title: Skilled Bimanual Training Drives Motor Cortex Plasticity in Children With Unilateral Cerebral Palsy.
abstract: Background Intensive bimanual therapy can improve hand function in children with unilateral spastic cerebral palsy (USCP). We compared the effects of structured bimanual skill training versus unstructured bimanual practice on motor outcomes and motor map plasticity in children with USCP. Objective We hypothesized that structured skill training would produce greater motor map plasticity than unstructured practice. Methods Twenty children with USCP (average age 9.5; 12 males) received therapy in a day camp setting, 6 h/day, 5 days/week, for 3 weeks. In structured skill training (n = 10), children performed progressively more difficult movements and practiced functional goals. In unstructured practice (n = 10), children engaged in bimanual activities but did not practice skillful movements or functional goals. We used the Assisting Hand Assessment (AHA), Jebsen-Taylor Test of Hand Function (JTTHF), and Canadian Occupational Performance Measure (COPM) to measure hand function. We used single-pulse transcranial magnetic stimulation to map the representation of first dorsal interosseous and flexor carpi radialis muscles bilaterally. Results Both groups showed significant improvements in bimanual hand use (AHA; P < .05) and hand dexterity (JTTHF; P < .001). However, only the structured skill group showed increases in the size of the affected hand motor map and amplitudes of motor evoked potentials (P < .01). Most children who showed the most functional improvements (COPM) had the largest changes in map size. Conclusions These findings uncover a dichotomy of plasticity: the unstructured practice group improved hand function but did not show changes in motor maps. Skill training is important for driving motor cortex plasticity in children with USCP.
authors: Burke-Cornell Medical Research Institute, White Plains, NY, USA Teachers College, Columbia University, New York, NY, USA Weill Cornell Medical College, New York, NY, USA kfriel@burke.org.
authors: Kathleen M
authors: KM
authors: Friel
authors: Teachers College, Columbia University, New York, NY, USA.
authors: Hsing-Ching
authors: HC
authors: Kuo
authors: Burke-Cornell Medical Research Institute, White Plains, NY, USA New York University, New York, NY, USA.
authors: Jason
authors: J
authors: Fuller
authors: Teachers College, Columbia University, New York, NY, USA.
authors: Claudio L
authors: CL
authors: Ferre
authors: Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
authors: Marina
authors: M
authors: Brandão
authors: Burke-Cornell Medical Research Institute, White Plains, NY, USA Weill Cornell Medical College, New York, NY, USA.
authors: Jason B
authors: JB
authors: Carmel
authors: Université Catholique de Louvain, Brussels, Belgium.
authors: Yannick
authors: Y
authors: Bleyenheuft
authors: Columbia University Medical Center, New York, NY, USA.
authors: Jaimie L
authors: JL
authors: Gowatsky
authors: Alkermes, Inc, Waltham, MA, USA.
authors: Arielle D
authors: AD
authors: Stanford
authors: Columbia University Medical Center, New York, NY, USA.
authors: Stefan B
authors: SB
authors: Rowny
authors: Duke University, Durham, NC, USA.
authors: Bruce
authors: B
authors: Luber
authors: Columbia University Medical Center, New York, NY, USA.
authors: Bruce
authors: B
authors: Bassi
authors: Columbia University Medical Center, New York, NY, USA.
authors: David L K
authors: DL
authors: Murphy
authors: Division of Translational Research, National Institutes of Health, Bethesda, MD, USA.
authors: Sarah H
authors: SH
authors: Lisanby
authors: Teachers College, Columbia University, New York, NY, USA Columbia University Medical Center, New York, NY, USA.
authors: Andrew M
authors: AM
authors: Gordon
mesh_terms: D000704:Analysis of Variance; D002547:Cerebral Palsy / Q000000981:diagnostic imaging / Q000473:pathology* / Q000534:rehabilitation*; D002648:Child; D019054:Evoked Potentials, Motor / Q000502:physiology; D005260:Female; D007839:Functional Laterality / Q000502:physiology*; D006225:Hand / Q000502:physiology; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D009044:Motor Cortex / Q000000981:diagnostic imaging / Q000503:physiopathology*; D009048:Motor Skills / Q000502:physiology*; D026741:Physical Therapy Modalities; D011214:Practice, Psychological; D050781:Transcranial Magnetic Stimulation
keywords: hemiplegia; neuroplasticity; pediatric; rehabilitation; transcranial magnetic stimulation