Identification of Functional Cortical Plasticity in Children with Cerebral Palsy Associated to Robotic-Assisted Gait Training: An fNIRS Study

Abstract

Cerebral palsy (CP) is a non-progressive neurologic condition that causes gait limitations, spasticity, and impaired balance and coordination. Robotic-assisted gait training (RAGT) has become a common rehabilitation tool employed to improve the gait pattern of people with neurological impairments. However, few studies have demonstrated the effectiveness of RAGT in children with CP and its neurological effects through portable neuroimaging techniques, such as functional near-infrared spectroscopy (fNIRS). The aim of the study is to evaluate the neurophysiological processes elicited by RAGT in children with CP through fNIRS, which was acquired during three sessions in one month. The repeated measure ANOVA was applied to the β-values delivered by the General Linear Model (GLM) analysis used for fNIRS data analysis, showing significant differences in the activation of both prefrontal cortex (F (1.652, 6.606) = 7.638; p = 0.022), and sensorimotor cortex (F (1.294, 5.175) = 11.92; p = 0.014) during the different RAGT sessions. In addition, a cross-validated Machine Learning (ML) framework was implemented to estimate the gross motor function measure (GMFM-88) from the GLM β-values, obtaining an estimation with a correlation coefficient r = 0.78. This approach can be used to tailor clinical treatment to each child, improving the effectiveness of rehabilitation for children with CP.

Prefrontal cortex hemodynamic activity during a test of lower extremity functional muscle strength in children with cerebral palsy: A functional near‐infrared spectroscopy study

“…The novel observation of decreased ΔHbO in children with CP compared to controls is consistent with previous work reporting decreased PFC hemodynamic activity in children with spastic CP during a robot‐assisted walking task (Perpetuini et al, 2022). While another study reported increased PFC hemodynamic activity in children with CP (Surkar et al, 2018), the task involved cognitive shape‐matching using the upper extremities and was performed in a seated position.…”

“…Studies in other neurologically impaired populations reported increased PFC activation during gait and postural control tasks in individuals with Parkinson's disease and post‐stroke (Gramigna et al, 2017; Stuart et al, 2018). The sole study assessing PFC hemodynamic activity during a functional mobility task in children with CP reported decreased PFC activity during a robot‐assisted walking task, with increased PFC activity observed post‐training associated with improvements in gait characteristics (Perpetuini et al, 2022). These observations support the potential of PFC hemodynamic activity levels to serve as possible biomarkers of functional recovery following brain injury (Stinear, 2017; Surkar et al, 2018).…”

Using fNIRS to evaluate ADHD medication effects on neuronal activity: A systematic literature review

“…For example, resting state and task-based paradigms have been used to evaluate activation differences among young children who are and are not high risk for ASD, with the clinical goal of identifying early quantitative biomarkers ( Conti et al, 2022 ). Further, fNIRS has been used to evaluate differences in brain activation during physical movement between children with and without cerebral palsy (CP; Sukal-Moulton et al, 2014 ) and to explore activation changes during treatment with the goal of intervention individualization ( Cao et al, 2015 ; Perpetuini et al, 2022 ). Although fNIRS may still be considered a novel neuroimaging tool in comparison to other modalities (e.g., electroencephalogram, fMRI), outcomes of fNIRS studies with ADHD participants have demonstrated convergence with fMRI findings, supporting the clinical usefulness and reliability of fNIRS as a tool in ADHD research ( Gossé et al, 2022 ).…”

Efficacy of Robot-Assisted Gait Therapy Compared to Conventional Therapy or Treadmill Training in Children with Cerebral Palsy: A Systematic Review with Meta-Analysis

“…Firstly, RAGT facilitates patients' alternate step movements, which would reproduce patterns of physiological muscle activation [101] and increase motor learning as a result of a task-specific repetitive approach [102]. A recent study, published in November 2022 by Perpetuini and colleagues, showed that RAGT produces modifications in the motor and pre-frontal brain cortex, improving motor control and attention during RAGT in children with CP [103], showing that neuroplasticity is essential in the recovery of these patients. For motor control improvements, RAGT produced bilateral changes in cortical areas BA 1, 6, 9, 11 and 46, which are involved in motor coordination and complex movements (BA 6 and 9), proprioceptive control (BA 1), spatial memory (BA 9) and in attention, self-control and working memory (BA 9 and 46).…”

“…Secondly, RAGT requires active and total participation of children in the therapy and can be used in combination with other activities of daily living that need standing balance training. Moreover, active participation involves attention and engagement in the therapy, which would involve an increase of activity in the pre-frontal cortex [103]. RAGT seems to improve cardiopulmonary function, allowing patients to perform activities for more time without experiencing fatigue or tiredness [104].…”