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

描述（由申请人提供）：近红外脑成像指导治疗脑瘫儿童摘要我们提出了一个可行性研究的翻译功能性近红外（fNIR）脑成像作为一种工具，以指导治疗脑瘫（CP）的儿童诊断。 这种运动缺陷深刻地影响了儿童发展年龄典型运动技能的能力，并充分参与游戏，探索和自助活动。 目前，治疗是盲目分配的，因此许多儿科患者经历了徒劳和繁重的治疗，持续很长一段时间。 神经影像学技术可用于研究神经可塑性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。 功能性磁共振成像已在少数情况下使用，但这项技术需要患者长时间的完全身体限制和稳定，这对CP儿童来说很难实现。 fNIR成像已被证明是一种敏感的方法，以映射健康的人类运动皮层的功能活动，是相对免疫患者的运动伪影，是成本有效的，并可以广泛部署在临床环境。 该提案的重点是探索fNIR成像提供的丰富信息，以了解皮质可塑性对约束诱导运动疗法（CIMT）的反应，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，特定的时空fNIR皮层激活模式存在CIMT治疗结果的强预测因子。 新颖的fNIR头探头技术，提高了设置速度和舒适度的儿童在测量过程中，而皮层激活模式和功能连接，探索他们的整个头顶。 此外，与目前的定性临床评估方法相比，由于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，以提供功能性能的客观测量。 将在治疗前和治疗后进行fNIR指标和功能性能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）构建和表征跨越整个头顶的用户友好的fNIR探头组件的性能特性，并识别与执行不同手部运动的成年志愿者中的运动分析性能度量相关的时空皮层激活度量的队列;（2）为了量化从患有CP的儿童和年龄匹配的儿科对照的头部探头获得的时空激活度量，同时他们执行不同的手部运动，并测试这些度量如何与不同运动损伤水平的运动分析度量相关;（3）识别在治疗后立即和治疗后6个月，发现与患有CP的儿童进行各种手部运动的运动分析相关的皮质激活模式的变化，并确定哪些治疗前fNIR指标可以作为每个运动损伤水平的CIMT成功的预测因子。

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.