Structural Neuroplastic Change After Constraint-Induced Movement Therapy in Children With Cerebral Palsy
Structural Neuroplastic Change After Constraint-Induced Movement Therapy in Children With Cerebral Palsy
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DOI：
10.1542/peds.2012-2051
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发表时间：
2013-05-01
期刊：
影响因子：
8
通讯作者：
Uswatte, Gitendra
中科院分区：
文献类型：
--
作者：
Sterling, Chelsey;Taub, Edward;Uswatte, Gitendra
目前实验室对成年脑卒中患者的研究表明，由于约束诱导运动（CI）治疗，结构神经可塑性改变与临床改善相关。这项初步研究评估了接受CI治疗的儿童是否会发生类似的变化。10名先天性偏瘫儿童（6名男孩）（平均年龄：3岁3个月）在接受3周CI治疗前3周、前3周和后3周接受了MRI扫描。在MRI扫描上进行纵向体素形态测量以确定灰质变化。此外，在这些时间点进行儿童运动活动日志修订，以评估治疗前后日常生活中的手臂使用情况。在CI治疗后，儿童自发使用受影响更大的手臂表现出很大的改善（P < 0.001, d' = 3.24）。受影响较重的手臂对侧感觉运动皮层灰质体积显著增加（P = 0.04）；这些变化有趋势与运动改善相关（r = 0.63, P = 0.063）。在同侧运动皮层（P = 0.055）和对侧海马（P = 0.1）灰质体积增加的趋势也被观察到。治疗前3周未见明显灰质改变。这些发现表明，CI治疗在发育中的神经系统中产生灰质增加，并提供了额外的证据，表明CI治疗与人脑结构重塑有关，同时对中枢神经系统疾病患者产生运动改善。
Research from the present laboratory with adult stroke patients showed that structural neuroplastic changes are correlated with clinical improvements due to constraint-induced movement (CI) therapy. This pilot study evaluated whether comparable changes occur in children receiving CI therapy. Ten children (6 boys) with congenital hemiparesis (mean age: 3 years, 3 months) underwent MRI scans 3 weeks before, immediately before, and immediately after receiving 3 weeks of CI therapy. Longitudinal voxel-based morphometry was performed on MRI scans to determine gray matter change. In addition, the Pediatric Motor Activity Log-Revised was administered at these time points to assess arm use in daily life before and after treatment. Children exhibited large improvements after CI therapy in spontaneous use of the more-affected arm (P < .001, d' = 3.24). A significant increase in gray matter volume occurred in the sensorimotor cortex contralateral to the more-affected arm (P = .04); there was a trend for these changes to be correlated with motor improvement (r = 0.63, P = .063). Trends were also observed for increases in gray matter volume in the ipsilateral motor cortex (P = .055) and contralateral hippocampus (P = .1). No significant gray matter change was seen during the 3 weeks before treatment. These findings suggest that CI therapy produces gray matter increases in the developing nervous system and provide additional evidence that CI therapy is associated with structural remodeling of the human brain while producing motor improvement in patients with disabling central nervous system diseases.