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Skilled Bimanual Training Drives Motor Cortex Plasticity in Children With Unilateral Cerebral Palsy.

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Friel, Kathleen M Kuo, Hsing-Ching Fuller, Jason Ferre, Claudio L Brandão, Marina Gordon, Andrew M

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.

Type de document Article de périodique (Journal article)
Type d'accès Accès libre
Année de publication 2016
Langue Anglais
Information sur le périodique "Neurorehabilitation and neural repair" - Vol. 30, no.9, p. 834-44 (2016)
Peer reviewed oui
e-issn 1552-6844
Statut de la publication Publié
Affiliations UCL - SSS/IONS/COSY - Systems & cognitive Neuroscience
Mots-clés hemiplegia ; neuroplasticity ; pediatric ; rehabilitation ; transcranial magnetic stimulation
Liens
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Référence bibliographique Friel, Kathleen M ; Kuo, Hsing-Ching ; Fuller, Jason ; Ferre, Claudio L ; Brandão, Marina ; et. al. Skilled Bimanual Training Drives Motor Cortex Plasticity in Children With Unilateral Cerebral Palsy.. In: Neurorehabilitation and neural repair, Vol. 30, no.9, p. 834-44 (2016)
Permalien http://hdl.handle.net/2078.1/203317