Cortical Plasticity after Hemispherectomy

描述（由申请人提供）：在脑半球切除术后控制癫痫发作的儿童中，本提案将检查体重支撑跑步机（BWST）训练前后的运动和步态功能，并将BWST训练与自愿踝关节运动引起的功能性MRI （fMRI）皮质激活的变化联系起来。我们的目标是通过确定受伤/手术时的年龄，从特定的病理，预测基线运动/步态功能和对BWST训练的反应，从而了解发育中的人类大脑的功能可塑性，这些训练可以用于设计康复计划，使用功能磁共振成像，提高脑损伤儿童的生活质量（QOL）。我们假设，从出生到2岁的损伤/手术维持了发育调节的同侧皮质脊髓束（ICS），其从初级运动/感觉（M1S1）皮层支配同侧肌肉。相比之下，后期损伤/手术，ICS束部分发育退化，将导致较差的功能恢复，特别是远端踝关节/足功能影响行走。基于从一项试点研究中获得的初步数据，我们建议确定：1)与病理相关的损伤/手术年龄预测上肢和下肢近端和远端肌肉半球切除术前后的运动和步态缺陷；2) BWST训练改善了运动功能和步行功能，如果在早期病变/手术的儿童中改变更好，并且如果训练诱导的步行和运动改善与更好的生活质量测量相关；3) bwst后运动和行走功能的增强与同侧和对侧足背屈时M1S1和扣带皮层的fMRI激活相关并增加，这与涉及ICS束保存的皮质可塑性一致。这项研究的结果将对大脑皮层可塑性的概念产生概念性影响，并在大脑半球切除术后儿童和其他形式的早期发育性脑损伤（如创伤、出血和肿瘤）的神经康复中具有实际应用价值。

DESCRIPTION (provided by applicant): In post-hemispherectomy children for seizure control, this proposal will examine motor and gait functions pre- and post- Body Weight Support Treadmill (BWST) training, and correlate changes from BWST training with functional MRI (fMRI) cortical activation from voluntary ankle movements. Our goals are to understand functional plasticity in the developing human brain by determining if age at injury/surgery, from specific pathologies, predicts baseline motor/gait functions and response to BWST training that can be used to design rehabilitation programs, using fMRI, that improve quality-of-life (QOL) for brain injured children. We hypothesize that injury/surgery from birth to 2 years maintains the developmental regulated ipsilateral corticospinal tract (ICS) that innervates ipsilateral muscles from primary motor/sensory (M1S1) cortex. By comparison, later injury/surgery, where the ICS tract has partially developmental regressed, will result in poorer functional recovery, especially for distal ankle/foot functions affecting walking. Based on Preliminary Data obtained from a Pilot Study we propose to determine if: 1) Age at injury/surgery related to pathology predicts motor and gait deficits pre- and post-hemispherectomy for proximal and distal muscles of the upper and lower limbs; 2) BWST training improves motor function and walking measures, if the changes are better in children with an early age at lesion/surgery, and if training induced walking and motor improvements are associated with better QOL measures; and 3) post-BWST gains of motor and walking function correlate with and increase in fMRI activation of M1S1 and cingulate cortex with ipsilateral and contralateral foot dorsiflexion consistent with cortical plasticity involving preservation of the ICS tract. The results of this research will have a conceptual impact regarding concepts of cortical plasticity in the developing human brain: and has practical application for neurorehabilitation in children post-hemispherectomy and for those with other forms of early developmental cerebral injury, such as trauma, hemorrhage, and tumors.