Neuroplastic adaptations of swallowing and speech in children with unilateral cerebral palsy

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Project Summary The developing human nervous system has a remarkable capacity to reorganize after brain injury, as is apparent in children with cerebral palsy (CP). CP affects 1.5 to 4 out of 1000 live births, is the most common motor disability of childhood, and has variable effects on functional outcomes. More than half of children with CP experience swallowing/feeding difficulties (a.k.a. dysphagia) and/or motor speech disorders (a.k.a. dysarthria) with potentially detrimental health and quality of life implications. The treatments currently available for these disorders are extremely limited, are not based on the underlying physiology and developmental profile of these children, and lack efficacy. The objective of this project is to start mapping the central and peripheral neuroplastic adaptations of swallowing and speech, as well as to determine the extent to which these domains interact in children with CP. Our long-term research goal is to use this newly acquired knowledge to develop evidence-based and developmentally appropriate interventions for swallowing and speech that capitalize on the nervous system's potential for reorganization. The initial focus will be on examining these adaptations in children with unilateral CP (UCP). UCP, where primarily one hemisphere has been affected, offers a less complex system structurally and functionally, thereby serving as a good foundation to begin understanding neural reorganization. The central hypothesis is that these two functions have both separate and common central and peripheral neuroplastic adaptations that predict the respective functional outcomes seen in unilateral CP. Specific aims of the proposed study are: 1) To determine the central (neuroimaging) correlates that predict peripheral (electromyographic) and behavioral swallowing and speech performance in children with UCP and typically developing peers; 2) To determine the peripheral (electromyographic) correlates that predict behavioral swallowing and speech performance in children with UCP and typically developing peers; and 3) To determine the individual and shared contributions of each neural control level (central and peripheral) to swallowing and speech in both children with UCP and typically developing peers. This study will employ novel integrative methods, including structural, diffusion, and resting- state functional connectivity MRI, peripheral electromyographic methods, and functional/behavioral testing to achieve these aims. This unique integration is innovative and necessary to inform the theory behind clinical decisions and to form the basis from which to explore other types of neural reorganization in the future, for example in patients with bilateral involvement. The contribution of this study will be significant, because it will reveal the neural reorganization for swallowing and speech in children with UCP, and will provide the empirical foundation to start developing new separate and/or common neurophysiologically-driven treatments. In the long-term, cumulative knowledge from this line of research will enhance our understanding of developmental neuroplasticity, improve clinical practice, and maximize the health and quality of life of these children.