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Morgan C, Badawi N, Boyd RN, Spittle AJ, Dale RC, Kirby A, Hunt RW, Whittingham K, Pannek K, Morton RL, Tarnow-Mordi W, Fahey MC, Walker K, Prelog K, Elliott C, Valentine J, Guzzetta A, Olivey S, Novak I. Harnessing neuroplasticity to improve motor performance in infants with cerebral palsy: a study protocol for the GAME randomised controlled trial. BMJ Open 2023; 13:e070649. [PMID: 36898755 PMCID: PMC10008404 DOI: 10.1136/bmjopen-2022-070649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
Abstract
INTRODUCTION Cerebral palsy (CP) is the most common physical disability of childhood worldwide. Historically the diagnosis was made between 12 and 24 months, meaning data about effective early interventions to improve motor outcomes are scant. In high-income countries, two in three children will walk. This evaluator-blinded randomised controlled trial will investigate the efficacy of an early and sustained Goals-Activity-Motor Enrichment approach to improve motor and cognitive skills in infants with suspected or confirmed CP. METHODS AND ANALYSIS Participants will be recruited from neonatal intensive care units and the community in Australia across four states. To be eligible for inclusion infants will be aged 3-6.5 months corrected for prematurity and have a diagnosis of CP or 'high risk of CP' according to the International Clinical Practice Guideline criteria. Eligible participants whose caregivers consent will be randomly allocated to receive usual care or weekly sessions at home from a GAME-trained study physiotherapist or occupational therapist, paired with a daily home programme, until age 2. The study requires 150 participants per group to detect a 0.5 SD difference in motor skills at 2 years of age, measured by the Peabody Developmental Motor Scales-2. Secondary outcomes include gross motor function, cognition, functional independence, social-emotional development and quality of life. A within-trial economic evaluation is also planned. ETHICS AND DISSEMINATION Ethical approval was obtained from the Sydney Children's Hospital Network Human Ethics Committee in April 2017 (ref number HREC/17/SCHN/37). Outcomes will be disseminated through peer-reviewed journal publications, presentations at international conferences and consumer websites. TRIAL REGISTRATION NUMBER ACTRN12617000006347.
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Affiliation(s)
- Catherine Morgan
- Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Nadia Badawi
- Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
- Grace Centre for Newborn Intensive Care, Sydney Children's Hospital Network, Sydney, New South Wales, Australia
| | - Roslyn N Boyd
- The Faculty of Medicine, Queensland Cerebral Palsy and Rehabilitation Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Alicia J Spittle
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Russell C Dale
- Children's Hospital at Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Adrienne Kirby
- Faculty of Medicine and Health, NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Rod W Hunt
- Department of Paediatrics, Monash University, Clayton, Victoria, Australia
- Cerebral Palsy Alliance, Forestville, New South Wales, Australia
| | - Koa Whittingham
- Queensland Cerebral Palsy Research Centre, The University of Queensland, Brisbane, Queensland, Australia
- The Faculty of Medicine, Queensland Cerebral Palsy and Rehabilitation Research Centre, UQ Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Kerstin Pannek
- Health and Biosecurity, The Australian E-Health Research Centre, CSIRO, Brisbane, Queensland, Australia
| | - Rachael L Morton
- Faculty of Medicine and Health, NHMRC Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - William Tarnow-Mordi
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Michael C Fahey
- Department of Paediatrics, Monash University, Clayton, Victoria, Australia
| | - Karen Walker
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- RPA Newborn Care, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Kristina Prelog
- Medical Imaging Department, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Catherine Elliott
- School of Allied Health, Curtin University, Perth, Western Australia, Australia
- Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Jane Valentine
- Paediatric Rehabilitation, Princess Margaret Hospital for Children, Perth, Western Australia, Australia
| | - Andrea Guzzetta
- Department of Developmental Neuroscience, IRCCS Stella Maris, University of Pisa, Pisa, Toscana, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Toscana, Italy
| | - Shannon Olivey
- Cerebral Palsy Alliance, Forestville, New South Wales, Australia
| | - Iona Novak
- Faculty of Medicine & Health, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine & Health, Cerebral Palsy Alliance Research Institute, Specialty of Child & Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
