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Martinie O, Karan P, Traverse E, Mercier C, Descoteaux M, Robert MT. The Challenge of Diffusion Magnetic Resonance Imaging in Cerebral Palsy: A Proposed Method to Identify White Matter Pathways. Brain Sci 2023; 13:1386. [PMID: 37891755 PMCID: PMC10605121 DOI: 10.3390/brainsci13101386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 09/19/2023] [Accepted: 09/26/2023] [Indexed: 10/29/2023] Open
Abstract
Cerebral palsy (CP), a neuromotor disorder characterized by prenatal brain lesions, leads to white matter alterations and sensorimotor deficits. However, the CP-related diffusion neuroimaging literature lacks rigorous and consensual methodology for preprocessing and analyzing data due to methodological challenges caused by the lesion extent. Advanced methods are available to reconstruct diffusion signals and can update current advances in CP. Our study demonstrates the feasibility of analyzing diffusion CP data using a standardized and open-source pipeline. Eight children with CP (8-12 years old) underwent a single diffusion magnetic resonance imaging (MRI) session on a 3T scanner (Achieva 3.0T (TX), Philips Healthcare Medical Systems, Best, The Netherlands). Exclusion criteria were contraindication to MRI and claustrophobia. Anatomical and diffusion images were acquired. Data were corrected and analyzed using Tractoflow 2.3.0 version, an open-source and robust tool. The tracts were extracted with customized procedures based on existing atlases and freely accessed standardized libraries (ANTs, Scilpy). DTI, CSD, and NODDI metrics were computed for each tract. Despite lesion heterogeneity and size, we successfully reconstructed major pathways, except for a participant with a larger lesion. Our results highlight the feasibility of identifying and quantifying subtle white matter pathways. Ultimately, this will increase our understanding of the clinical symptoms to provide precision medicine and optimize rehabilitation.
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Affiliation(s)
- Ophélie Martinie
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Québec, QC G1M 2S8, Canada; (O.M.); (E.T.); (C.M.)
- Department of Rehabilitation, Université Laval, Québec, QC G1V 0A6, Canada
| | - Philippe Karan
- Department of Computer Sciences, Université de Sherbrooke, Sherbrooke, QC J1K 2R1, Canada; (P.K.); (M.D.)
| | - Elodie Traverse
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Québec, QC G1M 2S8, Canada; (O.M.); (E.T.); (C.M.)
- Department of Rehabilitation, Université Laval, Québec, QC G1V 0A6, Canada
| | - Catherine Mercier
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Québec, QC G1M 2S8, Canada; (O.M.); (E.T.); (C.M.)
- Department of Rehabilitation, Université Laval, Québec, QC G1V 0A6, Canada
| | - Maxime Descoteaux
- Department of Computer Sciences, Université de Sherbrooke, Sherbrooke, QC J1K 2R1, Canada; (P.K.); (M.D.)
| | - Maxime T. Robert
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Québec, QC G1M 2S8, Canada; (O.M.); (E.T.); (C.M.)
- Department of Rehabilitation, Université Laval, Québec, QC G1V 0A6, Canada
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Vuong A, Joshi SH, Staudt LA, Matsumoto JH, Fowler EG. Improved Myelination following Camp Leg Power, a Selective Motor Control Intervention for Children with Spastic Bilateral Cerebral Palsy: A Diffusion Tensor MRI Study. AJNR Am J Neuroradiol 2023; 44:700-706. [PMID: 37142433 PMCID: PMC10249693 DOI: 10.3174/ajnr.a7860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 04/04/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND AND PURPOSE Children with spastic cerebral palsy have motor deficits associated with periventricular leukomalacia indicating WM damage to the corticospinal tracts. We investigated whether practice of skilled lower extremity selective motor control movements would elicit neuroplasticity. MATERIALS AND METHODS Twelve children with spastic bilateral cerebral palsy and periventricular leukomalacia born preterm (mean age, 11.5 years; age range, 7.3-16.6 years) participated in a lower extremity selective motor control intervention, Camp Leg Power. Activities promoted isolated joint movement including isokinetic knee exercises, ankle-controlled gaming, gait training, and sensorimotor activities (3 hours/day, 15 sessions, 1 month). DWI scans were collected pre- and postintervention. Tract-Based Spatial Statistics was used to analyze changes in fractional anisotropy, radial diffusivity, axial diffusivity, and mean diffusivity. RESULTS Significantly reduced radial diffusivity (P < . 05) was found within corticospinal tract ROIs, including 28.4% of the left and 3.6% of the right posterior limb of the internal capsule and 14.1% of the left superior corona radiata. Reduced mean diffusivity was found within the same ROIs (13.3%, 11.6%, and 6.6%, respectively). Additionally, decreased radial diffusivity was observed in the left primary motor cortex. Additional WM tracts had decreased radial diffusivity and mean diffusivity, including the anterior limb of the internal capsule, external capsule, anterior corona radiata, and corpus callosum body and genu. CONCLUSIONS Myelination of the corticospinal tracts improved following Camp Leg Power. Neighboring WM changes suggest recruitment of additional tracts involved in regulating neuroplasticity of the motor regions. Intensive practice of skilled lower extremity selective motor control movements promotes neuroplasticity in children with spastic bilateral cerebral palsy.
