Brain Plasticity following Intensive Bimanual Therapy in Children with Hemiparesis : Preliminary Evidence

• Neuroplasticity studies examining children with hemiparesis (CH) have focused predominantly on unilateral interventions. CH also have bimanual coordination impairments with bimanual interventions showing benefits. We explored neuroplasticity following hand-Arm bimanual intensive therapy (HABIT) of 60 hours in twelve CH (6 females, mean age 11 ± 3.6 y). Serial behavioral evaluations and MR imaging including diffusion tensor (DTI) and functional (fMRI) imaging were performed before, immediately after, and at 6-week follow-up. Manual skills were assessed repeatedly with the Assisting Hand Assessment, Children's Hand Experience Questionnaire, and Jebsen-Taylor Test of Hand Function. Beta values, indicating the level of activation, and lateralization index (LI), indicating the pattern of brain activation, were computed from fMRI. White matter integrity of major fibers was assessed using DTI. 11/12 children showed improvement after intervention in at least one measure, with 8/12 improving on two or more tests. Changes were retained in 6/8 children at follow-up. Beta activation in the affected hemisphere increased at follow-up, and LI increased both after intervention and at follow-up. Correlations between LI and motor function emerged after intervention. Increased white matter integrity was detected in the corpus callosum and corticospinal tract after intervention in about half of the participants. Results provide first evidence for neuroplasticity changes following bimanual intervention in CH.

Subject headings

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Neurologi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Neurology (hsv//eng)

Keyword

adolescent

Article

behavior change

child

clinical article

clinical assessment tool

corpus callosum

diffusion tensor imaging

female

follow up

functional magnetic resonance imaging

hand arm bimanual intensive therapy

hand function

hemiparesis

hemispheric dominance

human

individual behavior assessment

intensive care

male

motor performance

nerve cell plasticity

nerve fiber

nuclear magnetic resonance imaging

physiotherapy

pyramidal tract

questionnaire

school child

skill

white matter

brain

hand

kinesiotherapy

paresis

pathophysiology

psychomotor performance

skeletal muscle cell

treatment outcome

Exercise Therapy

Follow-Up Studies

Humans

Magnetic Resonance Imaging

Motor Skills

Muscle Fibers

Skeletal

Neuronal Plasticity

Pyramidal Tracts

Publication and Content Type

ref (subject category)

art (subject category)