Imaging Predictors of Improvement from a Motor Learning-Based Intervention for Children with Unilateral Cerebral Palsy

• Background:Motor-learning interventions may improve hand function in children with unilateral cerebral palsy (UCP) but with inconsistent outcomes across participants. Objective. To examine if pre-intervention brain imaging predicts benefit from bimanual intervention.Method:Twenty children with UCP with Manual Ability Classification System levels I to III, aged 7-16 years, participated in an intensive bimanual intervention. Assessments included the Assisting Hand Assessment (AHA), Jebsen Taylor Test of Hand Function (JTTHF) and Children's Hand Experience Questionnaire (CHEQ) at baseline (T1), completion (T2) and 8-10 weeks post-intervention (T3). Imaging at baseline included conventional structural (radiological score), functional (fMRI) and diffusion tensor imaging (DTI).Results:Improvements were seen across assessments; AHA (P = 0.04), JTTHF (P <.001) and CHEQ (P < 0.001). Radiological score significantly correlated with improvement at T2; AHA (r =.475) and CHEQ (r =.632), but negatively with improvement on unimanual measures at T3 (JTTFH r = -.514). fMRI showed negative correlations between contralesional brain activation when moving the affected hand and AHA improvements (T2: r = -.562, T3: r = -0.479). Fractional Anisotropy in the affected posterior limb of the internal capsule correlated negatively with increased bimanual use on CHEQ at T2 (r = -547) and AHA at T3 (r = -.656).Conclusions: Children with greater structural, functional and connective brain damage showed enhanced responses to bimanual intervention. Baseline imaging may identify parameters predicting response to intervention in children with UCP.

Ämnesord

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

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

Nyckelord

DTI

fMRI

prediction

treatment

unilateral cerebral palsy

adolescent

Article

Assisting Hand Assessment

brain injury

capsula interna

cerebral palsy

child

childhood disease

Children's Hand Experience Questionnaire

clinical article

corpus callosum

diffusion tensor imaging

female

follow up

fractional anisotropy

functional magnetic resonance imaging

functional neuroimaging

functional status assessment

hand function

human

International Classification of Functioning

Disability and Health

intervention study

Jebsen Taylor Test of Hand Function

male

school child

sensorimotor cortex

task performance

treatment response

white matter

clinical trial

diagnostic imaging

disability

hand

hemispheric dominance

image processing

movement (physiology)

multicenter study

musculoskeletal manipulation

neuroimaging

pathophysiology

physiology

procedures

psychomotor performance

questionnaire

Disability Evaluation

Functional Laterality

Humans

Image Processing

Computer-Assisted

Movement

Musculoskeletal Manipulations

Surveys and Questionnaires

Publikations- och innehållstyp

ref (ämneskategori)

art (ämneskategori)