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Affiliation(s)
- A Vuong
- From the Departments of Bioengineering (A.V., S.H.J.)
- Orthopaedic Surgery (A.V., L.A.S., E.G.F.)
- Center for Cerebral Palsy (A.V., L.A.S., E.G.F.), University of California Los Angeles/Orthopaedic Institute for Children, Los Angeles, California
| | - S H Joshi
- From the Departments of Bioengineering (A.V., S.H.J.)
- Neurology (S.H.J.), Ahmanson Lovelace Brain Mapping Center
| | - L A Staudt
- Orthopaedic Surgery (A.V., L.A.S., E.G.F.)
- Center for Cerebral Palsy (A.V., L.A.S., E.G.F.), University of California Los Angeles/Orthopaedic Institute for Children, Los Angeles, California
| | - J H Matsumoto
- Pediatrics (J.H.M.), University of California Los Angeles, Los Angeles, California
| | - E G Fowler
- Orthopaedic Surgery (A.V., L.A.S., E.G.F.)
- Center for Cerebral Palsy (A.V., L.A.S., E.G.F.), University of California Los Angeles/Orthopaedic Institute for Children, Los Angeles, California
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Ha SY, Sung YH. Changes of Neural Pathways after Vojta Approach in a Child with Developmental Delay. CHILDREN-BASEL 2021; 8:children8100918. [PMID: 34682183 PMCID: PMC8534406 DOI: 10.3390/children8100918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/06/2021] [Accepted: 10/13/2021] [Indexed: 11/16/2022]
Abstract
The development of motor function is related to the development of neural pathways in the white matter. Children with developmental delay (DD) and hypotonia have reduced motor function, and their neural pathways are observed differently from those of typically developed children. We investigated changes in neural pathways through diffusion tensor imaging (DTI) after utilizing the Vojta approach. The participant was a child with DD and hypotonia, and had delayed motor function. Although he had no brain damage on magnetic resonance imaging findings, damage to the neural pathway was confirmed through DTI due to cytomegalovirus infection in the mother's womb. From 11 months of age, the Vojta approach was performed for a total of 8 months. In this study, we found that in CST, the left FA and right TV increased in follow-up DTI more than in the initial DTI. In CRP, Wallerian degeneration was observed in the left FA, MD, and TV in follow-up DTI. GMFM-88 improved after intervention. The structural change of neural pathways through the Vojta approach influenced the improvement of gross motor function. Therefore, it is thought that the Vojta approach can be suggested as a meaningful intervention for children with DD and hypotonia.
