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Hilderley AJ, Wright FV, Taylor MJ, Chen JL, Fehlings D. Functional Neuroplasticity and Motor Skill Change Following Gross Motor Interventions for Children With Diplegic Cerebral Palsy. Neurorehabil Neural Repair 2023; 37:16-26. [PMID: 36524254 PMCID: PMC9896542 DOI: 10.1177/15459683221143503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Gross motor intervention designs for children with diplegic cerebral palsy (DCP) require an improved understanding of the children's potential for neuroplasticity. OBJECTIVE To identify relations between functional neuroplasticity and motor skill changes following gross motor interventions for children with DCP. METHODS There were 17 participants with DCP (ages 8-16 years; 6 females; Gross Motor Function Classification System Level I [n = 9] and II [n = 8]). Each completed a 6-week gross motor intervention program that was directed toward achievement of individualized motor/physical activity goals. Outcomes were assessed pre/post and 4 to 6 months post-intervention (follow-up). An active ankle dorsiflexion task was completed during functional magnetic resonance imaging. The ratio of motor cortical activation volume in each hemisphere was calculated using a laterality index. The Challenge was the primary gross motor skill measure. Change over time and relations among outcomes were evaluated. RESULTS Challenge scores improved post-intervention (4.57% points [SD 4.45], P = .004) and were maintained at follow-up (0.75% [SD 6.57], P = 1.000). The laterality index for dominant ankle dorsiflexion increased (P = .033), while non-dominant change was variable (P = .534). Contralateral activation (laterality index ≥+0.75) was most common for both ankles. Challenge improvements correlated with increased ipsilateral activity (negative laterality index) during non-dominant dorsiflexion (r = -.56, P = .045). Smaller activation volume during non-dominant dorsiflexion predicted continued gross motor gains at follow-up (R2 = .30, P = .040). CONCLUSIONS Motor cortical activation during non-dominant ankle dorsiflexion is a modest indicator of the potential for gross motor skill change. Further investigation of patterns of neuroplastic change will improve our understanding of effects. CLINICALTRIALS.GOV REGISTRY NCT02584491 and NCT02754128.
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Affiliation(s)
- Alicia J. Hilderley
- Bloorview Research Institute, Holland
Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - F. Virginia Wright
- Bloorview Research Institute, Holland
Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada,Department of Physical Therapy,
University of Toronto, Toronto, ON, Canada
| | - Margot J. Taylor
- Diagnostic Imaging, The Hospital for
Sick Children, Toronto, ON, Canada,Department of Medical Imaging,
University of Toronto, Toronto, ON, Canada,Department of Psychology, University of
Toronto, Toronto, ON, Canada
| | - Joyce L. Chen
- Faculty of Kinesiology and Physical
Education, University of Toronto, Toronto, ON, Canada,Hurvitz Brain Sciences Program,
Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, Toronto,
ON, Canada
| | - Darcy Fehlings
- Bloorview Research Institute, Holland
Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada,Department of Paediatrics, Faculty of
Medicine, University of Toronto, Toronto, ON, Canada,Darcy Fehlings, Holland Bloorview Kids
Rehabilitation Hospital, 150 Kilgour Road, Toronto, ON M4G 1R8, Canada.
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Wang XK, Gao C, Zhong HQ, Kong XY, Qiao R, Zhang HC, Chen BY, Gao Y, Li B. TNAP—a potential cytokine in the cerebral inflammation in spastic cerebral palsy. Front Mol Neurosci 2022; 15:926791. [PMID: 36187348 PMCID: PMC9515907 DOI: 10.3389/fnmol.2022.926791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 08/18/2022] [Indexed: 11/18/2022] Open
Abstract
Objective: Several studies have shown the significance of neuroinflammation in the pathological progress of cerebral palsy (CP). However, the etiology of CP remains poorly understood. Spastic CP is the most common form of CP, comprising 80% of all cases. Therefore, identifying the specific factors may serve to understand the etiology of spastic CP. Our research aimed to find some relevant factors through protein profiling, screening, and validation to help understand the pathogenesis of cerebral palsy. Materials and methods: In the current study, related clinical parameters were assessed in 18 children with spastic CP along with 20 healthy individuals of the same age. Blood samples of the spastic CP children and controls were analyzed with proteomics profiling to detect differentially expressed proteins. On the other hand, after hypoxic-ischemic encephalopathy (HIE) was induced in the postnatal day 7 rat pups, behavioral tests were performed followed by detection of the differentially expressed markers and inflammatory cytokines in the peripheral blood and cerebral cortex of the CP model rats by Elisa and Western blot. Independent sample t-tests, one-way analysis of variance, and the Pearson correlation were used for statistical analysis. Results: Through proteomic analysis, differentially expressed proteins were identified. Among them, tissue-nonspecific alkaline phosphatase (TNAP), the gene expression product of alkaline phosphatase (ALPL), was downregulated in spastic CP. In addition, significantly lower TNAP levels were found in the children with CP and model rats. In contrast, compared with the sham rats, the model rats demonstrated a significant increase in osteopontin and proinflammatory biomarkers in both the plasma and cerebral cortex on the ischemic side whereas serum 25 hydroxyvitamin D and IL-10 were significantly decreased. Moreover, serum TNAP level was positively correlated with serum CRP and IL-10 in model rats. Conclusion: These results suggest that TNAP is the potential molecule playing a specific and critical role in the neuroinflammation in spastic CP, which may provide a promising target for the diagnosis and treatment of spastic CP.
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Affiliation(s)
- Xiao-Kun Wang
- Research Center for Clinical Medicine, JinShan Hospital, Fudan University, Shanghai, China
| | - Chao Gao
- Department of Rehabilitation, Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Zhengzhou, China
- Henan Key Laboratory of Children’s Genetics and Metabolic Diseases, Zhengzhou, China
| | - He-Quan Zhong
- Research Center for Clinical Medicine, JinShan Hospital, Fudan University, Shanghai, China
| | - Xiang-Yu Kong
- Research Center for Clinical Medicine, JinShan Hospital, Fudan University, Shanghai, China
| | - Rui Qiao
- College of Acupuncture-Massage and Rehabilitation, Yunnan University of Traditional Chinese Medicine, Yunnan, China
| | - Hui-Chun Zhang
- Department of Rehabilitation, Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Zhengzhou, China
| | - Bai-Yun Chen
- Department of Rehabilitation, Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Zhengzhou, China
| | - Yang Gao
- Department of Rehabilitation, Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Zhengzhou, China
| | - Bing Li
- Research Center for Clinical Medicine, JinShan Hospital, Fudan University, Shanghai, China
- *Correspondence: Bing Li https://orcid.org/0000-0001-5709-9396
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Kuo HC, Zewdie E, Giuffre A, Gan LS, Carlson HL, Wrightson J, Kirton A. Robotic mapping of motor cortex in children with perinatal stroke and hemiparesis. Hum Brain Mapp 2022; 43:3745-3758. [PMID: 35451540 PMCID: PMC9294290 DOI: 10.1002/hbm.25881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 03/15/2022] [Accepted: 04/05/2022] [Indexed: 11/13/2022] Open
Abstract
Brain stimulation combined with intensive therapy may improve hand function in children with perinatal stroke‐induced unilateral cerebral palsy (UCP). However, response to therapy varies and underlying neuroplasticity mechanisms remain unclear. Here, we aimed to characterize robotic motor mapping outcomes in children with UCP. Twenty‐nine children with perinatal stroke and UCP (median age 11 ± 2 years) were compared to 24 typically developing controls (TDC). Robotic, neuronavigated transcranial magnetic stimulation was employed to define bilateral motor maps including area, volume, and peak motor evoked potential (MEP). Map outcomes were compared to the primary clinical outcome of the Jebsen–Taylor Test of Hand Function (JTT). Maps were reliably obtained in the contralesional motor cortex (24/29) but challenging in the lesioned hemisphere (5/29). Within the contralesional M1 of participants with UCP, area and peak MEP amplitude of the unaffected map were larger than the affected map. When comparing bilateral maps within the contralesional M1 in children with UCP to that of TDC, only peak MEP amplitudes were different, being smaller for the affected hand as compared to TDC. We observed correlations between the unaffected map when stimulating the contralesional M1 and function of the unaffected hand. Robotic motor mapping can characterize motor cortex neurophysiology in children with perinatal stroke. Map area and peak MEP amplitude may represent discrete biomarkers of developmental plasticity in the contralesional M1. Correlations between map metrics and hand function suggest clinical relevance and utility in studies of interventional plasticity.
