The correlation between transcranial magnetic stimulation parameters and neuromuscular properties in children with cerebral palsy

Therapeutic Effects of repetitive Transcranial Magnetic Stimulation on Corticospinal Tract Activities and Neuromuscular Properties in Children with Cerebral Palsy

The objective of this research was to study the therapeutic effects of repetitive transcranial magnetic stimulation (rTMS) on corticospinal tract (CST) activities, reflex hyper-excitability, muscle stiffness, and the clinical status of children with spastic hemiplegic cerebral palsy (CP). Three children participated in this study. The treatment lasted for 6 weeks. Two of the patients, the experimental group, received rTMS therapy 4 days a week during the first 3 weeks, and then received typical occupational therapy (OT) after each rTMS session during the second 3 weeks. One patient, the control group, received the same treatment except that a sham coil was used. Each rTMS session lasted for 20 minutes and each OT session lasted for 45 minutes. We evaluated CST activities by transcranial magnetic stimulation (TMS), reflex hyperexcitability by H-reflex response, and muscle stiffness by sonoelastography images. The tests were taken before and after the treatment. Major TMS parameters (i.e., motor evoked potential (MEP) latency, MEP p-p amplitude, cortical silent period (cSP), and intensity of pulse) for experimental patients were improved in comparison with the control patient. H response latency and max H response on max M-wave (H/M) were improved for the experimental group compared to the control group. Two parameters of texture analysis of the sonoelastography images (i.e., entropy and contrast) were improved for the experimental group. Clinical evaluations such as 10 meter walk test (10MWT), timed up and go (TUG), and 6 minute walk test (6MWT) were performed before and after the course of treatment and were improved for the experimental group compared to the control group. These results indicated that rTMS therapy can improve CST activities, reflexes, muscle stiffness, and walking capacity of spastic hemiplegic CP. Therefore, it can be considered as an effective therapeutic tool for enhancing neuromuscular abnormalities resulting from CP.

The Impact of Repetitive Transcranial Magnetic Stimulation on Affected and Unaffected Sides of a Child with Hemiplegic Cerebral Palsy

The purpose of this study was to investigate the therapeutic effects of neuro-navigated repetitive transcranial magnetic stimulation (rTMS) combined with occupational therapy (OT) on gait impairment of a child (male, age: 13.2) with spastic hemiplegic cerebral palsy (CP). The treatment included 4 days a week of rTMS sessions for 3 weeks and 4 days of rTMS and OT sessions per week for 3 weeks. Transcranial magnetic stimulation (TMS) was used to evaluate corticospinal tract (CST) activities and H-reflex test was used to assess reflex hyper-excitability. Common clinical tests demonstrate the clinical status of the patient. Evaluations were performed in 4 time steps: baseline, 3 weeks after the beginning of the treatment, at the end of the treatment, and 1 month after the end of the treatment. The patient did not receive any specific treatment after the end of the treatment up to the follow up evaluations. The tests' results were compared between the affected and unaffected legs of the patient. Four parameters of the TMS test were calculated (motor evoked potential (MEP) latency, MEP peak-to-peak amplitude, cortical silent period (cSP), and stimulation intensity). These parameters were all improved for the affected side and cSP improved for the unaffected side, but MEP p-p amplitude and intensity got worse slightly for the unaffected side. Recruitment curves of H response and M-wave of the H-reflex test for both sides were obtained. Improvements could be seen after the treatment for both sides. Max H response on max M-wave (H/M) and H response latency got better after the treatment for both sides. Walking speed for self and fast velocity, timed up and go, and walking endurance improved during and after the treatment. All the improvements persisted after one month of the end of the treatment in the follow up evaluations. These findings indicate that rTMS combined with OT can have effective and long-lasting impact on neuromuscular impairments in spastic CP children.

The Effects of Low Frequency Repetitive Transcranial Magnetic Stimulation on White Matter Structural Connectivity in Children with Cerebral Palsy

Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive treatment technique for recovery of movement disorders by altering cortical plasticity. In this research, we studied the effects of low-frequency rTMS on white matter (WM) structural connectivity and clinical parameters in children with cerebral palsy (CP).,Four spastic hemiplegic CP children were randomly divided into experimental and control groups. In the experimental group, at first, 1Hz rTMS treatment was performed 4 days/week for 3 weeks on two hemiplegia patients over a contralesional primary motor cortex (M1). Then, 1Hz rTMS treatment was performed 4 days/week for 3 weeks followed by a 30min occupational therapy (OT). In the control group, two CP children received sham rTMS for 3 weeks and then sham rTMS combined with OT for 3 weeks in the same schedule as the experimental group. Evaluations performed using diffusion tensor imaging (DTI), and clinical measurements of gait performance before and after the treatment. Graph theoretical analysis was used to characterize topological changes of structural connectivity. Our findings demonstrate the 1Hz rTMS is effective in improving motor activity in spastic hemiplegic CP children, and is more effective when combined with OT.

The Effects of Lower Body Positive Pressure Treadmill Training on Dynamic Balance of Children with Cerebral Palsy

We aimed to characterize the therapeutic effects of Anti-gravity (AlterG) body weight supported treadmill training on the impaired balance of children with cerebral palsy (CP). Four spastic CP children participated; two received AlterG training 3 times a week for 8 weeks and the other two received typical occupational therapy accordingly. Their dynamic balance was evaluated before the start of the treatment and 2 months after it. Features related to the center of pressure (COP) and the center of mass (COM) were considered as dynamic balance parameters. Our results showed that the maximum velocity and acceleration of the COP and COM, the average variability (RMS) and peak to peak of the COM-COP separation, and RMS of velocity and acceleration of the COM and COP were all improved for both AlterG training patients (15-90%), though there was a limited improvement of 0.2-24% in some features of the control patients. Our results demonstrate that intensive sessions of the AlterG training program could have the potential to be used as a therapeutic tool that can produce dynamic balance improvements in CP children compared to that of typical occupational therapy.

Therapeutic effects of anti-gravity treadmill (AlterG) training on reflex hyper-excitability, corticospinal tract activities, and muscle stiffness in children with cerebral palsy

We aimed to study therapeutic effects of antigravity treadmill (AlterG) training on reflex hyper-excitability, muscle stiffness, and corticospinal tract (CST) function in children with spastic hemiplegic cerebral palsy (CP). Three children received AlterG training 3 days per week for 8 weeks as experimental group. Each session lasted 45 minutes. One child as control group received typical occupational therapy for the same amount of time. We evaluated hyper-excitability of lower limb muscles by H-reflex response. We quantified muscle stiffness by sonoelastography images of the affected muscles. We quantified CST activity by transcranial magnetic stimulation (TMS). We performed the evaluations before and after training for both groups. H response latency and maximum M-wave amplitude were improved in experimental group after training compared to control group. Two children of experimental group had TMS response. Major parameters of TMS (i.e. peak-to-peak amplitude of motor evoked potential (MEP), latency of MEP, cortical silent period, and intensity of pulse) improved for both of them. Three parameters of texture analysis of sonoelastography images were improved for experimental group (i.e. contrast, entropy, and shear wave velocity). These findings indicate that AlterG training can improve reflexes, muscle stiffness, and CST activity in children with spastic hemiplegic CP and can be considered as a therapeutic tool to improve neuromuscular abnormalities occurring secondary to CP.