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

描述(申请人提供)：强化手部训练可以提高偏瘫脑瘫儿童的灵活性。对两类培训范例进行了测试。在强制诱导运动疗法(CIMT)中，受影响较小的上肢(UE)在训练的同时受到抑制。强化双工训练(例如，手-臂双工强化训练(习惯))鼓励儿童在双工任务中使用两个UE。然而，据报道，通过同侧皮质脊髓(CS)连接控制UE受损的儿童比通过对侧CS连接控制UE受损的儿童在CIMT中恢复得更差。这提出了一种有趣的可能性，即治疗类型和CS连接模式之间存在交互作用。有限地使用UE会降低对侧运动皮质(M1)的活动。对侧控制的儿童 受影响的UE，健康的M1中的活动减少使受影响的一方相对于另一方具有竞争优势。相反，在同侧控制受影响的UE的儿童中，健康的M1控制受影响的UE。限制受影响较小的UE会降低健康M1的活动，这可能会阻碍受损UE的恢复。督察会进一步调查这个重要的问题。他们将使用单脉冲经颅磁刺激来探测以前接受过习惯或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习惯后在灵巧性方面表现出更大的改善。重要的是，他们将帮助确定同侧CS投射的儿童是否能从双手疗法和CIMT疗法中获益最多。

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.