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Affiliation(s)
- Sun-Young Ha
- Department of Physical Therapy, Graduate School, Kyungnam University, Changwon 51767, Korea;
| | - Yun-Hee Sung
- Department of Physical Therapy, Graduate School, Kyungnam University, Changwon 51767, Korea;
- Department of Physical Therapy, College of Health Sciences, Kyungnam University, Changwon 51767, Korea
- Correspondence: ; Tel.: +82-55-249-6334
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4
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Perinatal stroke: mapping and modulating developmental plasticity. Nat Rev Neurol 2021; 17:415-432. [PMID: 34127850 DOI: 10.1038/s41582-021-00503-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2021] [Indexed: 02/04/2023]
Abstract
Most cases of hemiparetic cerebral palsy are caused by perinatal stroke, resulting in lifelong disability for millions of people. However, our understanding of how the motor system develops following such early unilateral brain injury is increasing. Tools such as neuroimaging and brain stimulation are generating informed maps of the unique motor networks that emerge following perinatal stroke. As a focal injury of defined timing in an otherwise healthy brain, perinatal stroke represents an ideal human model of developmental plasticity. Here, we provide an introduction to perinatal stroke epidemiology and outcomes, before reviewing models of developmental plasticity after perinatal stroke. We then examine existing therapeutic approaches, including constraint, bimanual and other occupational therapies, and their potential synergy with non-invasive neurostimulation. We end by discussing the promise of exciting new therapies, including novel neurostimulation, brain-computer interfaces and robotics, all focused on improving outcomes after perinatal stroke.
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Franki I, Mailleux L, Emsell L, Peedima ML, Fehrenbach A, Feys H, Ortibus E. The relationship between neuroimaging and motor outcome in children with cerebral palsy: A systematic review - Part A. Structural imaging. RESEARCH IN DEVELOPMENTAL DISABILITIES 2020; 100:103606. [PMID: 32192951 DOI: 10.1016/j.ridd.2020.103606] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 02/05/2020] [Accepted: 02/05/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Conventional Structural Magnetic Resonance Imaging (sMRI) is a mainstay in Cerebral Palsy (CP) diagnosis. AIMS A systematic literature review was performed with the aim to investigate the relationship between structural brain lesions identified by sMRI and motor outcomes in children with CP. METHODS Fifty-eight studies were included. The results were analysed in terms of population characteristics, sMRI (classified according to Krägeloh-Mann & Horber, 2007), gross and fine motor function and their interrelation. OUTCOMES White matter lesions were the most common brain lesion types and were present in 57.8 % of all children with uCP, in 67.0 % of all children with bCP and in 33 % of the group of mixed subtypes. Grey matter lesions were most frequently registered in children with dyskinesia (n = 42.2 %). No structural anomalies visualized by sMRI were reported in 5.7 % of all cases. In all lesion types, an equal distribution over the different gross motor function classification system categories was present. The included studies did not report sufficient information about fine motor function to relate these results to structural imaging. CONCLUSIONS AND IMPLICATIONS The relationship between brain structure and motor outcome needs to be further elucidated in a representative cohort of children with CP, using a more standardized MRI classification system.
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Affiliation(s)
- Inge Franki
- KU Leuven, Department of Development and Regeneration, Leuven, Belgium; Universitaire Ziekenhuizen Leuven, Campus Pellenberg, Cerebral Palsy Reference Centre, Leuven, Belgium.
| | - Lisa Mailleux
- KU Leuven, Department of Rehabilitation Sciences, Leuven, Belgium; Centre For Developmental Disabilities, Leuven, Belgium
| | - Louise Emsell
- KU Leuven, Department of Imaging an Pathology, Translational MRI, Leuven, Belgium; KU Leuven, University Psychiatric Center (UPC-) Geriatric Psychiatry, Leuven, Belgium
| | | | - Anna Fehrenbach
- KU Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
| | - Hilde Feys
- KU Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
| | - Els Ortibus
- KU Leuven, Department of Development and Regeneration, Leuven, Belgium; Universitaire Ziekenhuizen Leuven, Campus Pellenberg, Cerebral Palsy Reference Centre, Leuven, Belgium; Centre For Developmental Disabilities, Leuven, Belgium