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Affiliation(s)
- Hsing-Ching Kuo
- Calgary Pediatric Stroke Program, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute (ACHRI), Calgary, Alberta, Canada.,Hotchkiss Brain Institute (HBI), Calgary, Alberta, Canada.,Department of Pediatrics and Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Physical Medicine & Rehabilitation, University of California Davis, Sacramento, California, USA
| | - Ephrem Zewdie
- Calgary Pediatric Stroke Program, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute (ACHRI), Calgary, Alberta, Canada.,Hotchkiss Brain Institute (HBI), Calgary, Alberta, Canada.,Department of Pediatrics and Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Adrianna Giuffre
- Calgary Pediatric Stroke Program, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute (ACHRI), Calgary, Alberta, Canada.,Hotchkiss Brain Institute (HBI), Calgary, Alberta, Canada.,Department of Pediatrics and Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Liu Shi Gan
- Hotchkiss Brain Institute (HBI), Calgary, Alberta, Canada
| | - Helen L Carlson
- Calgary Pediatric Stroke Program, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute (ACHRI), Calgary, Alberta, Canada.,Hotchkiss Brain Institute (HBI), Calgary, Alberta, Canada.,Department of Pediatrics and Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - James Wrightson
- Calgary Pediatric Stroke Program, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute (ACHRI), Calgary, Alberta, Canada.,Hotchkiss Brain Institute (HBI), Calgary, Alberta, Canada.,Department of Pediatrics and Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Adam Kirton
- Calgary Pediatric Stroke Program, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute (ACHRI), Calgary, Alberta, Canada.,Hotchkiss Brain Institute (HBI), Calgary, Alberta, Canada.,Department of Pediatrics and Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Li J, Chen C, Zhu S, Niu X, Yu X, Ren J, Shen M. Evaluating the Effects of 5-Hz Repetitive Transcranial Magnetic Stimulation With and Without Wrist-Ankle Acupuncture on Improving Spasticity and Motor Function in Children With Cerebral Palsy: A Randomized Controlled Trial. Front Neurosci 2022; 15:771064. [PMID: 34975377 PMCID: PMC8714760 DOI: 10.3389/fnins.2021.771064] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 11/03/2021] [Indexed: 11/29/2022] Open
Abstract
Objective: The goal of this study is to explore the effect of wrist-ankle acupuncture combined with 5-Hz repetitive transcranial magnetic stimulation (rTMS) on improving spastic state and motor function of children with spastic cerebral palsy by measuring electrophysiological parameters and behaviors. Methods: Twenty-five children with spastic cerebral palsy were enrolled in a single-blind and randomized controlled trial. The control group received 20 sessions of 5-Hz rTMS over the affected hemisphere with 1,000 pulses. The experimental group was given wrist-ankle acupuncture on the basis of the control group. Gross motor function measure (GMFM-66), muscle tension, and electrophysiological parameters of the two groups were assessed at baseline and after intervention. Results: After treatment, the GMFM-66 scores in the same groups were significantly improved (p < 0.001). Besides, the R-value of soleus, gastrocnemius, and hamstring muscle decreased (p < 0.05), and the results showed a trend of shortening MEP latency, increasing amplitude and duration (p < 0.05). Compared to the controlled group, the experimental group displayed more excellent changes in the GMFM-66 scores and motor evoked potential (MEP) latency. The statistical results showed that the increase of GMFM-66 score and the shortening of MEP latency in the experimental group were greater than that in the control group (p < 0.05). However, no significant differences were found in the assessment of muscle tension, amplitude, and duration of MEPs between two groups (p > 0.05). Conclusion: Wrist-ankle acupuncture combined with 5-Hz rTMS is optimal to improve gross motor function and enhance the conductivity of corticospinal tract in children with cerebral palsy but cannot highlight its clinical superiority in improving spasticity. Clinical Trial Registration: [http://www.chictr.org.cn/index.aspx], identifier [chictr2000039495].
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Affiliation(s)
- Jiamin Li
- Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China.,School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Shanghai Taiping Rehabilitation Hospital, Shanghai, China
| | - Cen Chen
- Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
| | - Shenyu Zhu
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Xiulian Niu
- Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
| | - Xidan Yu
- Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China
| | - Jie Ren
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Min Shen
- Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, China.,School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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5
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Giuffre A, Zewdie E, Wrightson JG, Cole L, Carlson HL, Kuo HC, Babwani A, Kirton A. Effects of Transcranial Direct Current Stimulation and High-Definition Transcranial Direct Current Stimulation Enhanced Motor Learning on Robotic Transcranial Magnetic Stimulation Motor Maps in Children. Front Hum Neurosci 2021; 15:747840. [PMID: 34690726 PMCID: PMC8526891 DOI: 10.3389/fnhum.2021.747840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/16/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Conventional transcranial direct current stimulation (tDCS) and high-definition tDCS (HD-tDCS) may improve motor learning in children. Mechanisms are not understood. Neuronavigated robotic transcranial magnetic stimulation (TMS) can produce individualised maps of primary motor cortex (M1) topography. We aimed to determine the effects of tDCS- and HD-tDCS-enhanced motor learning on motor maps. Methods: Typically developing children aged 12-18 years were randomised to right M1 anodal tDCS, HD-tDCS, or Sham during training of their left-hand on the Purdue Pegboard Task (PPT) over 5 days. Bilateral motor mapping was performed at baseline (pre), day 5 (post), and 6-weeks retention time (RT). Primary muscle was the first dorsal interosseous (FDI) with secondary muscles of abductor pollicis brevis (APB) and adductor digiti minimi (ADM). Primary mapping outcomes were volume (mm2/mV) and area (mm2). Secondary outcomes were centre of gravity (COG, mm) and hotspot magnitude (mV). Linear mixed-effects modelling was employed to investigate effects of time and stimulation type (tDCS, HD-tDCS, Sham) on motor map characteristics. Results: Twenty-four right-handed participants (median age 15.5 years, 52% female) completed the study with no serious adverse events or dropouts. Quality maps could not be obtained in two participants. No effect of time or group were observed on map area or volume. LFDI COG (mm) differed in the medial-lateral plane (x-axis) between tDCS and Sham (p = 0.038) from pre-to-post mapping sessions. Shifts in map COG were also observed for secondary left-hand muscles. Map metrics did not correlate with behavioural changes. Conclusion: Robotic TMS mapping can safely assess motor cortex neurophysiology in children undergoing motor learning and neuromodulation interventions. Large effects on map area and volume were not observed while changes in COG may occur. Larger controlled studies are required to understand the role of motor maps in interventional neuroplasticity in children.
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Affiliation(s)
- Adrianna Giuffre
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, AB, Canada.,Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Ephrem Zewdie
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, AB, Canada.,Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - James G Wrightson
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, AB, Canada.,Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Lauran Cole
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, AB, Canada
| | - Helen L Carlson
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, AB, Canada.,Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Hsing-Ching Kuo
- Department of Physical Medicine & Rehabilitation, University of California, Davis, Sacramento, CA, United States
| | - Ali Babwani
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, AB, Canada
| | - Adam Kirton
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, AB, Canada.,Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Nardone R, Sebastianelli L, Ferrazzoli D, Brigo F, Lochner P, Saltuari L, Trinka E, Versace V. Brain functional reorganization in children with hemiplegic cerebral palsy: Assessment with TMS and therapeutic perspectives. Neurophysiol Clin 2021; 51:391-408. [PMID: 34615605 DOI: 10.1016/j.neucli.2021.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 09/15/2021] [Accepted: 09/15/2021] [Indexed: 11/16/2022] Open
Abstract
Transcranial magnetic stimulation (TMS) can be a useful tool for the assessment of the brain functional reorganization in subjects with hemiplegic cerebral palsy (HCP). In this review, we performed a systematic search of all studies using TMS in order to explore the neuroplastic changes that occur in HCP patients. We aimed at investigating the usefulness of TMS to explore cortical excitability, plasticity and connectivity changes in HCP. Children with HCP due to unilateral lesions of the corticospinal system had ipsilateral motor evoked potentials (MEPs) similar to those recorded contralaterally. TMS studies demonstrated that occupational and constraint-induced movement therapy were associated with significant improvements in contralateral and ipsilateral corticomotor projection patterns. In addition, after intensive bimanual therapy, children with HCP showed increased activation and size of the motor areas controlling the affected hand. A TMS mapping study revealed a mediolateral location of the upper and lower extremity map motor cortical representations. Deficits in intracortical and interhemispheric inhibitory mechanisms were observed in HCP. Early hand function impairment correlated with the extension of brain damage, number of involved areas, and radiological signs of corticospinal tract (CST) degeneration. Clinical mirror movements (MMs) correlated with disability and CST organization in subjects with HCP and a positive relationship was found between MMs and MEPs strength. Therefore, TMS studies have shed light on important pathophysiological aspects of motor cortex and CST reorganization in HCP patients. Furthermore, repetitive TMS (rTMS) might have therapeutic effects on CST activities, functional connectivity and clinical status in children with HCP.
