title: Capturing neuroplastic changes after bimanual intensive rehabilitation in children with unilateral spastic cerebral palsy: A combined DTI, TMS and fMRI pilot study.
abstract: Intensive rehabilitation interventions have been shown to be efficacious in improving upper extremity function in children with unilateral spastic cerebral palsy (USCP). These interventions are based on motor learning principles and engage children in skillful movements. Improvements in upper extremity function are believed to be associated with neuroplastic changes. However, these neuroplastic changes have not been well-described in children with cerebral palsy, likely due to challenges in defining and implementing the optimal tools and tests in children. Here we documented the implementation of three different neurological assessments (diffusion tensor imaging-DTI, transcranial magnetic stimulation-TMS and functional magnetic resonance imaging-fMRI) before and after a bimanual intensive treatment (HABIT-ILE) in two children with USCP presenting differential corticospinal developmental reorganization (ipsilateral and contralateral). The aim of the study was to capture neurophysiological changes and to document the complementary relationship between these measures, the potential measurable changes and the feasibility of applying these techniques in children with USCP. Independent of cortical reorganization, both children showed increases in activation and size of the motor areas controlling the affected hand, quantified with different techniques. In addition, fMRI provided additional unexpected changes in the reward circuit while using the affected hand.
authors.affiliation: Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium. Electronic address: Yannick.bleyenheuft@uclouvain.be.
authors.forename: Yannick
authors.initials: Y
authors.lastname: Bleyenheuft
authors.affiliation: Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium.
authors.forename: Laurence
authors.initials: L
authors.lastname: Dricot
authors.affiliation: Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Gilis
authors.affiliation: Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, USA.
authors.forename: Hsing-Ching
authors.initials: HC
authors.lastname: Kuo
authors.affiliation: Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium; Radioloy Service, Clinques Universitaires Saint-Luc, Brussels, Belgium.
authors.forename: Cécile
authors.initials: C
authors.lastname: Grandin
authors.affiliation: Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium; Physical Medicine and Rehabilitation Service, CHU Mont-Godinne, Yvoir, Belgium.
authors.forename: Corinne
authors.initials: C
authors.lastname: Bleyenheuft
authors.affiliation: Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, USA.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Gordon
authors.affiliation: Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, USA; Burke-Cornell Medical Research Institute, White Plains, NY, USA.
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Friel
mesh_terms: D001921:Brain / Q000473:pathology / Q000503:physiopathology; D001931:Brain Mapping; D002547:Cerebral Palsy / Q000209:etiology / Q000473:pathology / Q000503:physiopathology / Q000534:rehabilitation*; D002648:Child; D056324:Diffusion Tensor Imaging; D005260:Female; D059907:Functional Neuroimaging; D006801:Humans; D008279:Magnetic Resonance Imaging; D009044:Motor Cortex / Q000473:pathology / Q000503:physiopathology*; D026741:Physical Therapy Modalities; D010865:Pilot Projects; D020521:Stroke / Q000150:complications / Q000473:pathology / Q000503:physiopathology; D050781:Transcranial Magnetic Stimulation; D016896:Treatment Outcome
keywords: Bimanual training; Cerebral palsy; DTI; TMS; fMRI