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Mailleux L, Franki I, Emsell L, Peedima ML, Fehrenbach A, Feys H, Ortibus E. The relationship between neuroimaging and motor outcome in children with cerebral palsy: A systematic review-Part B diffusion imaging and tractography. RESEARCH IN DEVELOPMENTAL DISABILITIES 2020; 97:103569. [PMID: 31901671 DOI: 10.1016/j.ridd.2019.103569] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 11/13/2019] [Accepted: 12/25/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Diffusion magnetic resonance imaging (dMRI) is able to detect, localize and quantify subtle brain white matter abnormalities that may not be visible on conventional structural MRI. Over the past years, a growing number of studies have applied dMRI to investigate structure-function relationships in children with cerebral palsy (CP). AIMS To provide an overview of the recent literature on dMRI and motor function in children with CP. METHODS A systematic literature search was conducted in PubMed, Embase, Cochrane Central Register of Controlled trials, Cinahl and Web of Science from 2012 onwards. RESULTS In total, 577 children with CP in 19 studies were included. Sixteen studies only included unilateral CP, while none included dyskinetic CP. Most studies focused on specific regions/tracts of interest (n = 17) versus two studies that investigated the whole brain. In unilateral and bilateral CP, white matter abnormalities were widespread including non-motor areas. In unilateral CP, consistent relationships were found between white matter integrity of the corticospinal tract and somatosensory pathways (e.g. thalamocortical projections, medial lemniscus) with upper limb sensorimotor function. The role of commissural and associative tracts remains poorly investigated. Also results describing structure-function relationships in bilateral CP are scarce (n = 3). CONCLUSIONS This review underlines the importance of both the motor and somatosensory tracts for upper limb sensorimotor function in unilateral CP. However, the exact contribution of each tract requires further exploration. In addition, research on the relevance of non-motor pathways is warranted, as well as studies including other types of CP.
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Affiliation(s)
- Lisa Mailleux
- KU Leuven, Department of Rehabilitation Sciences, Leuven, Belgium; Centre For Developmental Disabilities, Leuven, Belgium.
| | - Inge Franki
- KU Leuven, Department of Development and Regeneration, Leuven, Belgium; University Hospitals Leuven, Campus Pellenberg, Cerebral Palsy Reference Centre, Leuven, Belgium
| | - Louise Emsell
- KU Leuven, Translational MRI, Department of Imaging and Pathology, Leuven, Belgium; KU Leuven, Geriatric Psychiatry, University Psychiatric Center (UPC), Leuven, Belgium
| | | | - Anna Fehrenbach
- KU Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
| | - Hilde Feys
- KU Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
| | - Els Ortibus
- Centre For Developmental Disabilities, Leuven, Belgium; KU Leuven, Department of Development and Regeneration, Leuven, Belgium; University Hospitals Leuven, Campus Pellenberg, Cerebral Palsy Reference Centre, Leuven, Belgium
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7
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Huang L, Zhang C, Gu J, Wu W, Shen Z, Zhou X, Lu H. A Randomized, Placebo-Controlled Trial of Human Umbilical Cord Blood Mesenchymal Stem Cell Infusion for Children With Cerebral Palsy. Cell Transplant 2019; 27:325-334. [PMID: 29637820 PMCID: PMC5898688 DOI: 10.1177/0963689717729379] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Cerebral palsy (CP) is a common disability which results in permanent chronic motor disability appearing in early childhood. Recently human umbilical cord blood mesenchymal stem cell (hUCB-MSC) infusion has emerged as a promising therapeutic strategy for CP, and the treatment efficacy remains to be confirmed by clinical trials. All 54 patients received basic rehabilitation as a background treatment. The infusion group comprising 27 patients received 4 infusions of hUCB-MSCs (intravenous infusions at a fixed dose of 5 × 107) and basic rehabilitation treatment, whereas 27 patients in the control group received 0.9% normal saline and basic rehabilitation treatment. Several indices were tested from baseline up to 24 months posttreatment regarding efficacy and safety evaluations, including the gross motor function measurement 88 (GMFM-88) scores, the comprehensive function assessment (CFA), lab tests, electroencephalogram (EEG), routine magnetic resonance imaging (MRI), and adverse events. The changes in the total proportion of GMFM-88 and total scores of CFA in the hUCB-MSC infusion group were significantly higher than that in control group at 3, 6, 12, 24 months posttreatment. Less diffuse slow waves were noticed after hUCB-MSC infusion in patients with slowing of EEG background rhythms at baseline. Based on the routine MRI exams, improvements in cerebral structures were rare after treatment. Serious adverse events were not observed during the whole study period. The results of the study indicated that hUCB-MSC infusion with basic rehabilitation was safe and effective in improving gross motor and comprehensive functions in children with CP.