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Affiliation(s)
- Raffaele Nardone
- Department of Neurology, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy; Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria; Spinal Cord Injury and Tissue Regeneration Center, Salzburg, Austria; Karl Landsteiner Institut für Neurorehabilitation und Raumfahrtneurologie, Salzburg, Austria.
| | - Luca Sebastianelli
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy; Research Unit for Neurorehabilitation South Tyrol, Bolzano, Italy
| | - Davide Ferrazzoli
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy; Research Unit for Neurorehabilitation South Tyrol, Bolzano, Italy
| | - Francesco Brigo
- Department of Neurology, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy; Department of Neuroscience, Biomedicine and Movement Science, University of Verona, Italy
| | - Piergiorgio Lochner
- Department of Neurology, Saarland University Medical Center, Homburg, Germany
| | - Leopold Saltuari
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy; Research Unit for Neurorehabilitation South Tyrol, Bolzano, Italy
| | - Eugen Trinka
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria; Centre for Cognitive Neuroscience, Salzburg, Austria; University for Medical Informatics and Health Technology, UMIT, Hall in Tirol, Austria
| | - Viviana Versace
- Department of Neurorehabilitation, Hospital of Vipiteno (SABES-ASDAA), Vipiteno-Sterzing, Italy; Research Unit for Neurorehabilitation South Tyrol, Bolzano, Italy
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Azizi S, Irani A, Shahrokhi A, Rahimian E, Mirbagheri MM. Contribution of altered corticospinal microstructure to gait impairment in children with cerebral palsy. Clin Neurophysiol 2021; 132:2211-2221. [PMID: 34311204 DOI: 10.1016/j.clinph.2021.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 06/22/2021] [Accepted: 06/25/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Corticospinal tract (CST) injury may lead to motor disorders in children with Cerebral Palsy (CP). However, the precise underlying mechanisms are still ambiguous. We aimed to characterize the CST structure and function in children with CP and determine their contributions to balance and gait impairments. METHOD Twenty-six children with spastic CP participated. Transcranial magnetic stimulation (TMS) and diffusion tensor imaging (DTI) were utilized to characterize CST structure and function. Common clinical measures were used to assess gait speed, endurance and balance, and mobility. RESULTS CST structure and function were significantly altered in children with CP. Different abnormal patterns of CST structure were identified as either abnormal appearance of brain hemispheres (Group-1) or semi-normal CST appearance (Group-2). We found significant correlations between the DTI parameters of the more affected CST and gait features only in Group-1. CONCLUSION CST structure and function are abnormal in children with CP and these abnormalities may contribute to balance and gait impairment in some children with CP. SIGNIFICANCE Our findings may lead to the development of further investigations on the mechanisms underlying gait impairment in children with CP and on decision-making for more effective rehabilitation.
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Affiliation(s)
- Shahla Azizi
- Medical Physics and Biomedical Engineering Department, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Ashkan Irani
- Department of Occupational Therapy, Faculty of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Elham Rahimian
- Shefa Neuroscience Research Center, Khatam Alanbia Hospital, Tehran, Iran
| | - Mehdi M Mirbagheri
- Medical Physics and Biomedical Engineering Department, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran; Physical Medicine and Rehabilitation Department, Northwestern University, USA.
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Sanches EF, Carvalho AS, van de Looij Y, Toulotte A, Wyse AT, Netto CA, Sizonenko SV. Experimental cerebral palsy causes microstructural brain damage in areas associated to motor deficits but no spatial memory impairments in the developing rat. Brain Res 2021; 1761:147389. [PMID: 33639200 DOI: 10.1016/j.brainres.2021.147389] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 02/16/2021] [Accepted: 02/17/2021] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Cerebral palsy (CP) is the major cause of motor and cognitive impairments during childhood. CP can result from direct or indirect structural injury to the developing brain. In this study, we aimed to describe brain damage and behavioural alterations during early adult life in a CP model using the combination of maternal inflammation, perinatal anoxia and postnatal sensorimotor restriction. METHODS Pregnant Wistar rats were injected intraperitoneally with 200 µg/kg LPS at embryonic days E18 and E19. Between 3 and 6 h after birth (postnatal day 0 - PND0), pups of both sexes were exposed to anoxia for 20 min. From postnatal day 2 to 21, hindlimbs of animals were immobilized for 16 h daily during their active phase. From PND40, locomotor and cognitive tests were performed using Rota-Rod, Ladder Walking and Morris water Maze. Ex-vivo MRI Diffusion Tensor Imaging (DTI) and Neurite Orientation Dispersion and Density Imaging (NODDI) were used to assess macro and microstructural damage and brain volume alterations induced by the model. Myelination and expression of neuronal, astroglial and microglial markers, as well as apoptotic cell death were evaluated by immunofluorescence. RESULTS CP animals showed decreased body weight, deficits in gross (rota-rod) and fine (ladder walking) motor tasks compared to Controls. No cognitive impairments were observed. Ex-vivo MRI showed decreased brain volumes and impaired microstructure in the cingulate gyrus and sensory cortex in CP brains. Histological analysis showed increased cell death, astrocytic reactivity and decreased thickness of the corpus callosum and altered myelination in CP animals. Hindlimb primary motor cortex analysis showed increased apoptosis in CP animals. Despite the increase in NeuN and GFAP, no differences between groups were observed as well as no co-localization with the apoptotic marker. However, an increase in Iba-1+ microglia with co-localization to cleaved caspase 3 was observed. CONCLUSION Our results suggest that experimental CP induces long-term brain microstructural alterations in myelinated structures, cell death in the hindlimb primary motor cortex and locomotor impairments. Such new evidence of brain damage could help to better understand CP pathophysiological mechanisms and guide further research for neuroprotective and neurorehabilitative strategies for CP patients.
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Affiliation(s)
- E F Sanches
- Division of Child Development and Growth, Department of Pediatrics, Gynecology and Obstetrics, School of Medicine, University of Geneva, Geneva, Switzerland
| | - A S Carvalho
- Post-graduation Program of Neuroscience, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Brazil
| | - Y van de Looij
- Division of Child Development and Growth, Department of Pediatrics, Gynecology and Obstetrics, School of Medicine, University of Geneva, Geneva, Switzerland; Center for Biomedical Imaging - Animal Imaging and Technology (CIBM-AIT), Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - A Toulotte
- Division of Child Development and Growth, Department of Pediatrics, Gynecology and Obstetrics, School of Medicine, University of Geneva, Geneva, Switzerland
| | - A T Wyse
- Department of Biochemistry, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - C A Netto
- Department of Biochemistry, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - S V Sizonenko
- Division of Child Development and Growth, Department of Pediatrics, Gynecology and Obstetrics, School of Medicine, University of Geneva, Geneva, Switzerland.
