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Julien L, Moreau-Pernet G, Rochette E, Lemaire JJ, Pontier B, Bourrand S, Pereira B, Chassain C, Sontheimer A, Sarret C. Robot-assisted gait training improves walking and cerebral connectivity in children with unilateral cerebral palsy. Pediatr Res 2024:10.1038/s41390-024-03240-1. [PMID: 38769400 DOI: 10.1038/s41390-024-03240-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 02/13/2024] [Accepted: 04/03/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Robot-assisted gait training (RAGT) is promising to help walking rehabilitation in cerebral palsy, but training-induced neuroplastic effects have little been investigated. METHODS Forty unilateral cerebral palsy children aged 4-18 years were randomly allocated in a monocentric study to ten 20-minute RAGT sessions with the G-EO system, five days a week (n = 20) or to a control group (who continued conventional care with six 30-minute physiotherapy sessions, three days a week) (n = 20), two weeks running, from September 2020 to December 2021. Clinical and MRI outcomes were compared before and one month after therapy. The primary outcome was gait speed. Secondary outcomes were a 6-minute walking test distance, Gross Motor Function Measure-88 (GMFM-88) dimensions D and E, Patient Global Impression of Improvement, resting-state functional connectivity within the sensorimotor network, and structural connectivity in the corticospinal tracts. RESULTS Gait speed and the 6-minute walking test distance improved more after RAGT. Resting-state functional connectivity increased after RAGT but decreased in controls between superior and lateral healthy or lateral injured sensorimotor networks. GMFM-88 and structural connectivity in corticospinal tracts were unchanged. Impression of improvement in children was better after RAGT. CONCLUSION Short-term benefit of repetitive RAGT on walking abilities and functional cerebral connectivity was found in unilateral cerebral palsy children. IMPACT STATEMENT Short-term repetitive robot-assisted gait training improves gait speed and walking resistance and increases cerebral functional connectivity in unilateral cerebral palsy. GMFM dimensions D and E were unchanged after short-term repetitive robot-assisted gait training in unilateral cerebral palsy.
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Affiliation(s)
- Laura Julien
- Department of Pediatrics, CRECHE, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
- Clermont Auvergne University, CNRS, Clermont Auvergne INP, Institut Pascal, Clermont-Ferrand, France
| | | | - Emmanuelle Rochette
- Department of Pediatrics, CRECHE, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Jean-Jacques Lemaire
- Clermont Auvergne University, CNRS, Clermont Auvergne INP, Institut Pascal, Clermont-Ferrand, France
- Department of Neurosurgery, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Bénédicte Pontier
- Department of Pediatrics, CRECHE, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
- Clermont Auvergne University, CNRS, Clermont Auvergne INP, Institut Pascal, Clermont-Ferrand, France
- Department of Neurosurgery, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Sacha Bourrand
- Clermont Auvergne University, CNRS, Clermont Auvergne INP, Institut Pascal, Clermont-Ferrand, France
| | - Bruno Pereira
- Clinical Research Division, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Carine Chassain
- Clermont Auvergne University, CNRS, Clermont Auvergne INP, Institut Pascal, Clermont-Ferrand, France
| | - Anna Sontheimer
- Clermont Auvergne University, CNRS, Clermont Auvergne INP, Institut Pascal, Clermont-Ferrand, France
- Department of Neurosurgery, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | - Catherine Sarret
- Department of Pediatrics, CRECHE, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France.
- Clermont Auvergne University, CNRS, Clermont Auvergne INP, Institut Pascal, Clermont-Ferrand, France.
