Near Infrared Brain Imaging for Guiding Treatment in Children with Cerebral Palsy

近红外脑成像指导脑瘫儿童的治疗

• 批准号: 8088032
• 负责人: Georgios Alexandrakis
• 金额: $ 40.96万
• 依托单位: UNIVERSITY OF TEXAS ARLINGTON
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-04-01 至 2014-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8088032
• 关键词: Adult; Affect; Aftercare; Age; Birth; Brain; Brain Injuries; Brain imaging; Cerebral Palsy; Cerebral cortex; Cerebrum; Characteristics; Child; Childhood; Classification; Clinic; Clinical; Clinical assessments; DNA Sequence Rearrangement; Development; Diagnosis; Disease; Feasibility Studies; Fetal Development; Fiber; Functional Magnetic Resonance Imaging; Hair; Hand; Head; Hemiplegia; Hemoglobin; Human; Image; Immune; Impairment; Injury; Intervention; Learning; Limb structure; Live Birth; Manuals; Maps; Measurement; Measures; Methods; Metric; Morphologic artifacts; Motion; Motor; Motor Cortex; Motor Skills; Multivariate Analysis; Nature; Neurons; Noise; Occupational Therapy; Optics; Outcome; Paralysed; Patient Selection; Patients; Pattern; Performance; Physicians; Physiology; Plastics; Play; Predictive Value; Publications; Reporting; Rest; Scalp structure; Sensory; Series; Severities; Spectrum Analysis; Speed; System; Taxes; Techniques; Technology; Testing; Thick; Time; Translations; Treatment outcome; Upper Extremity; Work; abstracting; arm; base; cohort; constraint induced movement therapy; cost; cost effective; experience; improved; motor deficit; motor disorder; motor impairment; neuroimaging; novel; response; self help; spatiotemporal; success; tool; user-friendly; volunteer

DESCRIPTION (provided by applicant): Near Infrared Brain Imaging for Guiding Treatment in Children with Cerebral Palsy Abstract We propose a feasibility study for the translation of functional near infrared (fNIR) brain imaging as a tool to guide the treatment of children diagnosed with cerebral palsy (CP). This motor deficit profoundly affects a child's ability to develop age-typical motor skills and to engage fully in play, exploration and self-help activities. Currently, treatments are being assigned blindly and as a result many pediatric patients undergo futile and taxing treatments that last for prolonged periods of time. Neuroimaging techniques are useful to study neuroplastic rearrangements in response to a given treatment and aide physicians to factor that information into treatment decisions. Functional magnetic resonance imaging has being employed in few cases, but this technique requires the patients' complete body confinement and steadiness for a long period of time, which is hard to attain for children with CP. fNIR imaging has been demonstrated as a sensitive method to map functional activities in the healthy human motor cortex and is relatively immune from patient motion artifacts, is cost effective, and can be widely deployable in a clinical setting. The focus of this proposal is to explore the rich information offered by fNIR imaging as a means to understand cortical plasticity in response to a Constraint Induced Motion Therapy (CIMT), which is one of the most prevalent and promising treatments available to date. Our hypothesis is that specific spatiotemporal fNIR cortical activation patterns exist that are strong predictors of CIMT treatment outcomes. Novel fNIR head probe technology is presented that increases setup speed and comfort for the children during measurements while cortical activation patterns and functional connectivity are explored across their entire head top. In addition, fNIR imaging of cortical activation due to arm motions will be integrated with camera-based motion analysis methods to provide objective measures of functional performance, in contrast to current qualitative clinical assessment methods. Multivariate analysis between fNIR metrics and functional performance measures will be performed pre- and post-treatment to test our hypothesis. Accordingly, our specific aims are: (1) To construct and characterize the performance characteristics of a user-friendly fNIR probe assembly spanning the entire head top, and identify a cohort of spatiotemporal cortical activation metrics that correlate with motion analysis performance metrics in adult volunteers performing different hand motions; (2) To quantify the spatiotemporal activation metrics obtained with the head probe from children with CP and age-matched pediatric controls, while they perform different hand motions, and test how these metrics correlate with motion analysis metrics for different motor impairment levels; (3) Identify changes in the cortical activation patterns found to correlate with motion analysis for children with CP performing a variety of hand motions, immediately after and 6 months post-treatment, and identify which pre-treatment fNIR metrics can serve as predictors of CIMT success for each motor impairment level. PUBLIC HEALTH RELEVANCE: Near Infrared Brain Imaging for Guiding Treatment in Children with Cerebral Palsy Project Narrative We will use near infrared light to map how neuronal networks on the surface of the brain of children reorganize their activity as a result of an early life stroke event that caused partial paralysis of the extremities. This condition is known as cerebral palsy, a common motor disorder in children. We propose to develop methods that physicians could use to assess the severity of cerebral palsy as well as help them decide if a given treatment option will have a positive outcome for each individual patient.