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9
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Developmental Remodelling of the Motor Cortex in Hemiparetic Children With Perinatal Stroke. Pediatr Neurol 2020; 112:34-43. [PMID: 32911261 DOI: 10.1016/j.pediatrneurol.2020.08.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 07/28/2020] [Accepted: 08/01/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Perinatal stroke often leads to lifelong motor impairment. Two common subtypes differ in timing, location, and mechanism of injury: periventricular venous infarcts (PVI) are fetal white matter lesions while most arterial ischemic strokes (AIS) are cortical injuries acquired near term birth. Both alter motor system development and primary motor cortex (M1) plasticity, often with retained ipsilateral corticospinal fibers from the non-lesioned motor cortex (M1'). METHODS Task-based functional magnetic resonance imaging was used to define patterns of motor cortex activity during paretic and unaffected hand movement. Peak coordinates of M1, M1', and the supplementary motor area in the lesioned and intact hemispheres were compared to age-matched controls. Correlations between displacements and clinical motor function were explored. RESULTS Forty-nine participants included 14 PVI (12.59 ± 3.7 years), 13 AIS (14.91 ± 3.9 years), and 22 controls (13.91 ± 3.4 years). AIS displayed the greatest M1 displacement from controls in the lesioned hemisphere while PVI locations approximated controls. Peak M1' activations were displaced from the canonical hand knob in both PVI and AIS. Extent of M1 and M1' displacement were correlated (r = 0.50, P = 0.025) but were not associated with motor function. Supplementary motor area activity elicited by paretic tapping was displaced in AIS compared to controls (P = 0.003). CONCLUSION Motor network components may be displaced in both hemispheres after perinatal stroke, particularly in AIS and those with ipsilateral control of the affected limb. Modest correlations with clinical function may support that more complex models of developmental plasticity are needed to inform targets for individualized neuromodulatory therapies in children with perinatal stroke.
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Sukal-Moulton T, de Campos AC, Alter KE, Damiano DL. Functional near-infrared spectroscopy to assess sensorimotor cortical activity during hand squeezing and ankle dorsiflexion in individuals with and without bilateral and unilateral cerebral palsy. NEUROPHOTONICS 2020; 7:045001. [PMID: 33062800 PMCID: PMC7536541 DOI: 10.1117/1.nph.7.4.045001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 09/04/2020] [Indexed: 05/10/2023]
Abstract
Significance: Our study is the first comparison of brain activation patterns during motor tasks across unilateral cerebral palsy (UCP), bilateral cerebral palsy (BCP), and typical development (TD) to elucidate neural mechanisms and inform rehabilitation strategies. Aim: Cortical activation patterns were compared for distal upper and lower extremity tasks in UCP, BCP, and TD using functional near-infrared spectroscopy (fNIRS) and related to functional severity. Approach: Individuals with UCP ( n = 10 , 18.8 ± 6.8 years ), BCP ( n = 14 , 17.5 ± 9.6 years ), and TD ( n = 16 , 17.3 ± 9.1 years ) participated in this cross-sectional cohort study. The fNIRS was used to noninvasively monitor the hemodynamic response to task-related cortical activation. The block design involved repetitive nondominant hand squeezing and ankle dorsiflexion. Results: Individuals with UCP demonstrated the highest levels of activation for the squeeze task ( UCP > BCP q = 0.049 ; BCP > TD q < 0.001 ; and UCP > TD q = 0.001 ) and more activity in the ipsilateral versus contralateral hemisphere. Individuals with BCP showed the highest levels of cortical activation in the dorsiflexion task ( BCP > UCP q < 0.001 ; BCP > TD ). Conclusions: Grouping by CP subtype and manual function or mobility level demonstrated significant differences from TD, even for individuals with the mildest forms of CP. Hemispheric activation patterns showed hypothesized but nonsignificant trends.
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Affiliation(s)
- Theresa Sukal-Moulton
- Northwestern University Feinberg School of Medicine, Department of Physical Therapy and Human Movement Sciences, Department of Pediatrics, Chicago, Illinois, United States
| | - Ana C. de Campos
- Federal University of São Carlos, Department of Physical Therapy, São Carlos, Brazil
| | - Katharine E. Alter
- National Institutes of Health, Clinical Center, Functional and Applied Biomechanics Section, Rehabilitation Medicine Department, Bethesda, Maryland, United States
| | - Diane L. Damiano
- National Institutes of Health, Clinical Center, Functional and Applied Biomechanics Section, Rehabilitation Medicine Department, Bethesda, Maryland, United States
- Address all correspondence to Diane L Damiano,
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Condliffe EG, Jeffery DT, Emery DJ, Treit S, Beaulieu C, Gorassini MA. Full Activation Profiles and Integrity of Corticospinal Pathways in Adults With Bilateral Spastic Cerebral Palsy. Neurorehabil Neural Repair 2018; 33:59-69. [DOI: 10.1177/1545968318818898] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background. Dysfunction of corticospinal pathways has been implicated in motor impairments in people with bilateral spastic cerebral palsy (CP). While structural damage to corticospinal pathways in people with CP is known, its impact on the activation of these pathways is not. Objective. To provide the first, complete activation profile of corticospinal pathways in adults with CP using a full range of transcranial magnetic stimulation (TMS) intensities and voluntary contractions. Methods. TMS targeted the soleus muscle of 16 adults with bilateral spastic CP and 15 neurologically intact (NI) control participants. Activation profiles were generated using motor-evoked potentials (MEPs) produced by varying both stimulation intensity and degree of voluntary muscle activity. Anatomical integrity of corticospinal pathways was also measured with diffusion tractography. Results. Participants with CP had smaller MEPs produced by TMS at 1.2× active motor threshold during submaximal (20%) muscle activity and smaller maximal MEPs produced under any combination of stimulation intensity and voluntary muscle activity. At a fixed stimulation intensity, increasing voluntary muscle activity facilitated MEP amplitudes to a lesser degree in the participants with CP. Consistent differences in diffusion tractography suggested structural abnormalities in the corticospinal pathways of participants with CP that correlated with maximal MEPs. Conclusion. People with bilateral spastic CP have impaired activation of low and high-threshold corticospinal pathways to soleus motoneurons by TMS and reduced facilitation by voluntary activity that may be associated with structural damage to these pathways. These impairments likely contribute to impaired voluntary movement.
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Affiliation(s)
- Elizabeth G. Condliffe
- University of Calgary, Calgary, Alberta, Canada
- University of Alberta, Edmonton, Alberta, Canada
| | | | | | - Sarah Treit
- University of Alberta, Edmonton, Alberta, Canada
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Grab J, Zewdie E, Carlson H, Kuo HC, Ciechanski P, Hodge J, Giuffre A, Kirton A. Robotic TMS mapping of motor cortex in the developing brain. J Neurosci Methods 2018; 309:41-54. [DOI: 10.1016/j.jneumeth.2018.08.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 08/08/2018] [Accepted: 08/08/2018] [Indexed: 12/22/2022]
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Relationship between sensorimotor cortical activation as assessed by functional near infrared spectroscopy and lower extremity motor coordination in bilateral cerebral palsy. NEUROIMAGE-CLINICAL 2018; 20:275-285. [PMID: 30101059 PMCID: PMC6083901 DOI: 10.1016/j.nicl.2018.07.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 06/28/2018] [Accepted: 07/25/2018] [Indexed: 12/31/2022]
Abstract
Background Evaluation of task-evoked cortical responses during movement has been limited in individuals with bilateral cerebral palsy (CP), despite documented alterations in brain structure/function and deficits in motor control. Objective To systematically evaluate cortical activity associated with lower extremity tasks, and relate activation parameters to clinical measures in CP. Methods 28 ambulatory participants (14 with bilateral CP and 14 with typical development) completed five motor tasks (non-dominant ankle dorsiflexion, hip flexion and leg cycling as well as bilateral dorsiflexion and cycling) in a block design while their sensorimotor cortex was monitored using functional near infrared spectroscopy (fNIRS), in addition to laboratory and clinical measures of performance. Results Main effects for group and task were found for extent of fNIRS activation (number of active channels; p < 0.001 and p = 0.010, respectively), magnitude of activation (sum of beta values; p < 0.001 for both), and number of active muscles (p = 0.001 and p < 0.001, respectively), but no group by task interactions. Collectively, subgroups with CP and especially those with greater impairments, showed higher extent and magnitude of cortical sensorimotor activation as well as higher amounts of concurrent activity in muscles not required for task performance. Magnitude of fNIRS activation during non-dominant dorsiflexion correlated with validated measures of selective control (r = −0.60, p = 0.03), as well as mobility and daily activity (r = −0.55, p = 0.04 and r = −0.52, p = 0.05, respectively) and self-reported gait function (r = −0.68, p = 0.01) in those with CP. Conclusions The association between higher activity in the sensorimotor cortex and decreased selectivity in cortical organization suggests a potential neural mechanism of motor deficits and target for intervention. First fNIRS comparison of a range of lower extremity tasks in children with and without bilateral CP. FNIRS showed a greater amount and extent of activation of sensorimotor cortices in CP. Greater activation correlated with a greater number of muscles involved in the task. fNIRS results correlated to clinical measures of motor control and function.