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Affiliation(s)
- Li Huang
- 1 Institute of Neurobiology and Department of Human Anatomy & Histoembriology, School of Basic Medical Sciences, Xi'an Jiaotong University, Xi'an, Shanxi, People Republic of China.,2 Taihe Hospital Affiliated to Hubei Medical College, Shiyan, Hubei, People Republic of China
| | - Che Zhang
- 2 Taihe Hospital Affiliated to Hubei Medical College, Shiyan, Hubei, People Republic of China.,3 Department of Neonatology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shanxi, People Republic of China
| | - Jiaowei Gu
- 2 Taihe Hospital Affiliated to Hubei Medical College, Shiyan, Hubei, People Republic of China
| | - Wei Wu
- 2 Taihe Hospital Affiliated to Hubei Medical College, Shiyan, Hubei, People Republic of China
| | - Zhujun Shen
- 2 Taihe Hospital Affiliated to Hubei Medical College, Shiyan, Hubei, People Republic of China
| | - Xihui Zhou
- 3 Department of Neonatology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shanxi, People Republic of China
| | - Haixia Lu
- 1 Institute of Neurobiology and Department of Human Anatomy & Histoembriology, School of Basic Medical Sciences, Xi'an Jiaotong University, Xi'an, Shanxi, People Republic of China
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Yokohama T, Iwasaki M, Oura D, Furuya S, Okuaki T. The Reliability of Reduced Field-of-view DTI for Highly Accurate Quantitative Assessment of Cervical Spinal Cord Tracts. Magn Reson Med Sci 2018; 18:36-43. [PMID: 29576582 PMCID: PMC6326762 DOI: 10.2463/mrms.mp.2017-0078] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Purpose: To compare the accuracy of fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values between reduced FOV or so-called zonally oblique multislice (ZOOM) and conventional diffusion tensor imaging (DTI) in the cervical spinal cord. Methods: Both ZOOM and conventional DTI were performed on 10 healthy volunteers. Intraclass correlation coefficient (ICC) was used to evaluate the reliability of the measurements obtained. Four radiologists evaluated the FA and ADC values at each cervical cord level and classified the visibility by 4 ranks. The geometric distortion ratios of the long axis and short axis were compared between ZOOM and conventional DTI. The imaging parameters were as follows: b-value = 600 s/mm2; TR = 4500 ms; TE = 81 ms; FOV = 70 × 47 mm2 / 200 × 200 mm2; matrix = 80 × 51 / 128 × 126 (ZOOM and conventional DTI, respectively). The region of interest was carefully drawn inside the spinal cord margin to exclude the spinal cord component, without excluding the white matter fiber tracts. Results: The average FA value decreased in both ZOOM and conventional DTI in lower spinal cord levels; in contrast, the ADC value increased in lower spinal cord levels. Zonally oblique multislice DTI was superior to conventional DTI with regard to inter-rater and intra-rater reliability; further, visibility was better and the standard deviation was smaller in ZOOM DTI. On both the long and short axis, the geometric distortion ratio was lower in ZOOM DTI at all cervical spinal cord levels compared with the conventional DTI. There was a significant difference in the distortion ratios of the long and short axis between ZOOM and conventional DTI. Conclusion: Conventional DTI is unreliable owing to its susceptibility to the surrounding magnetic field. ZOOM DTI is reliable for performing highly accurate evaluations.
