title: Changes of White Matter Diffusion Anisotropy in Response to a 6-Week iPad Application-Based Occupational Therapy Intervention in Children with Surgically Treated Hydrocephalus: A Pilot Study.
abstract: Objective Our aims were (1) to test whether diffusion tensor imaging (DTI) could detect underlying white matter (WM) changes after a 6-week iPad application-based occupational therapy (OT) intervention in children with surgically treated hydrocephalus (HCP); and (2) to explore the association between WM changes and performance outcomes. Methods Five children (age range: 6.05-9.10 years) with surgically treated HCP completed an intensive iPad-based OT intervention targeting common domains of long-term deficits in children with HCP. The intervention included 6 weekly sessions in an OT clinic supplementing home-based program (1 hour/day, 4 days/week). DTI and neuropsychological assessments were performed before and after the intervention. Observation After the therapy, significant increases in fractional anisotropy (FA) and/or decreases in radial diffusivity were found in extensive WM areas. All participants demonstrated an increased perceptual reasoning index (PRI, Wechsler Abbreviated Scale of Intelligence: 2nd edition, PRI gains = 14.20 ± 7.56, p = 0.014). A significant positive correlation was found between PRI increase and the increase of FA in the right posterior limb of the internal capsule and the right external capsule (both p < 0.05). Conclusion This study provides initial evidence of DTI's sensitivity to detect subtle WM changes associated with performance improvements in response to a 6-week OT intervention in children with HCP.
authors.affiliation: Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States.
authors.forename: Weihong
authors.initials: W
authors.lastname: Yuan
authors.affiliation: Division of Occupational Therapy and Physical Therapy, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States.
authors.forename: Karen
authors.initials: K
authors.lastname: Harpster
authors.affiliation: Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States.
authors.forename: Blaise V
authors.initials: BV
authors.lastname: Jones
authors.affiliation: Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, United States.
authors.forename: Joshua S
authors.initials: JS
authors.lastname: Shimony
authors.affiliation: Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, United States.
authors.forename: Robert C
authors.initials: RC
authors.lastname: McKinstry
authors.affiliation: Cerebral Palsy Center, St. Louis Children's Hospital, St. Louis, Missouri, United States.
authors.forename: Nicole
authors.initials: N
authors.lastname: Weckherlin
authors.affiliation: Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, United States.
authors.forename: Stephanie S
authors.initials: SS
authors.lastname: Powell
authors.affiliation: Division of Developmental and Behavioral Pediatrics-Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States.
authors.forename: Holly
authors.initials: H
authors.lastname: Barnard
authors.affiliation: Program in Occupational Therapy, Washington University School of Medicine, St. Louis, Missouri, United States.
authors.forename: Jack
authors.initials: J
authors.lastname: Engsberg
authors.affiliation: Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States.
authors.forename: Darren S
authors.initials: DS
authors.lastname: Kadis
authors.affiliation: Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, United States.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Dodd
authors.affiliation: University of Cincinnati College of Medicine, Cincinnati, Ohio, United States.
authors.forename: Mekibib
authors.initials: M
authors.lastname: Altaye
authors.affiliation: Department of Neurological Surgery, Washington University School of Medicine, St. Louis, Missouri, United States.
authors.forename: David D
authors.initials: DD
authors.lastname: Limbrick
authors.affiliation: Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States.
authors.forename: Scott K
authors.initials: SK
authors.lastname: Holland
authors.affiliation: Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States.
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Simpson
authors.affiliation: Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States.
authors.forename: Sarah
authors.initials: S
authors.lastname: Bidwell
authors.affiliation: University of Cincinnati College of Medicine, Cincinnati, Ohio, United States.
authors.forename: Francesco T
authors.initials: FT
authors.lastname: Mangano
mesh_terms: D016880:Anisotropy; D065850:Cerebral Peduncle / Q000000981:diagnostic imaging; D002648:Child; D034201:Computers, Handheld; D003337:Corpus Callosum / Q000000981:diagnostic imaging; D038524:Diffusion Magnetic Resonance Imaging; D056324:Diffusion Tensor Imaging; D066271:External Capsule / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000000981:diagnostic imaging / Q000534:rehabilitation* / Q000601:surgery; D020772:Internal Capsule / Q000000981:diagnostic imaging; D008137:Longitudinal Studies; D008297:Male; D009483:Neuropsychological Tests; D019635:Neurosurgical Procedures; D009788:Occupational Therapy; D010865:Pilot Projects; D066127:White Matter / Q000000981:diagnostic imaging*