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Marneweck M, Kuo HC, Smorenburg ARP, Ferre CL, Flamand VH, Gupta D, Carmel JB, Bleyenheuft Y, Gordon AM, Friel KM. The Relationship Between Hand Function and Overlapping Motor Representations of the Hands in the Contralesional Hemisphere in Unilateral Spastic Cerebral Palsy. Neurorehabil Neural Repair 2018; 32:62-72. [PMID: 29303031 DOI: 10.1177/1545968317745991] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND In many children with unilateral spastic cerebral palsy (USCP), the corticospinal tract to the affected hand atypically originates in the hemisphere ipsilateral to the affected hand. Such ipsilateral connectivity is on average a predictor of poor hand function. However, there is high variability in hand function in these children, which might be explained by the complexity of motor representations of both hands in the contralesional hemisphere. OBJECTIVE To measure the link between hand function and the size and excitability of motor representations of both hands, and their overlap, in the contralesional hemisphere of children with USCP. METHODS We used single-pulse transcranial magnetic stimulation to measure the size and excitability of motor representations of both hands, and their overlap, in the contralesional hemisphere of 50 children with USCP. We correlated these measures with manual dexterity of the affected hand, bimanual performance, and mirror movement strength. RESULTS The main and novel findings were (1) the large overlap in contralesional motor representations of the 2 hands and (2) the moderate positive associations of the size and excitability of such shared-site representations with hand function. Such functional associations were not present for overall size and excitability of representations of the affected hand. CONCLUSIONS Greater relative overlap of the affected hand representation with the less-affected hand representation within the contralesional hemisphere was associated with better hand function. This association suggests that overlapping representations might be adaptively "yoked," such that cortical control of the child's less-affected hand supports that of the affected hand.
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Affiliation(s)
| | - Hsing-Ching Kuo
- 2 University of Calgary, Calgary, Alberta, Canada.,3 Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
| | - Ana R P Smorenburg
- 4 Burke-Cornell Medical Research Institute, White Plains, NY, USA.,5 Weill Cornell Medical College, New York, NY, USA
| | - Claudio L Ferre
- 4 Burke-Cornell Medical Research Institute, White Plains, NY, USA.,5 Weill Cornell Medical College, New York, NY, USA
| | | | - Disha Gupta
- 4 Burke-Cornell Medical Research Institute, White Plains, NY, USA.,5 Weill Cornell Medical College, New York, NY, USA
| | - Jason B Carmel
- 4 Burke-Cornell Medical Research Institute, White Plains, NY, USA.,5 Weill Cornell Medical College, New York, NY, USA.,7 Blythedale Children's Hospital, Valhalla, NY, USA
| | | | - Andrew M Gordon
- 9 Teachers College of Columbia University, New York, NY, USA
| | - Kathleen M Friel
- 4 Burke-Cornell Medical Research Institute, White Plains, NY, USA.,5 Weill Cornell Medical College, New York, NY, USA.,7 Blythedale Children's Hospital, Valhalla, NY, USA
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15
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Gillick BT, Gordon AM, Feyma T, Krach LE, Carmel J, Rich TL, Bleyenheuft Y, Friel K. Non-Invasive Brain Stimulation in Children With Unilateral Cerebral Palsy: A Protocol and Risk Mitigation Guide. Front Pediatr 2018; 6:56. [PMID: 29616203 PMCID: PMC5864860 DOI: 10.3389/fped.2018.00056] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 02/26/2018] [Indexed: 01/04/2023] Open
Abstract
Non-invasive brain stimulation has been increasingly investigated, mainly in adults, with the aims of influencing motor recovery after stroke. However, a consensus on safety and optimal study design has not been established in pediatrics. The low incidence of reported major adverse events in adults with and without clinical conditions has expedited the exploration of NIBS in children with paralleled purposes to influence motor skill development after neurological injury. Considering developmental variability in children, with or without a neurologic diagnosis, adult dosing and protocols may not be appropriate. The purpose of this paper is to present recommendations and tools for the prevention and mitigation of adverse events (AEs) during NIBS in children with unilateral cerebral palsy (UCP). Our recommendations provide a framework for pediatric NIBS study design. The key components of this report on NIBS AEs are (a) a summary of related literature to provide the background evidence and (b) tools for anticipating and managing AEs from four international pediatric laboratories. These recommendations provide a preliminary guide for the assessment of safety and risk mitigation of NIBS in children with UCP. Consistent reporting of safety, feasibility, and tolerability will refine NIBS practice guidelines contributing to future clinical translations of NIBS.
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Affiliation(s)
- Bernadette T Gillick
- Physical Therapy Division, Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Andrew M Gordon
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, United States
| | - Tim Feyma
- Gillette Children's Specialty Healthcare, Pediatric Neurology, St. Paul, MN, United States
| | - Linda E Krach
- Courage Kenny Rehabilitation Institute, Minneapolis, MN, United States
| | - Jason Carmel
- Weill-Cornell Medical College, Blythedale Children's Hospital, Burke Medical Research Institute, White Plains, NY, United States
| | - Tonya L Rich
- Rehabilitation Science, University of Minnesota, Minneapolis, MN, United States
| | - Yannick Bleyenheuft
- Institute of Neuroscience (IoNS), Universite catholique de Louvain, Brussels, Belgium
| | - Kathleen Friel
- Weill-Cornell Medical College, Blythedale Children's Hospital, Burke Medical Research Institute, White Plains, NY, United States
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de Almeida Carvalho Duarte N, Collange Grecco LA, Zanon N, Galli M, Fregni F, Santos Oliveira C. Motor Cortex Plasticity in Children With Spastic Cerebral Palsy: A Systematic Review. J Mot Behav 2017; 49:355-364. [PMID: 27754798 DOI: 10.1080/00222895.2016.1219310] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
A review of the literature was performed to answer the following questions: Does motor cortex excitability correlate with motor function? Do motor cortex excitability and cortex activation change after a rehabilitation program that results in improvements in motor outcomes? Can the 10-20 electroencephalography (EEG) system be used to locate the primary motor cortex when employing transcranial direct current stimulation? Is there a bihemispheric imbalance in individuals with cerebral palsy similar to what is observed in stroke survivors? the authors found there is an adaptation in the geometry of motor areas and the cortical representation of movement is variable following a brain lesion. The 10-20 EEG system may not be the best option for locating the primary motor cortex and positioning electrodes for noninvasive brain stimulation in children with cerebral palsy.