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Simpson EA, Saiote C, Sutter E, Lench DH, Ikonomidou C, Villegas MA, Gillick BT. Remotely monitored transcranial direct current stimulation in pediatric cerebral palsy: open label trial protocol. BMC Pediatr 2022; 22:566. [PMID: 36175848 PMCID: PMC9521558 DOI: 10.1186/s12887-022-03612-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 09/14/2022] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Pediatric applications of non-invasive brain stimulation using transcranial direct current stimulation (tDCS) have demonstrated its safety with few adverse events reported. Remotely monitored tDCS, as an adjuvant intervention to rehabilitation, may improve quality of life for children with cerebral palsy (CP) through motor function improvements, reduced treatment costs, and increased access to tDCS therapies. Our group previously evaluated the feasibility of a remotely monitored mock tDCS setup in which families and children successfully demonstrated the ability to follow tDCS instructional guidance. METHODS AND DESIGN Here, we designed a protocol to investigate the feasibility, safety, and tolerability of at-home active transcranial direct current stimulation in children with CP with synchronous supervision from laboratory investigators. Ten participants will be recruited to participate in the study for 5 consecutive days with the following sessions: tDCS setup practice on day 1, sham tDCS on day 2, and active tDCS on days 3-5. Sham stimulation will consist of an initial 30-second ramp up to 1.5 mA stimulation followed by a 30-second ramp down. Active stimulation will be delivered at 1.0 - 1.5 mA for 20 minutes and adjusted based on child tolerance. Feasibility will be evaluated via photographs of montage setup and the quality of stimulation delivery. Safety and tolerability will be assessed through an adverse events survey, the Box and Blocks Test (BBT) motor assessment, and a setup ease/comfort survey. DISCUSSION We expect synchronous supervision of at-home teleneuromodulation to be tolerable and safe with increasing stimulation quality over repeated sessions when following a tDCS setup previously determined to be feasible. The findings will provide opportunity for larger clinical trials exploring efficacy and illuminate the potential of remotely monitored tDCS in combination with rehabilitation interventions as a means of pediatric neurorehabilitation. This will demonstrate the value of greater accessibility of non-invasive brain stimulation interventions and ultimately offer the potential to improve care and quality of life for children and families with CP. TRIAL REGISTRATION October 8, 2021( https://clinicaltrials.gov/ct2/show/NCT05071586 ).
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Affiliation(s)
- Emma A Simpson
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Avenue Room 491, Madison, Wisconsin, 53706, USA
| | - Catarina Saiote
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Avenue Room 491, Madison, Wisconsin, 53706, USA
| | - Ellen Sutter
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Avenue Room 491, Madison, Wisconsin, 53706, USA
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Daniel H Lench
- Department of Neurology, Medical University of South Carolina, Charleston, South Carolina, USA
| | | | - Melissa A Villegas
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Avenue Room 491, Madison, Wisconsin, 53706, USA
- University of Wisconsin-Madison Pediatrics, Madison, Wisconsin, USA
| | - Bernadette T Gillick
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Avenue Room 491, Madison, Wisconsin, 53706, USA.
- University of Wisconsin-Madison Pediatrics, Madison, Wisconsin, USA.
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Impact of Rehabilitation Intensity on 3-Year Mortality among Children with Moderate to Severe Cerebral Palsy: A Population-Based Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189932. [PMID: 34574857 PMCID: PMC8469265 DOI: 10.3390/ijerph18189932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 09/17/2021] [Accepted: 09/18/2021] [Indexed: 11/17/2022]
Abstract
Though numerous studies demonstrated the positive effect of rehabilitation on cerebral palsy (CP) children, there was no literature addressing the role of rehabilitation on mortality among children with CP. Therefore, we aimed to evaluate the impact of rehabilitation intensity on mortality among children with moderate to severe CP. This retrospective cohort study was conducted by National Health Insurance Research Database in Taiwan. Children (<12 years) with newly diagnosed moderate to severe CP between 1 January 2000 and 31 December 2013 were included. All patients were followed up for 3 years after CP diagnosis or death or until 31 December 2013. The intensity of rehabilitation therapy within 6 months after CP diagnosis was categorized into <6 times and ≥6 times. The Cox proportional hazard analysis was used to determine the association between rehabilitation intensity and all-cause mortality after adjusting age, sex, other demographic factors and comorbidities. Among 3936 severe CP children, 164 (4.2%) died during the 3-year follow-up period. The mortality rate was higher among patients receiving rehabilitation < 6 times within 6 months than those ≥6 times within 6 months after adjusting demographic profile and comorbidities (adjust HR (aHR): 1.96, 95% CI 1.33–2.89, p < 0.001). We found that patients who were younger (aHR: 0.84, 95% CI 0.76–0.92, p < 0.001), who were receiving inpatient care more than twice in 1 year before their CP diagnosis (aHR: 2.88; 95% CI: 1.96–4.23; p < 0.001), and who have pneumonia (aHR: 1.41, 95% CI 1.00–1.96, p = 0.047), epilepsy (aHR: 1.41, 95% CI: 1.02–1.95, p = 0.039) and dysphagia (aHR: 1.55, 95% CI: 1.06–2.26, p = 0.024) have higher risk of mortality. Rehabilitation ≥ 6 times within 6 months has a potentially positive impact on pediatric CP survival. Besides having a younger age, being hospitalized more than twice within a year before diagnosis and having pneumonia, epilepsy and dysphagia were modifiable risk factors in clinical practice for these children.
