title: Brain stimulation and constraint for perinatal stroke hemiparesis: The PLASTIC CHAMPS Trial.
abstract: OBJECTIVE
  To determine whether the addition of repetitive transcranial magnetic stimulation (rTMS) and/or constraint-induced movement therapy (CIMT) to intensive therapy increases motor function in children with perinatal stroke and hemiparesis.
  
  
  METHODS
  A factorial-design, blinded, randomized controlled trial (clinicaltrials.gov/NCT01189058) assessed rTMS and CIMT effects in hemiparetic children (aged 6-19 years) with MRI-confirmed perinatal stroke. All completed a 2-week, goal-directed, peer-supported motor learning camp randomized to daily rTMS, CIMT, both, or neither. Primary outcomes were the Assisting Hand Assessment and the Canadian Occupational Performance Measure at baseline, and 1 week, 2 and 6 months postintervention. Outcome assessors were blinded to treatment. Interim safety analyses occurred after 12 and 24 participants. Intention-to-treat analysis examined treatment effects over time (linear mixed effects model).
  
  
  RESULTS
  All 45 participants completed the trial. Addition of rTMS, CIMT, or both doubled the chances of clinically significant improvement. Assisting Hand Assessment gains at 6 months were additive and largest with rTMS + CIMT (β coefficient = 5.54 [2.57-8.51], p = 0.0004). The camp alone produced large improvements in Canadian Occupational Performance Measure scores, maximal at 6 months (Cohen d = 1.6, p = 0.002). Quality-of-life scores improved. Interventions were well tolerated and safe with no decrease in function of either hand.
  
  
  CONCLUSIONS
  Hemiparetic children participating in intensive, psychosocial rehabilitation programs can achieve sustained functional gains. Addition of CIMT and rTMS increases the chances of improvement.
  