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Affiliation(s)
- Natália de Almeida Carvalho Duarte
- a Rehabilitation Sciences, Universidade Nove de Julho , São Paulo , Brazil
- b Pediatric Neurosurgical Center (CENEPE) , São Paulo , Brazil
| | - Luanda André Collange Grecco
- a Rehabilitation Sciences, Universidade Nove de Julho , São Paulo , Brazil
- b Pediatric Neurosurgical Center (CENEPE) , São Paulo , Brazil
| | - Nelci Zanon
- b Pediatric Neurosurgical Center (CENEPE) , São Paulo , Brazil
| | - Manuela Galli
- c Department of Electronic Information and Bioengineering , Politecnico di Milan , Italy
- d IRCCS San Raffaele Pisana , Rome , Italy
| | - Felipe Fregni
- e Department of Physical Medicine & Rehabilitation, Spaulding Neuromodulation Center , Spaulding Rehabilitation Hospital, Harvard Medical School , Boston , Massachusetts
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Moura RCF, Santos CA, Grecco LAC, Lazzari RD, Dumont AJL, Duarte NCDA, Braun LA, Lopes JBP, Santos LAD, Rodrigues ELS, Albertini G, Cimolin V, Galli M, Oliveira CS. Transcranial direct current stimulation combined with upper limb functional training in children with spastic, hemiparetic cerebral palsy: study protocol for a randomized controlled trial. Trials 2016; 17:405. [PMID: 27530758 PMCID: PMC4987976 DOI: 10.1186/s13063-016-1534-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 08/03/2016] [Indexed: 11/13/2022] Open
Abstract
Background The aim of the proposed study is to perform a comparative analysis of functional training effects for the paretic upper limb with and without transcranial direct current stimulation over the primary motor cortex in children with spastic hemiparetic cerebral palsy. Methods The sample will comprise 34 individuals with spastic hemiparetic cerebral palsy, 6 to 16 years old, classified at level I, II, or III of the Manual Ability Classification System. Participants will be randomly allocated to two groups: (1) functional training of the paretic upper limb combined with anodic transcranial stimulation; (2) functional training of the paretic upper limb combined with sham transcranial stimulation. Evaluation will involve three-dimensional movement analysis and electromyography using the SMART-D 140® system (BTS Engineering) and the FREEEMG® system (BTS Engineering), the Quality of Upper Extremity Skills Test, to assess functional mobility, the Portable Device and Ashworth Scale, to measure movement resistance and spasticity, and the Pediatric Evaluation of Disability Inventory, to evaluate performance. Functional reach training of the paretic upper limb will include a range of manual activities using educational toys associated with an induced constraint of the non-paretic limb during the training. Training will be performed in five weekly 20-minute sessions for two weeks. Transcranial stimulation over the primary motor cortex will be performed during the training sessions at an intensity of 1 mA. Findings will be analyzed statistically considering a 5 % significance level (P ≤ 0.05). Discussion This paper presents a detailed description of a prospective, randomized, controlled, double-blind, clinical trial designed to demonstrate the effects of combining transcranial direct current stimulation over the primary motor cortex and functional training of the paretic limb in children with cerebral palsy classified at level I, II, or III of the Manual Ability Classification System. The results will be published and evidence found may contribute to the use of transcranial stimulation for this population. Trial registration ReBEC RBR-6V4Y3K. Registered on 11 February 2015.
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Affiliation(s)
| | | | | | | | | | | | - Luiz Alfredo Braun
- Rehabilitation Sciences, Nove de Julho University (UNINOVE), São Paulo, SP, Brazil
| | | | | | | | - Giorgio Albertini
- Motion Analysis Laboratory, IRCCS San Raffaele Pisana, Pisana, Rome, Italy
| | - Veronica Cimolin
- Department of Electronic Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Manuela Galli
- Motion Analysis Laboratory, IRCCS San Raffaele Pisana, Pisana, Rome, Italy.,Department of Electronic Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Claudia Santos Oliveira
- Rehabilitation Sciences, Nove de Julho University (UNINOVE), São Paulo, SP, Brazil. .,Rua Itapicuru, 380 apto 111, Perdizes bairro, CEP 05006-000, São Paulo, SP, Brazil.
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Grecco LAC, Oliveira CS, Galli M, Cosmo C, Duarte NDAC, Zanon N, Edwards DJ, Fregni F. Spared Primary Motor Cortex and The Presence of MEP in Cerebral Palsy Dictate the Responsiveness to tDCS during Gait Training. Front Hum Neurosci 2016; 10:361. [PMID: 27486393 PMCID: PMC4949210 DOI: 10.3389/fnhum.2016.00361] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 07/05/2016] [Indexed: 01/06/2023] Open
Abstract
The current priority of investigations involving transcranial direct current stimulation (tDCS) and neurorehabilitation is to identify biomarkers associated with the positive results of the interventions such that respondent and non-respondent patients can be identified in the early phases of treatment. The aims were to determine whether: (1) present motor evoked potential (MEP); and (2) injuries involving the primary motor cortex, are associated with tDCS-enhancement in functional outcome following gait training in children with cerebral palsy (CP). We reviewed the data from our parallel, randomized, sham-controlled, double-blind studies. Fifty-six children with spastic CP received gait training (either treadmill training or virtual reality training) and tDCS (active or sham). Univariate and multivariate logistic regression analyses were employed to identify clinical, neurophysiologic and neuroanatomic predictors associated with the responsiveness to treatment with tDCS. MEP presence during the initial evaluation and the subcortical injury were associated with positive effects in the functional results. The logistic regression revealed that present MEP was a significant predictor for the six-minute walk test (6MWT; p = 0.003) and gait speed (p = 0.028), whereas the subcortical injury was a significant predictor of gait kinematics (p = 0.013) and gross motor function (p = 0.021). In this preliminary study involving children with CP, two important prediction factors of good responses to anodal tDCS combined with gait training were identified. Apparently, MEP (integrity of the corticospinal tract) and subcortical location of the brain injury exerted different influences on aspects related to gait, such as velocity and kinematics.
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Affiliation(s)
- Luanda A Collange Grecco
- Center of Pediatric Neurosurgery, CENEPE-RehabilitationSão Paulo, Brazil; Movement Analysis Laboratory, Department of Rehabilitation Sciences, University Nove de JulhoSão Paulo, Brazil
| | - Claudia Santos Oliveira
- Movement Analysis Laboratory, Department of Rehabilitation Sciences, University Nove de Julho São Paulo, Brazil
| | - Manuela Galli
- Department of Electronics, Computer Science and Bioengineering (DEIB), Politecnico di MilanoMilano, Italy; IRCCS San Raffaele PisanaRome, Italy
| | - Camila Cosmo
- PostGraduate Program-Interactive Process of Organs and Systems, Health Sciences Institute, Federal University of Bahia Salvador, Brazil
| | | | - Nelci Zanon
- Center of Pediatric Neurosurgery, CENEPE-Rehabilitation São Paulo, Brazil
| | - Dylan J Edwards
- Departments of Neurology and Neuroscience, Burke Medical Research Institute, Weill Medical College of Cornel University White Plains, NY, USA
| | - Felipe Fregni
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Massachusetts General Hospital, Harvard Medical School Boston, MA, USA
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Raffin E, Richard N, Giraux P, Reilly KT. Primary motor cortex changes after amputation correlate with phantom limb pain and the ability to move the phantom limb. Neuroimage 2016; 130:134-144. [DOI: 10.1016/j.neuroimage.2016.01.063] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 01/11/2016] [Accepted: 01/15/2016] [Indexed: 01/25/2023] Open
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Reti IM, Schwarz N, Bower A, Tibbs M, Rao V. Transcranial magnetic stimulation: A potential new treatment for depression associated with traumatic brain injury. Brain Inj 2015; 29:789-97. [PMID: 25950260 DOI: 10.3109/02699052.2015.1009168] [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: 01/29/2023]
Abstract
BACKGROUND Each year, more than 1.7 million Americans suffer a traumatic brain injury (TBI) and the lifetime prevalence of major depressive disorder following TBI is between 25-50%. There are no validated established strategies to treat TBI depression. Repetitive transcranial magnetic stimulation (rTMS) is a novel putative treatment option for post-TBI depression, which, compared with standard pharmacological agents, may provide a more targeted treatment with fewer side-effects. However, TBI is associated with an increased risk of both early and late spontaneous seizures, a significant consideration in evaluating rTMS as a potential treatment for TBI depression. Whilst the risk of seizure from rTMS is low, underlying neuropathology may somewhat increase that risk. REVIEW This review focuses on the safety aspects of rTMS in TBI patients. The authors review why low frequency rTMS might be less likely to trigger a seizure than high frequency rTMS and propose low frequency rTMS as a safer option in TBI patients. Because there is little data on the safety of rTMS in TBI, the authors also review the safety of rTMS in patients with other brain pathology. CONCLUSION It is concluded that pilot safety and tolerability studies should be first conducted in persons with TBI and neuropsychiatric comorbidities. These results could be used to help design larger randomized controlled trials.
