Capturing neuroplastic changes after bimanual intensive rehabilitation in children with unilateral spastic cerebral palsy: A combined DTI, TMS and fMRI pilot study

Abstract

Intensive rehabilitation interventions have been shown to be efficacious in improving upper extremity function in children with unilateral spastic cerebral palsy (USCP). These interventions are based on motor learning principles and engage children in skillful movements. Improvements in upper extremity function are believed to be associated with neuroplastic changes. However, these neuroplastic changes have not been well-described in children with cerebral palsy, likely due to challenges in defining and implementing the optimal tools and tests in children. Here we documented the implementation of three different neurological assessments (diffusion tensor imaging-DTI, transcranial magnetic stimulation-TMS and functional magnetic resonance imaging-fMRI) before and after a bimanual intensive treatment (HABIT-ILE) in two children with USCP presenting differential corticospinal developmental reorganization (ipsilateral and contralateral). The aim of the study was to capture neurophysiological changes and to document the complementary relationship between these measures, the potential measurable changes and the feasibility of applying these techniques in children with USCP.Independent of cortical reorganization, both children showed increases in activation and size of the motor areas controlling the affected hand, quantified with different techniques. In addition, fMRI provided additional unexpected changes in the reward circuit while using the affected hand.

Does Corticospinal Tract Connectivity Influence the Response to Intensive Bimanual Therapy in Children With Unilateral Cerebral Palsy?

“…This raises the question why the efficacy of this approach does not seem to be influenced by CST connectivity pattern whereas CIMT may be. Neurophysiological assessments may help to delineate this matter 18 . However, based on the suggestions by Kuhnke and colleagues 13 the question seems not so much why HABIT could work for both groups but rather why CIMT may not be ideal for children with an ipsilateral CST.…”

Stability of stereognosis after pediatric repetitive transcranial magnetic stimulation and constraint-induced movement therapy clinical trial

“…The responsivity of a child to a therapeutic or neuromodulation intervention resulting in changes in function such as stereognosis depends on cognition (awareness of the more-affected limb or developmental disregard, planning, organization), 25 neurological status (lesion location, tract integrity, cortical reorganization), 26 and the integration of sensory-motor feedback. 27 Therapeutically, CIMT includes directing the child’s attention toward the more-affected hand to improve performance.…”

Rehabilitation‐induced brain changes detected through magnetic resonance imaging in children with neurodevelopmental disorders: A systematic review

“…Structural connectivity or white matter microstructure were only studied in children with CP and seven out of 10 studies specifically focused on the corticospinal tract (Kwon et al, 2014; Manning et al, 2016; Trivedi et al, 2008; Kim et al, 2015; Rickards et al, 2014; Bleyenheuft et al, 2015; Baek et al, 2013). Three moderate‐quality studies found that long‐term rehabilitation (> 6 months) changed structural or white matter connectivity, as assessed by tractography—an indirect measure of anatomical connectivity by either quantifying connection probability of two brain regions (probabilistic tractography) or estimating the number of streamlines between the two regions (deterministic tractography)—which correlated with functional improvement in children with CP (Chaturvedi et al, 2013; Englander et al, 2015); another study used a region‐of‐interest based analysis (Trivedi et al, 2008).…”