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Trevarrow MP, Dukkipati SS, Baker SE, Wilson TW, Kurz MJ. Reduced brainstem volume is associated with mobility impairments in youth with cerebral palsy. J Clin Neurosci 2023; 117:114-119. [PMID: 37801875 PMCID: PMC10841759 DOI: 10.1016/j.jocn.2023.09.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 08/09/2023] [Accepted: 09/28/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND Persons with cerebral palsy (CP) have impaired mobility that has been attributed to changes in structure and function within the nervous system. The brainstem is a region that plays a critical role in mobility by connecting the cortex and cerebellum to the spinal cord, yet this region has been largely unstudied in persons with CP. RESEARCH QUESTION We used high-resolution structural MRI and biomechanical analyses to examine whether the volume of the whole brainstem and its constituent elements are altered in CP and if these alterations relate to the mobility impairments within this population. METHODS A cohort study was conducted to assess the volume of the whole brainstem, pons, midbrain, medulla, and superior cerebellar peduncle in a cohort of persons with CP (N = 26; Age = 16.3 ± 1.0 years; GMFCS levels I-IV, Females = 12) and a cohort of neurotypical (NT) controls (N = 38; Age = 14.3 ± 0.4 years, Females = 14) using structural MR imaging of the brainstem. Outside the scanner, a digital mat was used to quantify the spatiotemporal gait biomechanics of these individuals. RESULTS We found a significant decrease in volume of the total brainstem, midbrain, and pons in persons with CP in comparison to the NT controls. Furthermore, we found that the altered volumes were related to reduced gait velocity and step length. SIGNIFICANCE The structural changes in the brainstems of persons with CP may contribute to the mobility impairments that are ubiquitous within this population.
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Affiliation(s)
- Michael P Trevarrow
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE 68010, USA
| | - Saihari S Dukkipati
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE 68010, USA
| | - Sarah E Baker
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE 68010, USA
| | - Tony W Wilson
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE 68010, USA; Department of Pharmacology & Neuroscience, Creighton University, Omaha, NE, USA
| | - Max J Kurz
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE 68010, USA; Department of Pharmacology & Neuroscience, Creighton University, Omaha, NE, USA.
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Bergwell H, Trevarrow MP, Heinrichs-Graham E, Reelfs A, Ott LR, Penhale SH, Wilson TW, Kurz MJ. Aberrant age-related alterations in spontaneous cortical activity in participants with cerebral palsy. Front Neurol 2023; 14:1163964. [PMID: 37521295 PMCID: PMC10374009 DOI: 10.3389/fneur.2023.1163964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 06/22/2023] [Indexed: 08/01/2023] Open
Abstract
Introduction Cerebral Palsy (CP) is the most common neurodevelopmental motor disability, resulting in life-long sensory, perception and motor impairments. Moreover, these impairments appear to drastically worsen as the population with CP transitions from adolescents to adulthood, although the underlying neurophysiological mechanisms remain poorly understood. Methods We began to address this knowledge gap by utilizing magnetoencephalographic (MEG) brain imaging to study how the amplitude of spontaneous cortical activity (i.e., resting state) is altered during this transition period in a cohort of 38 individuals with spastic diplegic CP (Age range = 9.80-47.50 years, 20 females) and 67 neurotypical controls (NT) (Age range = 9.08-49.40 years, Females = 27). MEG data from a five-minute eyes closed resting-state paradigm were source imaged, and the power within the delta (2-4 Hz), theta (5-7 Hz), alpha (8-12 Hz), beta (15-29 Hz), and gamma (30-59 Hz) frequency bands were computed. Results For both groups, the delta and theta spontaneous power decreased in the bilateral temporoparietal and superior parietal regions with age, while alpha, beta, and gamma band spontaneous power increased in temporoparietal, frontoparietal and premotor regions with age. We also found a significant group x age interaction, such that participants with CP demonstrated significantly less age-related increases in the spontaneous beta activity in the bilateral sensorimotor cortices compared to NT controls. Discussion Overall, these results demonstrate that the spontaneous neural activity in individuals with CP has an altered trajectory when transitioning from adolescents to adulthood. We suggest that these differences in spontaneous cortical activity may play a critical role in the aberrant motor actions seen in this patient group, and may provide a neurophysiological marker for assessing the effectiveness of current treatment strategies that are directed at improving the mobility and sensorimotor impairments seen in individuals with CP.