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Affiliation(s)
- Irving M Reti
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University , Baltimore, MD , USA
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Narayana S, Rezaie R, McAfee SS, Choudhri AF, Babajani-Feremi A, Fulton S, Boop FA, Wheless JW, Papanicolaou AC. Assessing motor function in young children with transcranial magnetic stimulation. Pediatr Neurol 2015; 52:94-103. [PMID: 25439485 DOI: 10.1016/j.pediatrneurol.2014.08.031] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 08/28/2014] [Accepted: 08/31/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Accurate noninvasive assessment of motor function using functional MRI (fMRI) and magnetoencephalography (MEG) is a challenge in patients who are very young or who are developmentally delayed. In such cases, passive mapping of the sensorimotor cortex is performed under sedation. We examined the feasibility of using transcranial magnetic stimulation (TMS) as a motor mapping tool in awake children younger than 3 years of age. METHODS Six children underwent motor mapping with TMS while awake as well as passive sensorimotor mapping under conscious sedation with MEG during tactile stimulation (n = 5) and fMRI during passive hand movements (n = 4). RESULTS Stimulation of the motor cortex via TMS successfully elicited evoked responses in contralateral hand muscles in 5 patients. The location of primary motor cortex in the precentral gyrus identified by TMS corresponded with the postcentral location of the primary sensory cortex identified by MEG in 2 patients and to the sensorimotor cortex identified by fMRI in 3 children. In this cohort, we demonstrate that TMS can illuminate abnormalities in motor physiology including motor reorganization. We also demonstrate the feasibility of using TMS-derived contralateral silent periods to approximate the location of motor cortex in the absence of an evoked response. When compared to chronological age, performance functioning level appears to be better in predicting successful mapping outcome with TMS. CONCLUSIONS Our findings indicate that awake TMS is a safe alternative to MEG and fMRI performed under sedation to localize the motor cortex and provides additional insight into the underlying pathophysiology and motor plasticity in toddlers.
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Affiliation(s)
- Shalini Narayana
- Division of Clinical Neurosciences, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee; Le Bonheur Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, Tennessee; Department of Neurobiology and Anatomy, University of Tennessee Health Science Center, Memphis, Tennessee.
| | - Roozbeh Rezaie
- Division of Clinical Neurosciences, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee; Le Bonheur Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Samuel S McAfee
- Le Bonheur Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Asim F Choudhri
- Le Bonheur Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, Tennessee; Department of Radiology, University of Tennessee Health Science Center, Memphis, Tennessee; Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Abbas Babajani-Feremi
- Division of Clinical Neurosciences, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee; Le Bonheur Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Stephen Fulton
- Le Bonheur Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, Tennessee; Division of Pediatric Neurology, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Frederick A Boop
- Le Bonheur Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, Tennessee; Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - James W Wheless
- Le Bonheur Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, Tennessee; Division of Pediatric Neurology, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Andrew C Papanicolaou
- Division of Clinical Neurosciences, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee; Le Bonheur Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, Tennessee; Department of Neurobiology and Anatomy, University of Tennessee Health Science Center, Memphis, Tennessee
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22
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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: 19] [Impact Index Per Article: 1.9] [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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23
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Grecco LAC, Duarte NAC, Zanon N, Galli M, Fregni F, Oliveira CS. Effect of a single session of transcranial direct-current stimulation on balance and spatiotemporal gait variables in children with cerebral palsy: A randomized sham-controlled study. Braz J Phys Ther 2014; 18:419-27. [PMID: 25372004 PMCID: PMC4228627 DOI: 10.1590/bjpt-rbf.2014.0053] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 06/09/2014] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Transcranial direct-current stimulation (tDCS) has been widely studied with the aim of enhancing local synaptic efficacy and modulating the electrical activity of the cortex in patients with neurological disorders. OBJECTIVE The purpose of the present study was to determine the effect of a single session of tDCS regarding immediate changes in spatiotemporal gait and oscillations of the center of pressure (30 seconds) in children with cerebral palsy (CP). METHOD A randomized controlled trial with a blinded evaluator was conducted involving 20 children with CP between six and ten years of age. Gait and balance were evaluated three times: Evaluation 1 (before the stimulation), Evaluation 2 (immediately after stimulation), and Evaluation 3 (20 minutes after the stimulation). The protocol consisted of a 20-minute session of tDCS applied to the primary motor cortex at an intensity of 1 mA. The participants were randomly allocated to two groups: experimental group - anodal stimulation of the primary motor cortex; and control group - placebo transcranial stimulation. RESULTS Significant reductions were found in the experimental group regarding oscillations during standing in the anteroposterior and mediolateral directions with eyes open and eyes closed in comparison with the control group (p<0.05). In the intra-group analysis, the experimental group exhibited significant improvements in gait velocity, cadence, and oscillation in the center of pressure during standing (p<0.05). No significant differences were found in the control group among the different evaluations. CONCLUSION A single session of tDCS applied to the primary motor cortex promotes positive changes in static balance and gait velocity in children with cerebral palsy.
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Affiliation(s)
| | | | - Nelci Zanon
- Centro de Neurocirurgia Pediátrica, São Paulo, SP, Brazil
| | - Manuela Galli
- Dipartimento di Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Felipe Fregni
- Center of Clinical Research Learning, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, United States
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24
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Duarte NDAC, Grecco LAC, Galli M, Fregni F, Oliveira CS. Effect of transcranial direct-current stimulation combined with treadmill training on balance and functional performance in children with cerebral palsy: a double-blind randomized controlled trial. PLoS One 2014; 9:e105777. [PMID: 25171216 PMCID: PMC4149519 DOI: 10.1371/journal.pone.0105777] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Accepted: 07/24/2014] [Indexed: 11/24/2022] Open
Abstract
Background Cerebral palsy refers to permanent, mutable motor development disorders stemming from a primary brain lesion, causing secondary musculoskeletal problems and limitations in activities of daily living. The aim of the present study was to determine the effects of gait training combined with transcranial direct-current stimulation over the primary motor cortex on balance and functional performance in children with cerebral palsy. Methods A double-blind randomized controlled study was carried out with 24 children aged five to 12 years with cerebral palsy randomly allocated to two intervention groups (blocks of six and stratified based on GMFCS level (levels I-II or level III).The experimental group (12 children) was submitted to treadmill training and anodal stimulation of the primary motor cortex. The control group (12 children) was submitted to treadmill training and placebo transcranial direct-current stimulation. Training was performed in five weekly sessions for 2 weeks. Evaluations consisted of stabilometric analysis as well as the administration of the Pediatric Balance Scale and Pediatric Evaluation of Disability Inventory one week before the intervention, one week after the completion of the intervention and one month after the completion of the intervention. All patients and two examiners were blinded to the allocation of the children to the different groups. Results The experimental group exhibited better results in comparison to the control group with regard to anteroposterior sway (eyes open and closed; p<0.05), mediolateral sway (eyes closed; p<0.05) and the Pediatric Balance Scale both one week and one month after the completion of the protocol. Conclusion Gait training on a treadmill combined with anodal stimulation of the primary motor cortex led to improvements in static balance and functional performance in children with cerebral palsy. Trial Registration Ensaiosclinicos.gov.br/RBR-9B5DH7
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Affiliation(s)
| | - Luanda André Collange Grecco
- Doctoral Program in Rehabilitation Sciences, Movement Analysis Lab, University Nove de Julho, São Paulo, São Paulo, Brazil
| | - Manuela Galli
- Dept. of Electronic Information and Bioengineering, Politecnico di Milano and IRCCS San Raffaele Pisana, Rome
| | - Felipe Fregni
- Laboratory of Neuromodulation & Center of Clinical Research Learning, Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Cláudia Santos Oliveira
- Professor, Master and Doctoral Programs in Rehabilitation Sciences, Movement Analysis Lab, University Nove de Julho, São Paulo, São Paulo, Brazil
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25
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Methods for estimating cortical motor representation size and location in navigated transcranial magnetic stimulation. J Neurosci Methods 2014; 232:125-33. [DOI: 10.1016/j.jneumeth.2014.05.020] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 05/14/2014] [Accepted: 05/15/2014] [Indexed: 11/20/2022]
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26
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Marques MR, Stigger F, Segabinazi E, Augustin OA, Barbosa S, Piazza FV, Achaval M, Marcuzzo S. Beneficial effects of early environmental enrichment on motor development and spinal cord plasticity in a rat model of cerebral palsy. Behav Brain Res 2014; 263:149-57. [DOI: 10.1016/j.bbr.2014.01.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 01/09/2014] [Accepted: 01/11/2014] [Indexed: 11/25/2022]
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27
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Pihko E, Nevalainen P, Vaalto S, Laaksonen K, Mäenpää H, Valanne L, Lauronen L. Reactivity of sensorimotor oscillations is altered in children with hemiplegic cerebral palsy: A magnetoencephalographic study. Hum Brain Mapp 2014; 35:4105-17. [PMID: 24522997 DOI: 10.1002/hbm.22462] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 12/20/2013] [Accepted: 01/03/2014] [Indexed: 11/05/2022] Open
Abstract
Cerebral palsy (CP) is characterized by difficulty in control of movement and posture due to brain damage during early development. In addition, tactile discrimination deficits are prevalent in CP. To study the function of somatosensory and motor systems in CP, we compared the reactivity of sensorimotor cortical oscillations to median nerve stimulation in 12 hemiplegic CP children vs. 12 typically developing children using magnetoencephalography. We also determined the primary cortical somatosensory and motor representation areas of the affected hand in the CP children using somatosensory-evoked magnetic fields and navigated transcranial magnetic stimulation, respectively. We hypothesized that the reactivity of the sensorimotor oscillations in alpha (10 Hz) and beta (20 Hz) bands would be altered in CP and that the beta-band reactivity would depend on the individual pattern of motor representation. Accordingly, in children with CP, suppression and rebound of both oscillations after stimulation of the contralateral hand were smaller in the lesioned than intact hemisphere. Furthermore, in two of the three children with CP having ipsilateral motor representation, the beta- but not alpha-band modulations were absent in both hemispheres after affected hand stimulation suggesting abnormal sensorimotor network interactions in these individuals. The results are consistent with widespread alterations in information processing in the sensorimotor system and complement current understanding of sensorimotor network development after early brain insults. Precise knowledge of the functional sensorimotor network organization may be useful in tailoring individual rehabilitation for people with CP.
