IMPACT OF MOTOR CONNECTIVITY ON EFFICACY OF HAND THERAPY IN CONGENITAL HEMIPLEGIA

描述（申请人提供）：手部强化训练可以提高偏瘫性脑瘫儿童的灵巧性。测试了两类训练范例。在约束诱导运动疗法（CIMT）中，受影响较小的上肢（UE）受到限制，而受影响的UE受到训练。强化双手训练（例如，手-手臂双手强化训练（HABIT））鼓励儿童在完成双手任务时同时使用两种ue。然而，有报道称，通过同侧皮质脊髓（CS）连接控制UE受损的儿童在CIMT中的恢复比通过对侧CS连接控制UE受损的儿童要少。这提出了一种有趣的可能性，即治疗类型和CS连接模式之间存在相互作用。有限的UE使用会降低对侧运动皮质（M1）的活动。对侧控制的儿童

DESCRIPTION (provided by applicant): Intensive hand training can improve dexterity in children with hemiplegic cerebral palsy. Two categories of training paradigms have been tested. In constraint-induced movement therapy (CIMT), the less-affected upper extremity (UE) is restrained while the affected UE is trained. Intensive bimanual training (e.g., Hand-arm bimanual intensive training (HABIT)) encourages children to use both UEs in bimanual tasks. However, it has been reported that children whose impaired UE is controlled via ipsilateral corticospinal (CS) connections show less recovery in CIMT than children whose impaired UE is controlled by contralateral CS connections. This raises the interesting possibility that there is a interaction between treatment type and CS connection pattern. Limited use of an UE drives down activity in the contralateral motor cortex (M1). In children with contralateral control of the affected UE, decreasing activity in the healthy M1 gives the affected side a competitive advantage over the other side. In contrast, in children with ipsilateral control of the affected UE the healthy M1 controls the affected UE. Constraining the less-affected UE drives down activity in the healthy M1, which may impede recovery of the impaired UE. The PIs will further investigate this important issue. They will use single-pulse transcranial magnetic stimulation to probe M1 function in children who have previously received HABIT or CIMT. The PIs hypothesize that children with ipsilateral connectivity of the affected hand showed greater improvement in dexterity after HABIT, compared to CIMT. Importantly, they will help determine whether children with ipsilateral CS projections would best benefit from bimanual therapy vs. CIMT.