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Affiliation(s)
- Hannah Bergwell
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE, United States
| | - Michael P. Trevarrow
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE, United States
| | - Elizabeth Heinrichs-Graham
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE, United States
- Department of Pharmacology & Neuroscience, Creighton University, Omaha, NE, United States
| | - Anna Reelfs
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE, United States
| | - Lauren R. Ott
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE, United States
| | - Samantha H. Penhale
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE, United States
| | - Tony W. Wilson
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE, United States
- Department of Pharmacology & Neuroscience, Creighton University, Omaha, NE, United States
| | - Max J. Kurz
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE, United States
- Department of Pharmacology & Neuroscience, Creighton University, Omaha, NE, United States
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Trevarrow MP, Dukkipati SS, Baker SE, Wilson TW, Kurz MJ. Reduced Brainstem Volume is Associated with Mobility Impairments in Youth with Cerebral Palsy. RESEARCH SQUARE 2023:rs.3.rs-2566073. [PMID: 36824764 PMCID: PMC9949252 DOI: 10.21203/rs.3.rs-2566073/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Persons with cerebral palsy (CP) have impaired mobility that has been attributed to changes in structure and function within the nervous system. The brainstem is a region that plays a critical role in locomotion by connecting the cortex and cerebellum to the spinal cord, yet this region has been largely unstudied in persons with CP. The objective of this investigation was to use high-resolution structural MRI and biomechanical analyses to examine whether the volume of the whole brainstem and its constituent elements are altered in CP, and if these alterations relate to the mobility impairments within this population. We assessed the volume of the pons, midbrain, medulla, and superior cerebellar peduncle (SCP) in a cohort of persons with CP (N = 26; Age = 16.3 ± 1.0 yrs; GMFCS levels I-IV, Females = 12) and a cohort of neurotypical (NT) controls (N = 38; Age = 14.3 ± 0.4 yrs, Females = 14) using structural MR imaging of the brainstem. Outside the scanner, a digital mat was used to quantify the spatiotemporal gait biomechanics of these individuals. Our MRI results revealed that there was a significant decrease in volume of the total brainstem, midbrain, and pons in persons with CP in comparison to the NT controls. Furthermore, we found that the altered volumes were related to reduced gait velocity and step length. These results suggest that there are structural changes in the brainstems of persons with CP that may contribute to the mobility impairments that are ubiquitous within this population.
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Jacobs NPT, Pouwels PJW, van der Krogt MM, Meyns P, Zhu K, Nelissen L, Schoonmade LJ, Buizer AI, van de Pol LA. Brain structural and functional connectivity and network organization in cerebral palsy: A scoping review. Dev Med Child Neurol 2023. [PMID: 36750309 DOI: 10.1111/dmcn.15516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 12/10/2022] [Accepted: 12/13/2022] [Indexed: 02/09/2023]
Abstract
AIM To explore altered structural and functional connectivity and network organization in cerebral palsy (CP), by clinical CP subtype (unilateral spastic, bilateral spastic, dyskinetic, and ataxic CP). METHOD PubMed and Embase databases were systematically searched. Extracted data included clinical characteristics, analyses, outcome measures, and results. RESULTS Sixty-five studies were included, of which 50 investigated structural connectivity, and 20 investigated functional connectivity using functional magnetic resonance imaging (14 studies) or electroencephalography (six studies). Five of the 50 studies of structural connectivity and one of 14 of functional connectivity investigated whole-brain network organization. Most studies included patients with unilateral spastic CP; none included ataxic CP. INTERPRETATION Differences in structural and functional connectivity were observed between investigated clinical CP subtypes and typically developing individuals on a wide variety of measures, including efferent, afferent, interhemispheric, and intrahemispheric connections. Directions for future research include extending knowledge in underrepresented CP subtypes and methodologies, evaluating the prognostic potential of specific connectivity and network measures in neonates, and understanding therapeutic effects on brain connectivity.