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Affiliation(s)
- Elina Pihko
- Brain Research Unit, O.V. Lounasmaa Laboratory, Aalto University School of Science, Espoo, Finland
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28
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Grecco LAC, Duarte NDAC, de Mendonça ME, Pasini H, Lima VLCDC, Franco RC, de Oliveira LVF, de Carvalho PDTC, Corrêa JCF, Collange NZ, Sampaio LMM, Galli M, Fregni F, Oliveira CS. Effect of transcranial direct current stimulation combined with gait and mobility training on functionality in children with cerebral palsy: study protocol for a double-blind randomized controlled clinical trial. BMC Pediatr 2013; 13:168. [PMID: 24112817 PMCID: PMC3852945 DOI: 10.1186/1471-2431-13-168] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 09/17/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The project proposes three innovative intervention techniques (treadmill training, mobility training with virtual reality and transcranial direct current stimulation that can be safely administered to children with cerebral palsy. The combination of transcranial stimulation and physical therapy resources will provide the training of a specific task with multiple rhythmic repetitions of the phases of the gait cycle, providing rich sensory stimuli with a modified excitability threshold of the primary motor cortex to enhance local synaptic efficacy and potentiate motor learning. METHODS/DESIGN A prospective, double-blind, randomized, controlled, analytical, clinical trial will be carried out.Eligible participants will be children with cerebral palsy classified on levels I, II and III of the Gross Motor Function Classification System between four and ten years of age. The participants will be randomly allocated to four groups: 1) gait training on a treadmill with placebo transcranial stimulation; 2) gait training on a treadmill with active transcranial stimulation; 3) mobility training with virtual reality and placebo transcranial stimulation; 4) mobility training with virtual reality and active transcranial stimulation. Transcranial direct current stimulation will be applied with the anodal electrode positioned in the region of the dominant hemisphere over C3, corresponding to the primary motor cortex, and the cathode positioned in the supraorbital region contralateral to the anode. A 1 mA current will be applied for 20 minutes. Treadmill training and mobility training with virtual reality will be performed in 30-minute sessions five times a week for two weeks (total of 10 sessions). Evaluations will be performed on four occasions: one week prior to the intervention; one week following the intervention; one month after the end of the intervention;and 3 months after the end of the intervention. The evaluations will involve three-dimensional gait analysis, analysis of cortex excitability (motor threshold and motor evoked potential), Six-Minute Walk Test, Timed Up-and-Go Test, Pediatric Evaluation Disability Inventory, Gross Motor Function Measure, Berg Balance Scale, stabilometry, maximum respiratory pressure and an effort test. DISCUSSION This paper offers a detailed description of a prospective, double-blind, randomized, controlled, analytical, clinical trial aimed at demonstrating the effect combining transcranial stimulation with treadmill and mobility training on functionality and primary cortex excitability in children with Cerebral Palsy classified on Gross Motor Function Classification System levels I, II and III. The results will be published and will contribute to evidence regarding the use of treadmill training on this population. TRIAL REGISTRATION ReBEC RBR-9B5DH7.
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Affiliation(s)
- Luanda André Collange Grecco
- Master’s and Doctoral Programs in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, SP, Brazil
- Rua Diogo de Faria 775, Vila Mariana, CEP 04037-000 São Paulo, SP, Brazil
| | | | | | - Hugo Pasini
- Master’s and Doctoral Programs in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, SP, Brazil
| | - Vânia Lúcia Costa de Carvalho Lima
- Master’s and Doctoral Programs in Communication disordes: Speech area, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Renata Calhes Franco
- Master’s and Doctoral Programs in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, SP, Brazil
| | | | | | - João Carlos Ferrari Corrêa
- Master’s and Doctoral Programs in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, SP, Brazil
| | - Nelci Zanon Collange
- 4th Pediatric Neurosurgery, University of São Paulo and the Federal Pediatric Neurosurgical Center (CENEPE), São Paulo, Brazil
| | - Luciana Maria Malosá Sampaio
- Master’s and Doctoral Programs in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, SP, Brazil
| | - Manuela Galli
- Associate professor of Dipartimento di Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Felipe Fregni
- Laboratory of Neuromodulation & Center of Clinical Research Learning, Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Claudia Santos Oliveira
- Master’s and Doctoral Programs in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, SP, Brazil
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Andersen JC, Majnemer A, O'Grady K, Gordon AM. Intensive upper extremity training for children with hemiplegia: from science to practice. Semin Pediatr Neurol 2013; 20:100-5. [PMID: 23948684 DOI: 10.1016/j.spen.2013.06.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
For children with hemiplegic cerebral palsy, bimanual abilities are central to independent function. Over the last decade, considerable attention has been given to 2 forms of extended practice therapy for the upper limb, constraint-induced movement therapy and intensive bimanual training. This article reviews the varying nature of these 2 approaches and the existing scientific rationale supporting them. Comparisons between these 2 intensive upper extremity training approaches indicate similar improvements in unimanual capacity and bimanual performance outcomes; however, when considering participant and caregiver goal achievement, evidence favors a bimanual approach. Careful selection of either therapy for this population requires consideration of individual and contextual factors in relation to treatment goals. The key ingredients and dose responses remain unknown. Treatment intensity, intrinsic motivation, and individualization of treatment are hypothesized as requisite in either approach.
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Affiliation(s)
- John C Andersen
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
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30
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Sajedi F, Ahmadlou M, Vameghi R, Gharib M, Hemmati S. Linear and nonlinear analysis of brain dynamics in children with cerebral palsy. RESEARCH IN DEVELOPMENTAL DISABILITIES 2013; 34:1388-1396. [PMID: 23474991 DOI: 10.1016/j.ridd.2013.01.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2012] [Revised: 01/20/2013] [Accepted: 01/21/2013] [Indexed: 06/01/2023]
Abstract
This study was carried out to determine linear and nonlinear changes of brain dynamics and their relationships with the motor dysfunctions in CP children. For this purpose power of EEG frequency bands (as a linear analysis) and EEG fractality (as a nonlinear analysis) were computed in eyes-closed resting state and statistically compared between 26 CP and 26 normal children. Based on these characteristics accuracy of the classification between the two groups was obtained by enhanced probabilistic neural network (EPNN). Severity of gross motor and manual disabilities was determined by standard systems and the relation between the deficient brain dynamics and severity of the motor dysfunctions was obtained by Pearson's correlation coefficient. A definitely higher delta and lower theta and alpha powers, and higher EEG complexity in CP patients. As such a high accuracy of 94.8% in distinguishing the two groups was obtained. Moreover significant positive correlations were found between beta power and severity of manual disabilities and gross motor dysfunctions in the boys with CP. It is concluded that the obtained brain dynamics' characteristics are useful in diagnosis of CP. Furthermore severity of the motor dysfunctions in boys with CP could be evaluated by the beta activity.
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Affiliation(s)
- Firoozeh Sajedi
- Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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