title: Does Corticospinal Tract Connectivity Influence the Response to Intensive Bimanual Therapy in Children With Unilateral Cerebral Palsy?
abstract: Reorganization of the corticospinal tract (CST) can occur in unilateral spastic cerebral palsy (USCP). The affected hand can be controlled via (1) typical contralateral projections from the lesioned hemisphere, (2) ipsilateral projections from the nonlesioned hemisphere, and (3) a combination of contralateral and ipsilateral projections (ie, bilateral). Intensive bimanual therapy and constraint-induced movement therapy (CIMT) improve hand function of children with USCP. Earlier it was suggested that the CST connectivity pattern may influence the efficacy of CIMT.
  
  
  
  To examine whether CST projection pattern influences the efficacy of intensive bimanual therapy in children with USCP.
  
  
  
  Thirty-three children with USCP (age 8.9 ± 2.6 years, 16 females).
  
  
  
  Bimanual therapy was provided in a day-camp setting (90 hours). Participants were involved in different bimanual play and functional activities actively engaging both hands. Hand function was tested before and after the intervention with the Jebsen-Taylor Test of Hand Function, Assisting Hand Assessment, ABILHAND-Kids, and the Canadian Occupational Performance Measure. Single-pulse transcranial magnetic stimulation (TMS) was used to determine each child's CST projection pattern (ie, ipsilateral, contralateral, or bilateral).
  
  
  
  Children whose affected hand was controlled only by ipsilateral CST projections had worse Jebsen-Taylor Test of Hand Function and Assisting Hand Assessment scores than children in the contralateral group at baseline. Bimanual hand use and functional hand use was independent of CST projection pattern. After bimanual therapy, improvements on all outcome measures were observed, and these improvements were independent of the CST connectivity pattern.
  
  
  
  The efficacy of bimanual therapy on hand function in children with USCP appears to be independent of CST connectivity pattern.
authors.affiliation: 1 Burke-Cornell Medical Research Institute, White Plains, NY, USA.
authors.forename: Ana R P
authors.initials: AR
authors.lastname: Smorenburg
authors.affiliation: 2 Teachers College, Columbia University, New York, NY, USA.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Gordon
authors.affiliation: 1 Burke-Cornell Medical Research Institute, White Plains, NY, USA.|2 Teachers College, Columbia University, New York, NY, USA.
authors.forename: Hsing-Ching
authors.initials: HC
authors.lastname: Kuo
authors.affiliation: 1 Burke-Cornell Medical Research Institute, White Plains, NY, USA.|2 Teachers College, Columbia University, New York, NY, USA.
authors.forename: Claudio L
authors.initials: CL
authors.lastname: Ferre
authors.affiliation: 3 Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
authors.forename: Marina
authors.initials: M
authors.lastname: Brandao
authors.affiliation: 4 Université Catholique de Louvain, Brussels, Belgium.
authors.forename: Yannick
authors.initials: Y
authors.lastname: Bleyenheuft
authors.affiliation: 1 Burke-Cornell Medical Research Institute, White Plains, NY, USA.|5 Weill Cornell Medical College, New York, NY, USA.
authors.forename: Jason B
authors.initials: JB
authors.lastname: Carmel
authors.affiliation: 1 Burke-Cornell Medical Research Institute, White Plains, NY, USA.|5 Weill Cornell Medical College, New York, NY, USA.
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Friel
mesh_terms: D000203:Activities of Daily Living; D002547:Cerebral Palsy / Q000503:physiopathology* / Q000534:rehabilitation*; D002648:Child; D005081:Exercise Therapy; D005260:Female; D007839:Functional Laterality; D006225:Hand / Q000503:physiopathology*; D006801:Humans; D008297:Male; D010988:Play and Playthings; D011712:Pyramidal Tracts / Q000503:physiopathology*; D012720:Severity of Illness Index; D050781:Transcranial Magnetic Stimulation; D016896:Treatment Outcome
keywords: cerebral palsy; corticospinal tract; exercise therapy; hemiplegia; rehabilitation; reorganization