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Affiliation(s)
- Nina P T Jacobs
- Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, the Netherlands
| | - Petra J W Pouwels
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Radiology & Nuclear Medicine, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Marjolein M van der Krogt
- Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, the Netherlands
| | - Pieter Meyns
- REVAL Rehabilitation Research, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Kangdi Zhu
- Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Loïs Nelissen
- Department of Pediatric Neurology, Emma Children's Hospital, Amsterdam UMC, location Vrije Universiteit, Amsterdam, the Netherlands
| | - Linda J Schoonmade
- Medical Library, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Annemieke I Buizer
- Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, the Netherlands.,Emma Children's Hospital, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Laura A van de Pol
- Department of Pediatric Neurology, Emma Children's Hospital, Amsterdam UMC, location Vrije Universiteit, Amsterdam, the Netherlands
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Qian G, Cai X, Xu K, Tian H, Meng Q, Ossowski Z, Liang J. Which gait training intervention can most effectively improve gait ability in patients with cerebral palsy? A systematic review and network meta-analysis. Front Neurol 2023; 13:1005485. [PMID: 36703638 PMCID: PMC9871496 DOI: 10.3389/fneur.2022.1005485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 11/30/2022] [Indexed: 01/11/2023] Open
Abstract
Background A vital objective to treat people with cerebral palsy (CP) is to increase gait velocity and improve gross motor function. This study aimed to evaluate the relative effectiveness of gait training interventions for persons with CP. Methods Studies published up to October 26, 2022 were searched from four electronic databases [including Medline (via PubMed), Web of Science, Embase and Cochrane]. Studies with randomized controlled trials (RCTs), people with CP, comparisons of different gait training interventions and outcomes of gait velocity and gross motor function measures (GMFM) were included in this study. The quality of the literature was evaluated using the risk of bias tool in the Cochrane Handbook, the extracted data were analyzed through network meta-analysis (NMA) using Stata16.0 and RevMan5.4 software. Results Twenty RCTs with a total of 516 individuals with CP were included in accordance with the criteria of this study. The results of the NMA analysis indicated that both external cues treadmill training (ECTT) [mean difference (MD) = 0.10, 95% confidence interval CI (0.04, 0.17), P < 0.05] and partial body weight supported treadmill training (BWSTT) [MD = 0.12, 95% CI (0.01, 0.23), P < 0.05] had better gait velocity than over ground gait training (OGT), BWSTT [MD = 0.09, 95%CI(0.01,0.18), P < 0.05] had a better gait velocity than robot-assisted gait training (RAGT), BWSTT [MD = 0.09, 95% CI (0.06, 0.13) P < 0.05] had a better gait velocity than treadmill training (TT), and BWSTT [MD = 0.14, 95% CI (0.07, 0.21), P < 0.05] had a better gait velocity than conventional physical therapy (CON). The SUCRA ranking indicated that BWSTT optimally improved the gait velocity, and the other followed an order of BWSTT (91.7%) > ECTT (80.9%) > RAGT (46.2%) > TT (44%) > OGT (21.6%) > CON (11.1%). In terms of GMFM, for dimension D (GMFM-D), there was no statistical difference between each comparison; for dimension E (GMFM-E), RAGT [MD = 10.45, 95% CI (2.51, 18.40), P < 0.05] was significantly more effective than CON. Both SUCRA ranking results showed that RAGT improved GMFM-D/E optimally, with rankings of RAGT (69.7%) > TT (69.3%) > BWSTT (67.7%) > OGT (24%) > CON (20.3%), and RAGT (86.1%) > BWSTT (68.2%) > TT (58%) > CON (20.1%) > OGT (17.6%) respectively. Conclusion This study suggested that BWSTT was optimal in increasing the gait velocity and RAGT was optimal in optimizing GMFM in persons with CP. Impacted by the limitations of the number and quality of studies, randomized controlled trials with larger sample sizes, multiple centers, and high quality should be conducted to validate the above conclusion. Further studies will be required to focus on the total duration of the intervention, duration and frequency of sessions, and intensity that are optimal for the promotion of gait ability in this population. Systematic review registration https://doi.org/10.37766/inplasy2022.10.0108, identifier: INPLASY2022100108.