描述(申请人提供)：近红外脑成像用于指导脑瘫儿童的治疗摘要我们提出了一项可行性研究，将功能性近红外(FNIR)脑成像翻译为指导诊断为脑瘫(CP)的儿童治疗的工具。这种运动缺陷对儿童发展典型的年龄运动技能以及充分参与游戏、探索和自助活动的能力产生了深远的影响。目前，治疗是盲目分配的，因此许多儿科患者接受徒劳和繁重的治疗，持续时间较长。神经成像技术有助于研究神经整形重排对特定治疗的反应，并帮助医生将这些信息纳入治疗决策。功能磁共振成像在少数病例中得到应用，但这项技术需要患者长时间的完全禁闭和稳定，这对于脑瘫儿童来说是很难达到的。FNIR成像已被证明是一种敏感的方法来绘制健康人体运动皮质的功能活动图，相对不受患者运动伪影的影响，具有成本效益，可以在临床环境中广泛部署。这项建议的重点是探索FNIR成像提供的丰富信息，作为一种手段来了解皮质可塑性对约束诱导运动疗法(CIMT)的响应，这是迄今为止最流行和最有前途的治疗方法之一。我们的假设是，存在特定的时空FNIR皮质激活模式，这些模式是CIMT治疗结果的强烈预测因素。提出了新颖的FNIR头探头技术，在测量过程中提高了儿童的设置速度和舒适性，同时探索了他们整个头顶的皮质激活模式和功能连接。此外，手臂运动引起的皮质激活的FNIR成像将与基于相机的运动分析方法相结合，以提供功能表现的客观测量，与当前的定性临床评估方法形成对比。治疗前和治疗后将进行FNIR指标和功能表现指标之间的多变量分析，以检验我们的假设。因此，我们的具体目标是：(1)构建和表征用户友好的横跨整个头顶的FNIR探头组件的性能特征，并确定一组与执行不同手部动作的成年志愿者的运动分析性能指标相关的时空皮质激活指标；(2)量化从脑性瘫痪儿童和年龄匹配的儿童对照组获得的时空激活指标，当他们执行不同的手部动作时，并测试这些指标与不同运动障碍程度的运动分析指标的相关性；(3)确定治疗后即刻和6个月后脑性瘫痪儿童的皮质激活模式的变化，发现这些变化与进行各种手部运动的运动分析有关，并确定哪些治疗前FNIR指标可以作为CIMT成功预测每个运动障碍程度的指标。 公共卫生相关性：近红外脑成像用于指导脑瘫儿童的治疗项目叙述我们将使用近红外光绘制儿童大脑表面的神经元网络如何重组他们的活动，这是早期中风事件导致肢体部分瘫痪的结果。这种情况被称为脑瘫，这是一种常见的儿童运动障碍。我们建议开发医生可以用来评估脑瘫严重程度的方法，并帮助他们决定给定的治疗方案是否会对每个患者产生积极的结果。