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

描述（由申请人提供）：强化手部训练可以提高偏瘫型脑瘫儿童的灵活性。已经测试了两类培训范例。在限制性运动疗法（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，手臂双手强化训练（HABIT））鼓励儿童在双手任务中使用两个UE。然而，据报道，儿童的损害UE是通过同侧皮质脊髓（CS）连接控制的CIMT比儿童的损害UE是通过对侧CS连接控制的恢复较少。这提出了一个有趣的可能性，即治疗类型和CS连接模式之间存在相互作用。 UE的有限使用降低了对侧运动皮层（M1）的活动。对侧控制的儿童， 在受影响的UE中，降低健康M1中的活动给予受影响侧相对于另一侧的竞争优势。相反，在患侧控制受影响UE的儿童中，健康的M1控制受影响UE。约束受影响较小的UE会降低健康M1中的活动，这可能会阻碍受损UE的恢复。 PI将进一步调查这一重要问题。他们将使用单脉冲经颅磁刺激来探测以前接受过HABIT或CIMT的儿童的M1功能。PI假设，与CIMT相比，患手同侧连接的儿童在HABIT后显示出更大的灵活性改善。重要的是，他们将有助于确定是否有同侧CS预测的儿童将最好地受益于双手疗法与CIMT。

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.