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Affiliation(s)
- Guoping Qian
- Department of Sport, Gdansk University of Physical Education and Sport, Gdańsk, Poland
| | - Xiaoye Cai
- Department of General Education, Shanghai Normal University Tianhua College, Shanghai, China
| | - Kai Xu
- Department of Sport, Gdansk University of Physical Education and Sport, Gdańsk, Poland,Department of Art and Sports, Huanghe Science and Technology University, Zhengzhou, Henan, China
| | - Hao Tian
- Department of Sport, Gdansk University of Physical Education and Sport, Gdańsk, Poland,Department of Physical Education and Humanities, Nanjing Sport Institute, Nanjing, China
| | - Qiao Meng
- Department of Sport, Gdansk University of Physical Education and Sport, Gdańsk, Poland
| | - Zbigniew Ossowski
- Department of Sport, Gdansk University of Physical Education and Sport, Gdańsk, Poland,*Correspondence: Zbigniew Ossowski ✉
| | - Jinghong Liang
- Department of Maternal and Child Health, School of Public Health, Medical College of Sun Yat-sen University, Guangzhou, China,Jinghong Liang ✉
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Trevarrow MP, Reelfs A, Ott LR, Penhale SH, Lew BJ, Goeller J, Wilson TW, Kurz MJ. Altered spontaneous cortical activity predicts pain perception in individuals with cerebral palsy. Brain Commun 2022; 4:fcac087. [PMID: 35441137 PMCID: PMC9014448 DOI: 10.1093/braincomms/fcac087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 01/13/2022] [Accepted: 03/31/2022] [Indexed: 12/04/2022] Open
Abstract
Cerebral palsy is the most common paediatric neurological disorder and results in extensive impairment to the sensorimotor system. However, these individuals also experience increased pain perception, resulting in decreased quality of life. In the present study, we utilized magnetoencephalographic brain imaging to examine whether alterations in spontaneous neural activity predict the level of pain experienced in a cohort of 38 individuals with spastic diplegic cerebral palsy and 67 neurotypical controls. Participants completed 5 min of an eyes closed resting-state paradigm while undergoing a magnetoencephalography recording. The magnetoencephalographic data were then source imaged, and the power within the delta (2–4 Hz), theta (5–7 Hz), alpha (8–12 Hz), beta (15–29 Hz), low gamma (30–59 Hz) and high gamma (60–90 Hz) frequency bands were computed. The resulting power spectral density maps were analysed vertex-wise to identify differences in spontaneous activity between groups. Our findings indicated that spontaneous cortical activity was altered in the participants with cerebral palsy in the delta, alpha, beta, low gamma and high gamma bands across the occipital, frontal and secondary somatosensory cortical areas (all pFWE < 0.05). Furthermore, we also found that the altered beta band spontaneous activity in the secondary somatosensory cortices predicted heightened pain perception in the individuals with cerebral palsy (P = 0.039). Overall, these results demonstrate that spontaneous cortical activity within individuals with cerebral palsy is altered in comparison to their neurotypical peers and may predict increased pain perception in this patient population. Potentially, changes in spontaneous resting-state activity may be utilized to measure the effectiveness of current treatment approaches that are directed at reducing the pain experienced by individuals with cerebral palsy.
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Affiliation(s)
- Michael P. Trevarrow
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE, USA
| | - Anna Reelfs
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE, USA
| | - Lauren R. Ott
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE, USA
| | - Samantha H. Penhale
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE, USA
| | - Brandon J. Lew
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE, USA
| | - Jessica Goeller
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Tony W. Wilson
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE, USA
- Department of Pharmacology & Neuroscience, Creighton University, Omaha, NE, USA
| | - Max J. Kurz
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE, USA
- Department of Pharmacology & Neuroscience, Creighton University, Omaha, NE, USA
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Brain Dynamics and Connectivity from Birth through Adolescence. Brain Sci 2022; 12:brainsci12030395. [PMID: 35326351 PMCID: PMC8946026 DOI: 10.3390/brainsci12030395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 03/10/2022] [Accepted: 03/14/2022] [Indexed: 12/04/2022] Open
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