title: Brain Plasticity following Intensive Bimanual Therapy in Children with Hemiparesis: Preliminary Evidence.
abstract: Neuroplasticity studies examining children with hemiparesis (CH) have focused predominantly on unilateral interventions. CH also have bimanual coordination impairments with bimanual interventions showing benefits. We explored neuroplasticity following hand-arm bimanual intensive therapy (HABIT) of 60 hours in twelve CH (6 females, mean age 11 ± 3.6 y). Serial behavioral evaluations and MR imaging including diffusion tensor (DTI) and functional (fMRI) imaging were performed before, immediately after, and at 6-week follow-up. Manual skills were assessed repeatedly with the Assisting Hand Assessment, Children's Hand Experience Questionnaire, and Jebsen-Taylor Test of Hand Function. Beta values, indicating the level of activation, and lateralization index (LI), indicating the pattern of brain activation, were computed from fMRI. White matter integrity of major fibers was assessed using DTI. 11/12 children showed improvement after intervention in at least one measure, with 8/12 improving on two or more tests. Changes were retained in 6/8 children at follow-up. Beta activation in the affected hemisphere increased at follow-up, and LI increased both after intervention and at follow-up. Correlations between LI and motor function emerged after intervention. Increased white matter integrity was detected in the corpus callosum and corticospinal tract after intervention in about half of the participants. Results provide first evidence for neuroplasticity changes following bimanual intervention in CH.
authors.affiliation: Functional Brain Center, The Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, 6423906 Tel Aviv, Israel ; Department of Psychology, Gonda Multidisciplinary Brain Research Center, Bar-Ilan University, 5290002 Ramat Gan, Israel.
authors.forename: Maya
authors.initials: M
authors.lastname: Weinstein
authors.affiliation: Functional Brain Center, The Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, 6423906 Tel Aviv, Israel ; Sackler Faculty of Medicine, Tel Aviv Sourasky Medical Center, 6997801 Tel Aviv, Israel.
authors.forename: Vicki
authors.initials: V
authors.lastname: Myers
authors.affiliation: Health and Life Sciences, Oxford Brookes University, Oxford OX3 3FL, UK.
authors.forename: Dido
authors.initials: D
authors.lastname: Green
authors.affiliation: Child Development & Pediatric Neurology Service, Meuhedet, 3350127 Haifa, Israel.
authors.forename: Mitchell
authors.initials: M
authors.lastname: Schertz
authors.affiliation: Department of Radiology, Tel Aviv Sourasky Medical Center, 6423906 Tel Aviv, Israel.
authors.forename: Shelly I
authors.initials: SI
authors.lastname: Shiran
authors.affiliation: Department of Psychology, Gonda Multidisciplinary Brain Research Center, Bar-Ilan University, 5290002 Ramat Gan, Israel.
authors.forename: Ronny
authors.initials: R
authors.lastname: Geva
authors.affiliation: Functional Brain Center, The Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, 6423906 Tel Aviv, Israel ; Sackler Faculty of Medicine, Tel Aviv Sourasky Medical Center, 6997801 Tel Aviv, Israel.
authors.forename: Moran
authors.initials: M
authors.lastname: Artzi
authors.affiliation: Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY 10027, USA.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Gordon
authors.affiliation: Paediatric Neurology Unit, Tel Aviv Sourasky Medical Center, 6423906 Tel Aviv, Israel.
authors.forename: Aviva
authors.initials: A
authors.lastname: Fattal-Valevski
authors.affiliation: Functional Brain Center, The Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, 6423906 Tel Aviv, Israel ; Sackler Faculty of Medicine, Tel Aviv Sourasky Medical Center, 6997801 Tel Aviv, Israel ; Sagol School of Neuroscience, Tel Aviv University, 6997801 Tel Aviv, Israel.
authors.forename: Dafna
authors.initials: D
authors.lastname: Ben Bashat
mesh_terms: D000293:Adolescent; D001921:Brain / Q000503:physiopathology*; D002648:Child; D003337:Corpus Callosum / Q000503:physiopathology; D056324:Diffusion Tensor Imaging; D005081:Exercise Therapy; D005260:Female; D005500:Follow-Up Studies; D006225:Hand; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009048:Motor Skills; D018485:Muscle Fibers, Skeletal; D009473:Neuronal Plasticity; D010291:Paresis / Q000503:physiopathology* / Q000534:rehabilitation*; D011597:Psychomotor Performance; D011712:Pyramidal Tracts / Q000503:physiopathology; D016896:Treatment Outcome