  
  METHODS
  This study provides Class II evidence that combined rTMS and CIMT enhance therapy-induced functional motor gains in children with stroke-induced hemiparetic cerebral palsy.
authors.affiliation: From the Departments of Pediatrics and Clinical Neurosciences (A.K., A.M.), Cumming School of Medicine, Alberta Children's Hospital Research Institute, University of Calgary; University of Alberta (J.A.), Glenrose Rehabilitation Hospital, Edmonton; Clinical Neurosciences (M.H., L.C.), Alberta Children's Hospital, Alberta Health Services; Department of Pediatrics (A.N.-A.) and Calgary Pediatric Stroke Program (A.K., O.D., J.K., A.M., J.H.), Alberta Children's Hospital; Hotchkiss Brain Institute (A.K., M.D.H.), Cumming School of Medicine, University of Calgary, Canada. adam.kirton@ahs.ca.
authors.forename: Adam
authors.initials: A
authors.lastname: Kirton
authors.affiliation: From the Departments of Pediatrics and Clinical Neurosciences (A.K., A.M.), Cumming School of Medicine, Alberta Children's Hospital Research Institute, University of Calgary; University of Alberta (J.A.), Glenrose Rehabilitation Hospital, Edmonton; Clinical Neurosciences (M.H., L.C.), Alberta Children's Hospital, Alberta Health Services; Department of Pediatrics (A.N.-A.) and Calgary Pediatric Stroke Program (A.K., O.D., J.K., A.M., J.H.), Alberta Children's Hospital; Hotchkiss Brain Institute (A.K., M.D.H.), Cumming School of Medicine, University of Calgary, Canada.
authors.forename: John
authors.initials: J
authors.lastname: Andersen
authors.affiliation: From the Departments of Pediatrics and Clinical Neurosciences (A.K., A.M.), Cumming School of Medicine, Alberta Children's Hospital Research Institute, University of Calgary; University of Alberta (J.A.), Glenrose Rehabilitation Hospital, Edmonton; Clinical Neurosciences (M.H., L.C.), Alberta Children's Hospital, Alberta Health Services; Department of Pediatrics (A.N.-A.) and Calgary Pediatric Stroke Program (A.K., O.D., J.K., A.M., J.H.), Alberta Children's Hospital; Hotchkiss Brain Institute (A.K., M.D.H.), Cumming School of Medicine, University of Calgary, Canada.
authors.forename: Mia
authors.initials: M
authors.lastname: Herrero
authors.affiliation: From the Departments of Pediatrics and Clinical Neurosciences (A.K., A.M.), Cumming School of Medicine, Alberta Children's Hospital Research Institute, University of Calgary; University of Alberta (J.A.), Glenrose Rehabilitation Hospital, Edmonton; Clinical Neurosciences (M.H., L.C.), Alberta Children's Hospital, Alberta Health Services; Department of Pediatrics (A.N.-A.) and Calgary Pediatric Stroke Program (A.K., O.D., J.K., A.M., J.H.), Alberta Children's Hospital; Hotchkiss Brain Institute (A.K., M.D.H.), Cumming School of Medicine, University of Calgary, Canada.
authors.forename: Alberto
authors.initials: A
authors.lastname: Nettel-Aguirre
authors.affiliation: From the Departments of Pediatrics and Clinical Neurosciences (A.K., A.M.), Cumming School of Medicine, Alberta Children's Hospital Research Institute, University of Calgary; University of Alberta (J.A.), Glenrose Rehabilitation Hospital, Edmonton; Clinical Neurosciences (M.H., L.C.), Alberta Children's Hospital, Alberta Health Services; Department of Pediatrics (A.N.-A.) and Calgary Pediatric Stroke Program (A.K., O.D., J.K., A.M., J.H.), Alberta Children's Hospital; Hotchkiss Brain Institute (A.K., M.D.H.), Cumming School of Medicine, University of Calgary, Canada.
authors.forename: Lisa
authors.initials: L
authors.lastname: Carsolio
authors.affiliation: From the Departments of Pediatrics and Clinical Neurosciences (A.K., A.M.), Cumming School of Medicine, Alberta Children's Hospital Research Institute, University of Calgary; University of Alberta (J.A.), Glenrose Rehabilitation Hospital, Edmonton; Clinical Neurosciences (M.H., L.C.), Alberta Children's Hospital, Alberta Health Services; Department of Pediatrics (A.N.-A.) and Calgary Pediatric Stroke Program (A.K., O.D., J.K., A.M., J.H.), Alberta Children's Hospital; Hotchkiss Brain Institute (A.K., M.D.H.), Cumming School of Medicine, University of Calgary, Canada.
authors.forename: Omar
authors.initials: O
authors.lastname: Damji
authors.affiliation: From the Departments of Pediatrics and Clinical Neurosciences (A.K., A.M.), Cumming School of Medicine, Alberta Children's Hospital Research Institute, University of Calgary; University of Alberta (J.A.), Glenrose Rehabilitation Hospital, Edmonton; Clinical Neurosciences (M.H., L.C.), Alberta Children's Hospital, Alberta Health Services; Department of Pediatrics (A.N.-A.) and Calgary Pediatric Stroke Program (A.K., O.D., J.K., A.M., J.H.), Alberta Children's Hospital; Hotchkiss Brain Institute (A.K., M.D.H.), Cumming School of Medicine, University of Calgary, Canada.
authors.forename: Jamie
authors.initials: J
authors.lastname: Keess
authors.affiliation: From the Departments of Pediatrics and Clinical Neurosciences (A.K., A.M.), Cumming School of Medicine, Alberta Children's Hospital Research Institute, University of Calgary; University of Alberta (J.A.), Glenrose Rehabilitation Hospital, Edmonton; Clinical Neurosciences (M.H., L.C.), Alberta Children's Hospital, Alberta Health Services; Department of Pediatrics (A.N.-A.) and Calgary Pediatric Stroke Program (A.K., O.D., J.K., A.M., J.H.), Alberta Children's Hospital; Hotchkiss Brain Institute (A.K., M.D.H.), Cumming School of Medicine, University of Calgary, Canada.
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Mineyko
authors.affiliation: From the Departments of Pediatrics and Clinical Neurosciences (A.K., A.M.), Cumming School of Medicine, Alberta Children's Hospital Research Institute, University of Calgary; University of Alberta (J.A.), Glenrose Rehabilitation Hospital, Edmonton; Clinical Neurosciences (M.H., L.C.), Alberta Children's Hospital, Alberta Health Services; Department of Pediatrics (A.N.-A.) and Calgary Pediatric Stroke Program (A.K., O.D., J.K., A.M., J.H.), Alberta Children's Hospital; Hotchkiss Brain Institute (A.K., M.D.H.), Cumming School of Medicine, University of Calgary, Canada.
authors.forename: Jacquie
authors.initials: J
authors.lastname: Hodge
authors.affiliation: From the Departments of Pediatrics and Clinical Neurosciences (A.K., A.M.), Cumming School of Medicine, Alberta Children's Hospital Research Institute, University of Calgary; University of Alberta (J.A.), Glenrose Rehabilitation Hospital, Edmonton; Clinical Neurosciences (M.H., L.C.), Alberta Children's Hospital, Alberta Health Services; Department of Pediatrics (A.N.-A.) and Calgary Pediatric Stroke Program (A.K., O.D., J.K., A.M., J.H.), Alberta Children's Hospital; Hotchkiss Brain Institute (A.K., M.D.H.), Cumming School of Medicine, University of Calgary, Canada.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Hill
mesh_terms: D000293:Adolescent; D002648:Child; D003131:Combined Modality Therapy / Q000009:adverse effects / Q000379:methods; D005260:Female; D006225:Hand / Q000503:physiopathology; D006801:Humans; D008297:Male; D010291:Paresis / Q000209:etiology* / Q000503:physiopathology / Q000534:rehabilitation*; D018579:Patient Selection; D026741:Physical Therapy Modalities / Q000009:adverse effects; D000067250:Psychiatric Rehabilitation / Q000379:methods; D011788:Quality of Life; D020127:Recovery of Function; D012149:Restraint, Physical; D016037:Single-Blind Method; D020521:Stroke / Q000150:complications* / Q000503:physiopathology; D000071939:Stroke Rehabilitation / Q000009:adverse effects / Q000379:methods*; D050781:Transcranial Magnetic Stimulation / Q000009:adverse effects / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult