title: Imaging Predictors of Improvement From a Motor Learning-Based Intervention for Children With Unilateral Cerebral Palsy.
abstract: Background Motor-learning interventions may improve hand function in children with unilateral cerebral palsy (UCP) but with inconsistent outcomes across participants. Objective To examine if pre-intervention brain imaging predicts benefit from bimanual intervention. Method Twenty children with UCP with Manual Ability Classification System levels I to III, aged 7-16 years, participated in an intensive bimanual intervention. Assessments included the Assisting Hand Assessment (AHA), Jebsen Taylor Test of Hand Function (JTTHF) and Children's Hand Experience Questionnaire (CHEQ) at baseline (T1), completion (T2) and 8-10 weeks post-intervention (T3). Imaging at baseline included conventional structural (radiological score), functional (fMRI) and diffusion tensor imaging (DTI). Results Improvements were seen across assessments; AHA (P = 0.04), JTTHF (P < .001) and CHEQ (P < 0.001). Radiological score significantly correlated with improvement at T2; AHA (r = .475) and CHEQ (r = .632), but negatively with improvement on unimanual measures at T3 (JTTFH r = -.514). fMRI showed negative correlations between contralesional brain activation when moving the affected hand and AHA improvements (T2: r = -.562, T3: r = -0.479). Fractional Anisotropy in the affected posterior limb of the internal capsule correlated negatively with increased bimanual use on CHEQ at T2 (r = -547) and AHA at T3 (r = -.656). Conclusions Children with greater structural, functional and connective brain damage showed enhanced responses to bimanual intervention. Baseline imaging may identify parameters predicting response to intervention in children with UCP.
authors.affiliation: Child Development and Pediatric Neurology Service, Meuhedet-Northern Region, Haifa, Israel Tel Aviv Sourasky Medical Center, Tel Aviv, Israel mitchell.schertz@gmail.com.
authors.forename: Mitchell
authors.initials: M
authors.lastname: Schertz
authors.affiliation: Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
authors.forename: Shelly I
authors.initials: SI
authors.lastname: Shiran
authors.affiliation: Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
authors.forename: Vicki
authors.initials: V
authors.lastname: Myers
authors.affiliation: Tel Aviv Sourasky Medical Center, Tel Aviv, Israel Bar Ilan University, Ramat Gan, Israel.
authors.forename: Maya
authors.initials: M
authors.lastname: Weinstein
authors.affiliation: Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
authors.forename: Aviva
authors.initials: A
authors.lastname: Fattal-Valevski
authors.affiliation: Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
authors.forename: Moran
authors.initials: M
authors.lastname: Artzi
authors.affiliation: Tel Aviv Sourasky Medical Center, Tel Aviv, Israel Tel Aviv University, Tel Aviv, Israel.
authors.forename: Dafna
authors.initials: D
authors.lastname: Ben Bashat
authors.affiliation: Columbia University, New York, USA.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Gordon
authors.affiliation: Tel Aviv University, Tel Aviv, Israel Oxford Brookes University, Oxford, UK.
authors.forename: Dido
authors.initials: D
authors.lastname: Green
mesh_terms: D000293:Adolescent; D002547:Cerebral Palsy / Q000000981:diagnostic imaging* / Q000534:rehabilitation*; D002648:Child; D003337:Corpus Callosum / Q000000981:diagnostic imaging*; D004185:Disability Evaluation; D005260:Female; D007839:Functional Laterality / Q000502:physiology*; D006225:Hand / Q000503:physiopathology; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D009068:Movement; D026201:Musculoskeletal Manipulations / Q000379:methods*; D059906:Neuroimaging; D011597:Psychomotor Performance; D066191:Sensorimotor Cortex / Q000000981:diagnostic imaging*; D011795:Surveys and Questionnaires
keywords: DTI; fMRI; prediction; treatment; unilateral cerebral palsy