Multipulse TCS and DCS train stimulation was delivered, with simultaneous recordings from bilateral abductor pollicis brevis and abductor halluces, to determine the corticospinal projection pattern of the paretic limbs. RESULTS The above mapping techniques revealed ipsilateral corticospinal projections from the contralesional hemisphere to target muscles in the paretic limbs in three patients, projections from both hemispheres to target muscles in three, and preserved crossed projections from the affected hemisphere in four. Nine patients were seizure free after surgery. Five had unchanged postoperative functional status, and three showed minimally improved use of the paretic hand. Two developed new motor deficits after surgery, which may have been due to a premotor syndrome in one patient, since it completely resolved within 2 weeks. The other experienced increased weakness of the paretic lower limb because a small part of the eloquent cortex was removed for better seizure control. CONCLUSIONS Using IONM to define the corticospinal projection pattern is a valuable technique that can potentially replace preoperative fMRI and transcranial magnetic stimulation in resective epilepsy surgery, particularly for younger patients.
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Sakzewski L, Gordon A, Eliasson AC. The state of the evidence for intensive upper limb therapy approaches for children with unilateral cerebral palsy. J Child Neurol 2014; 29:1077-90. [PMID: 24820334 DOI: 10.1177/0883073814533150] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 04/03/2014] [Indexed: 11/16/2022]
Abstract
Children with unilateral cerebral palsy experience difficulties with unimanual and bimanual upper limb function, impacting independence in daily life. Targeted upper limb therapies such as constraint-induced movement therapy, bimanual training, and combined approaches have emerged in the last decade. This article reviews the scientific rationale underpinning these treatments and current evidence to improve upper limb outcomes and goal attainment. Intensive models of therapy achieved modest to strong effects to improve upper limb function compared to usual care. Dose-matched comparisons of bimanual and unimanual training demonstrated similar gains in upper limb outcomes. The optimum timing, dose and impact of repeat episodes of intensive upper limb therapies require further investigation. Characteristics of children who achieve clinically meaningful outcomes remain unclear. Key components of intervention include collaborative goal setting with families and intensive repetitive, incrementally challenging, task practice. Choice of treatment approach should be governed by child/family goals and preferences, individual, and contextual factors.
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Affiliation(s)
- Leanne Sakzewski
- Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine, University of Queensland, Queensland, Australia
| | - Andrew Gordon
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA
| | - Ann-Christin Eliasson
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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Mackey A, Stinear C, Stott S, Byblow WD. Upper limb function and cortical organization in youth with unilateral cerebral palsy. Front Neurol 2014; 5:117. [PMID: 25071705 PMCID: PMC4082181 DOI: 10.3389/fneur.2014.00117] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 06/21/2014] [Indexed: 11/16/2022] Open
Abstract
Aim: To explore the relationship between motor cortical and descending motor pathway reorganization, lesion type, and upper limb function in youth with unilateral cerebral palsy (CP). Methods: Twenty participants with unilateral CP (mean age 15 ± 3 years; 11 males) completed a range of upper limb functional measures. Structural MRI, diffusion-weighted, and functional MRI were conducted to determine type and extent of brain lesion, descending white matter integrity, and whole-brain activity during affected hand use. Single pulse transcranial magnetic stimulation (TMS) (n = 12) was used to examine functional integrity of the corticospinal pathway as well as primary motor cortex intracortical and interhemispheric inhibition from motor-evoked potentials and silent periods. Results: Fractional anisotropy measures within the posterior limb of the internal capsule were a predictor of upper limb function (R2 = 0.41, F = 11.3, p = 0.004). Participants with periventricular lesions tended to have better upper limb function [F(2, 17) = 42.48, p < 0.0001]. Five participants with evidence of cortical reorganization and functional ipsilateral projections to their affected hand had worse upper limb function. Deficits in intracortical and interhemispheric inhibitory mechanisms were found in participants with worse upper limb function (Melbourne Assessment of Unilateral Upper Limb Function: Mann Whitney p = 0.02). Conclusion: Neuroimaging and TMS can provide useful information related to hand function of individuals with unilateral CP and may have potential to assist as a predictive tool and/or guide rehabilitation.
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Affiliation(s)
- Anna Mackey
- Department of Surgery, University of Auckland , Auckland , New Zealand
| | - Cathy Stinear
- Department of Medicine, Centre for Brain Research, University of Auckland , Auckland , New Zealand
| | - Susan Stott
- Department of Surgery, University of Auckland , Auckland , New Zealand
| | - Winston D Byblow
- Department of Sport and Exercise Science, Centre for Brain Research, University of Auckland , Auckland , New Zealand
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Staudt M, Berweck S. Is constraint-induced movement therapy harmful in unilateral spastic cerebral palsy with ipsilateral cortico-spinal projections? Dev Med Child Neurol 2014; 56:202-3. [PMID: 24372093 DOI: 10.1111/dmcn.12372] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Martin Staudt
- Clinic for Neuropediatrics and Neurorehabilitation, Epilepsy Center for Children and Adolescents, Schön Klinik, Vogtareuth, Germany; Department of Pediatric Neurology and Developmental Medicine, University Children's Hospital, Tübingen;, Germany
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Brain reorganization following intervention in children with congenital hemiplegia: a systematic review. Neural Plast 2013; 2013:356275. [PMID: 24367726 PMCID: PMC3866714 DOI: 10.1155/2013/356275] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 10/29/2013] [Accepted: 10/30/2013] [Indexed: 11/17/2022] Open
Abstract
Noninvasive rehabilitation strategies for children with unilateral cerebral palsy are routinely used to improve hand motor function, activity, and participation. Nevertheless, the studies exploring their effects on brain structure and function are very scarce. Recently, structural neuroplasticity was demonstrated in adult poststroke patients, in response to neurorehabilitation. Our purpose is to review current evidence on the effects of noninvasive intervention strategies on brain structure or function, in children with unilateral cerebral palsy. The main literature databases were searched up to October 2013. We included studies where the effects of upper limb training were evaluated at neurofunctional and/or neurostructural levels. Only seven studies met our selection criteria; selected studies were case series, six using the intervention of the constraint-induced movement therapy (CIMT) and one used virtual reality therapy (VR). CIMT and VR seem to produce measurable neuroplastic changes in sensorimotor cortex associated with enhancement of motor skills in the affected limb. However, the level of evidence is limited, due to methodological weaknesses and small sample sizes of available studies. Well-designed and larger experimental studies, in particular RCTs, are needed to strengthen the generalizability of the findings and to better understand the mechanism of intervention-related brain plasticity in children with brain injury.
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