Multi-modal neuroimaging in children with congenital hemiplegia to assess functional and anatomical reorganization in relation to hand function

项目摘要 脑性瘫痪（CP）是儿童早期最常见的身体残疾， 感觉障碍约30%的脑瘫患儿有先天性偏瘫， 白色物质损伤（PV-损伤），损害单手的使用并破坏双手协调。 先天性偏瘫对每个儿童的一生都有着深远的影响，因此，对公众来说非常重要 健康脑组织的变化通常发生在PV-10之后，取决于时间、位置， 和损伤的程度，以及涉及的功能系统。理解这些变化至关重要 用于开发新的或改进的神经康复策略。此R21应用程序 旨在识别与手部功能相关的异常功能和解剖大脑重组， 使用创新的多功能， 模态神经影像学方法多模态神经影像学研究在CP儿童中很少见， 在患有CP的幼儿中不存在。通过利用儿科领域的最新进展 脑磁图（MEG）和基于弥散MRI的多张量纤维束成像（MTT），我们建议 开发一种创新的儿科MEG引导MTT技术，以确定脑功能-结构关系 在患有先天性偏瘫的幼儿中。对于小儿脑磁图，我们将使用婴儿脑磁图系统，一种小儿脑磁图系统。 具有独特功能的MEG系统专为0至3岁儿童设计，可在波士顿使用 儿童医院我们假设单侧PV儿童的麻痹手的运动指令- 感觉反馈在对侧半球产生，而感觉反馈在同侧半球处理 半球为了验证我们的假设，我们计划：（i）用小儿脑磁图确定大脑皮层的功能图， 在食指和初级躯体感觉的主动运动期间，初级运动皮层（M1） 皮质（S1）在食指的被动运动期间和在拇指、中指的触觉刺激期间， 和小指;（ii）确定皮质脊髓运动和丘脑皮质感觉束的完整性， 我们的MEG引导的MTT技术;和（iii）将M1和S1的激活图中的功能变化相关联， 以及皮质脊髓运动和丘脑皮质感觉束的结构变化， 使用辅助手评估测试评估性能。我们的研究将提供详细的见解， 损伤后手部感觉运动功能重组的神经可塑性机制， 发育中的人脑我们的研究将直接影响儿童的生活质量， 先天性偏瘫，以及其他形式的CP，因为它有可能：（i）告知发展 神经康复策略量身定制个别患者的测量，（ii）促进发展， 针对特定脑网络的可塑性促进干预，以及（iii）确定最佳治疗参数 以及哪些患者群体将从此类治疗中受益。

Project Summary Cerebral palsy (CP) is the most common physical disability in early childhood causing serious motor and sensory impairments. About 30% of children with CP have congenital hemiplegia, resulting from periventricular white matter injury (PV-WMI), which impairs the use of one hand and disrupts bimanual co-ordination. Congenital hemiplegia has a profound effect on each child’s life and, thus, is of great importance to public health. Changes in brain organization often occur following PV-WMI varies depending on the timing, location, and extent of the injury, as well as the functional system involved. Understanding these changes is essential for the development of novel or improved neurological rehabilitation strategies. This R21 application is designed to identify abnormal functional and anatomical brain reorganization associated with hand function in young children (18-24 months) with congenital hemiplegia due to unilateral PV-WMI using an innovative multi- modal neuroimaging approach. Multi-modal neuroimaging studies are rare in children with CP, and are nearly non-existent in young children with CP. By capitalizing on recent advances in pediatric magnetoencephalography (MEG) and diffusion MRI based multi-tensor tractography (MTT), we propose to develop an innovative pediatric MEG-guided MTT technique to determine the brain function-structure relations in young children with congenital hemiplegia. For pediatric MEG, we will use the BabyMEG system, a pediatric MEG system with unique features designed specifically for children 0 to 3 years, which is available at Boston Children’s Hospital. We hypothesize that motor commands of the paretic hand in children with unilateral PV- WMI are generated in the contralesional hemisphere, while sensory feedback is processed in the ipsilesional hemisphere. To test our hypothesis, we plan to: (i) determine with pediatric MEG the functional maps of the primary motor cortex (M1) during active movements of the index finger, and of the primary somatosensory cortex (S1) during passive movements of the index finger and during tactile stimulation of the thumb, middle, and little fingers; (ii) determine the integrity of the corticospinal motor and thalamocortical sensory tracts using our MEG-guided MTT technique; and (iii) correlate the functional changes in the activation maps of M1 and S1, and the structural changes in the corticospinal motor and thalamocortical sensory tracts, with the hand motor performance assessed with the Assisting Hand Assessment test. Our study will provide detailed insights into the neuroplastic mechanisms involved in the reorganization of hand sensorimotor function following lesions to the developing human brain. Our research will have direct impact on the quality of life of children with congenital hemiplegia, as well as other forms of CP, because it has the potential to: (i) inform the development of neurorehabilitation strategies tailored to individual patients’ measurements, (ii) facilitate the development of plasticity-promoting interventions for specific brain networks, and (iii) determine optimal therapy parameters and which patient populations will benefit from such treatments.