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Affiliation(s)
| | | | | | - Sho Furuya
- Department of Neurosurgery, Otaru General Hospital
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Zhang J. Multivariate Analysis and Machine Learning in Cerebral Palsy Research. Front Neurol 2017; 8:715. [PMID: 29312134 PMCID: PMC5742591 DOI: 10.3389/fneur.2017.00715] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 12/11/2017] [Indexed: 11/24/2022] Open
Abstract
Cerebral palsy (CP), a common pediatric movement disorder, causes the most severe physical disability in children. Early diagnosis in high-risk infants is critical for early intervention and possible early recovery. In recent years, multivariate analytic and machine learning (ML) approaches have been increasingly used in CP research. This paper aims to identify such multivariate studies and provide an overview of this relatively young field. Studies reviewed in this paper have demonstrated that multivariate analytic methods are useful in identification of risk factors, detection of CP, movement assessment for CP prediction, and outcome assessment, and ML approaches have made it possible to automatically identify movement impairments in high-risk infants. In addition, outcome predictors for surgical treatments have been identified by multivariate outcome studies. To make the multivariate and ML approaches useful in clinical settings, further research with large samples is needed to verify and improve these multivariate methods in risk factor identification, CP detection, movement assessment, and outcome evaluation or prediction. As multivariate analysis, ML and data processing technologies advance in the era of Big Data of this century, it is expected that multivariate analysis and ML will play a bigger role in improving the diagnosis and treatment of CP to reduce mortality and morbidity rates, and enhance patient care for children with CP.
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Affiliation(s)
- Jing Zhang
- Department of Neurology, Washington University in St. Louis, St. Louis, MO, United States
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10
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Hodge J, Goodyear B, Carlson H, Wei XC, Kirton A. Segmental Diffusion Properties of the Corticospinal Tract and Motor Outcome in Hemiparetic Children With Perinatal Stroke. J Child Neurol 2017; 32:550-559. [PMID: 28424004 DOI: 10.1177/0883073817696815] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Perinatal stroke injures developing motor systems, resulting in hemiparetic cerebral palsy. Diffusion tensor imaging can explore structural connectivity. We used diffusion tensor imaging to assess corticospinal tract diffusion in hemiparetic children with perinatal stroke. Twenty-eight children (6-18 years) with unilateral stroke underwent diffusion tensor imaging. Four corticospinal tract assessments included full tract, partial tract, minitract and region of interest. Diffusion characteristics (fractional anisotropy, mean, axial, and radial diffusivity) were calculated. Ratios (lesioned/nonlesioned) were compared across segments and to validated long-term motor outcomes (Pediatric Stroke Outcome Measure, Assisting Hand Assessment, Melbourne Assessment). Fractional anisotropy and radial diffusivity ratios decreased as tract size decreased, while mean diffusivity showed consistent symmetry. Poor motor outcomes were associated with lower fractional anisotropy in all segments and radial diffusivity correlated with both Assisting Hand Assessment and Melbourne Assessment. Diffusion imaging of segmented corticospinal tracts is feasible in hemiparetic children with perinatal stroke. Correlations with disability support clinical relevance and utility in model development for personalized rehabilitation.
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Affiliation(s)
- Jacquie Hodge
- 1 Calgary Pediatric Stroke Program, University of Calgary, Calgary, AB, Canada
| | - Bradley Goodyear
- 2 Department of Radiology, University of Calgary, Calgary, AB, Canada.,3 Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Helen Carlson
- 1 Calgary Pediatric Stroke Program, University of Calgary, Calgary, AB, Canada.,4 Alberta Children's Hospital Research Institute, Alberta Children's Hospital, Calgary, AB, Canada
| | - Xing-Chang Wei
- 2 Department of Radiology, University of Calgary, Calgary, AB, Canada
| | - Adam Kirton
- 1 Calgary Pediatric Stroke Program, University of Calgary, Calgary, AB, Canada.,4 Alberta Children's Hospital Research Institute, Alberta Children's Hospital, Calgary, AB, Canada
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11
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Brown-Lum M, Zwicker JG. Neuroimaging and Occupational Therapy: Bridging the Gap to Advance Rehabilitation in Developmental Coordination Disorder. J Mot Behav 2017; 49:98-110. [DOI: 10.1080/00222895.2016.1271295] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Meisan Brown-Lum
- Department of Occupational Science & Occupational Therapy, University of British Columbia, Vancouver, Canada
- BC Children's Hospital Research Institute, Vancouver, Canada
