Capturing neuroplastic changes after bimanual intensive rehabilitation in children with unilateral spastic cerebral palsy: A combined DTI, TMS and fMRI pilot study.
Capturing neuroplastic changes after bimanual intensive rehabilitation in children with unilateral spastic cerebral palsy: A combined DTI, TMS and fMRI pilot study.
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DOI：
10.1016/j.ridd.2015.06.014
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发表时间：
2015-08
影响因子：
3.1
通讯作者：
Friel KM
中科院分区：
文献类型：
--
作者：
Bleyenheuft Y;Dricot L;Gilis N;Kuo HC;Grandin C;Bleyenheuft C;Gordon AM;Friel KM
强化康复干预已被证明可有效改善单侧痉挛性脑瘫（USCP）儿童的上肢功能。这些干预措施基于运动学习原则，让儿童进行熟练的运动。上肢功能的改善被认为与神经塑性变化有关。然而，脑瘫儿童的这些神经塑性变化尚未得到很好的描述，这可能是由于在儿童中定义和实施最佳工具和测试方面存在挑战。在这里，我们记录了两名 USCP 儿童在双手强化治疗 (HABIT-ILE) 前后进行的三种不同神经学评估（弥散张量成像 - DTI、经颅磁刺激 - TMS 和功能性磁共振成像 - fMRI）的实施情况，这些儿童表现出不同的皮质脊髓发育重组（同侧和对侧）。该研究的目的是捕捉神经生理学变化并记录这些测量之间的互补关系、潜在的可测量变化以及将这些技术应用于 USCP 儿童的可行性。独立于皮质重组，两个孩子都表现出控制受影响手的运动区域的激活和大小的增加，并通过不同的技术进行量化。此外，当使用受影响的手时，功能磁共振成像在奖励回路中提供了额外的意想不到的变化。
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.