title: Innovative strength training-induced neuroplasticity and increased muscle size and strength in children with spastic cerebral palsy: an experimenter-blind case study--three-month follow-up.
abstract: BACKGROUND
  In children with cerebral palsy (CP), the never-learned-to-use (NLTU) effect and underutilization suppress the normal development of cortical plasticity in the paretic limb, which further inhibits its functional use and increases associated muscle weakness.
  
  
  OBJECTIVE
  To highlight the effects of a novel comprehensive hand repetitive intensive strengthening training system on neuroplastic changes associated with upper extremity (UE) muscle strength and motor performance in children with spastic hemiplegic CP.
  
  
  METHODS
  Two children with spastic hemiplegic CP were recruited. Intervention with the comprehensive hand repetitive intensive strengthening training system was provided for 60 min a day, three times a week, for 10 weeks. Neuroplastic changes, muscle size, strength, and associated motor function were measured using functional magnetic resonance imaging (MRI), ultrasound imaging, and standardized motor tests, respectively.
  
  
  RESULTS
  The functional MRI data showed that the comprehensive hand repetitive intensive strengthening training intervention produced measurable neuroplastic changes in the neural substrates associated with motor control and learning. These neuroplastic changes were associated with increased muscle size, strength and motor function.
  
  
  CONCLUSIONS
  These results provide compelling evidence of neuroplastic changes and associated improvements in muscle size and motor function following innovative upper extremity strengthening exercise.
authors.affiliation: Department of Physical Therapy, Honam University, Gwangju, Repulbic of Korea.
authors.forename: Dong Ryul
authors.initials: DR
authors.lastname: Lee
authors.affiliation: Department of Physical Medicine and Rehabilitation, Stroke and Cerebrovascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Yun Hee
authors.initials: YH
authors.lastname: Kim
authors.affiliation: Korea National Rehabilitation Center, Seoul, Republic of Korea.
authors.forename: Dong A
authors.initials: DA
authors.lastname: Kim
authors.affiliation: Department of Motor & Cognitive Rehabilitation, National Rehabilitation Research Institution, Seoul, Republic of Korea.
authors.forename: Jung Ah
authors.initials: JA
authors.lastname: Lee
authors.affiliation: Department of Motor & Cognitive Rehabilitation, National Rehabilitation Research Institution, Seoul, Republic of Korea.
authors.forename: Pil Woo
authors.initials: PW
authors.lastname: Hwang
authors.affiliation: Department of Rehabilitation Standard and Policy, National Rehabilitation Center Research Institute, Seoul, Republic of Korea.
authors.forename: Min Jin
authors.initials: MJ
authors.lastname: Lee
authors.affiliation: Movement Healing Lab, Department of Physical Therapy Program, Yonsei University, Wonju, Republic of Korea.
authors.forename: Sung Hyun
authors.initials: SH
authors.lastname: You
mesh_terms: D002547:Cerebral Palsy / Q000175:diagnosis* / Q000503:physiopathology / Q000534:rehabilitation*; D002648:Child; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D053580:Muscle Strength / Q000502:physiology*; D018482:Muscle, Skeletal / Q000503:physiopathology; D009473:Neuronal Plasticity / Q000502:physiology*; D055070:Resistance Training / Q000379:methods*; D016037:Single-Blind Method; D034941:Upper Extremity / Q000503:physiopathology
keywords: Neuroplasticity; cerebral palsy; functional magnetic resonance imaging; muscle size; strength training