| | - Jill G. Zwicker
- Department of Occupational Science & Occupational Therapy, University of British Columbia, Vancouver, Canada
- BC Children's Hospital Research Institute, Vancouver, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
- Sunny Hill Health Centre for Children, Vancouver, Canada
- CanChild Centre for Childhood Disability Research, Hamilton, Canada
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12
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Li HX, Feng X, Wang Q, Dong X, Yu M, Tu WJ. Diffusion tensor imaging assesses white matter injury in neonates with hypoxic-ischemic encephalopathy. Neural Regen Res 2017; 12:603-609. [PMID: 28553341 PMCID: PMC5436359 DOI: 10.4103/1673-5374.205102] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
With improvements in care of at-risk neonates, more and more children survive. This makes it increasingly important to assess, soon after birth, the prognosis of children with hypoxic-ischemic encephalopathy. Computed tomography, ultrasound, and conventional magnetic resonance imaging are helpful to diagnose brain injury, but cannot quantify white matter damage. In this study, ten full-term infants without brain injury and twenty-two full-term neonates with hypoxic-ischemic encephalopathy (14 moderate cases and 8 severe cases) underwent diffusion tensor imaging to assess its feasibility in evaluating white matter damage in this condition. Results demonstrated that fractional anisotropy, voxel volume, and number of fiber bundles were different in some brain areas between infants with brain injury and those without brain injury. The correlation between fractional anisotropy values and neonatal behavioral neurological assessment scores was closest in the posterior limbs of the internal capsule. We conclude that diffusion tensor imaging can quantify white matter injury in neonates with hypoxic-ischemic encephalopathy.
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Affiliation(s)
- Hong-Xin Li
- Department of Neonatology, Children's Hospital of Soochow University, Suzhou, Jiangsu Province, China.,Department of Neonatology, Changzhou Children's Hospital, Changzhou, Jiangsu Province, China
| | - Xing Feng
- Department of Neonatology, Children's Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Qian Wang
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Xuan Dong
- Department of Children's Health Research Center, Changzhou Children's Hospital, Changzhou, Jiangsu Province, China
| | - Min Yu
- Nantong University, Nantong, Jiangsu Province, China
| | - Wen-Juan Tu
- Department of Neonatology, Changzhou Children's Hospital, Changzhou, Jiangsu Province, China
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13
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Kwon YM, Kwon HG, Rose J, Son SM. The Change of Intra-cerebral CST Location during Childhood and Adolescence; Diffusion Tensor Tractography Study. Front Hum Neurosci 2016; 10:638. [PMID: 28066209 PMCID: PMC5167720 DOI: 10.3389/fnhum.2016.00638] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 11/30/2016] [Indexed: 11/13/2022] Open
Abstract
Objectives: Corticospinal tract (CST) is the most important tract in motor control. However, there was no study about the change of CST location with aging. In this study, using diffusion tensor tractography (DTT), we attempted to investigate the change of CST location at cortex, corona radiata (CR) and posterior limb of internal capsule (IC) level with aging in typically developing children. Methods: We recruited 76 healthy pediatric subjects (range; 0-19 years). According to the result of DTT, the location of CST at cortex level was classified as follows; prefrontal cortex (PFC), PFC with Premotor cortex (PMC), PMC, PMC with primary motor cortex (M1), M1, M1 with Primary sensory cortex (S1). Anterior-posterior location (%) of CSTs at CR and IC level was also assessed. Results: DTT results about CSTs of 152 hemispheres from 76 subjects were obtained. The most common location of CST projection was M1 area (58.6%) including PMC with M1 (25.7%), M1 (17.8%), and M1 with S1 (15.1%). The mean age of the projection of CST showed considerably younger at anterior cortex than posterior; (PFC; 4.12 years, PFC with PMC; 6.41 years, PMC; 6.72 years, PMC with M1; 9.75 years, M1; 9.85 years, M1 with S1; 12.99 years, S1; 13.75 years). Spearman correlation showed positive correlation between age and the location of CST from anterior to posterior brain cortex (r = 0.368). Conclusion: We demonstrated that the location of CST projection is different with aging. The result of this study can provide the scientific insight to the maturation study in human brain.
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Affiliation(s)
- Yong M Kwon
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University Taegu, South Korea
| | - Hyeok G Kwon
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University Taegu, South Korea
| | - Jessica Rose
- Department of Orthopaedic Surgery, School of Medicine, Stanford University Stanford, CA, USA
| | - Su M Son
- Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University Taegu, South Korea
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