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Effect of additional load on angular parameters during gait and balance in children with hemiparesis – Cross sectional study. BIOMEDICAL HUMAN KINETICS 2021. [DOI: 10.2478/bhk-2021-0016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Study aim: To study the effect of additional load over ankle and knee joints on angular parameters during gait and balance in children with hemiparesis.
Material and methods: 10 children with hemiparesis were recruited and stratified into 2 chronological age groups: group A (4–8 years) and group B (9–12 years). Additional loads of 0.7 kg and 1.1 kg were placed on the affected and non-affected lower limb at the ankle and knee joint for group A and group B respectively. Angular parameters during gait were assessed using Kinovea software (version 0.8.15) and balance using the Pediatric Balance Scale.
Results: Application of additional load of 0.7 kg over the non-affected leg knee joint is able to produce significant changes in ankle joint angles (p < 0.05) at initial contact and knee joint angles at heel-off (p < 0.05), toe-off (p < 0.001), acceleration (p < 0.05) and deceleration (p < 0.05) phases of gait and balance in group A, whereas on application of additional load of 1.1 kg over the affected leg at the ankle joint significant improvement in knee joint angles at initial contact (p < 0.001) and the deceleration (p < 0.05) phase of gait in group B was observed. There was significant improvement in the Pediatric Balance Scale score in both groups (p < 0.05).
Conclusions: Additional load over knee and ankle joints of the affected and non-affected leg showed more improvement in angular parameters during gait and balance in younger children with hemiparesis than older children, as they present an immature form of gait that can be modified, corrected and brought back to a normal angle.
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Portnova GV, Girzhova IN, Martynova OV. Residual and compensatory changes of resting‐state EEG in successful recovery after moderate TBI. BRAIN SCIENCE ADVANCES 2021. [DOI: 10.26599/bsa.2020.9050025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Purpose: Even in years after recovery from moderate traumatic brain injury (moderate TBI), patients complain about residual cognitive impairment and fatigue. We hypothesized that non‐linear and linear resting‐state electroencephalography (rsEEG) features might also reflect neural underpinnings of these deficits. Methods: We analyzed a 10‐minute rsEEG in 77 moderate TBI‐survivors and 151 healthy volunteers after cognitive and psychological assessment. The rsEEG analysis included linear measures, such as power spectral density and peak alpha frequency, and non‐linear parameters such as Higuchi fractal dimension, envelope frequency, and Hjorth complexity. Results: The patients with moderate TBI had higher scores for fatigue and sleepiness and lower scores for mood and life satisfaction than controls. The behavioral test for directed attention showed a smaller and non‐significant between‐group difference. In rsEEG patterns, moderate TBI‐group had significantly higher deltaand theta‐rhythm power, which correlated with higher sleepiness and fatigue scores. The higher beta and lower alpha power were associated with a higher attention level in moderate TBI patients. Non‐linear rsEEG features were significantly higher in moderate TBI patients than in healthy controls but correlated with sleepiness and fatigue scores in both controls and patients. Conclusion: The rsEEG patterns may reflect compensatory processes supporting directed attention and residual effect of moderate TBI causing subjective fatigue in patients even after full physiological recovery.
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Affiliation(s)
- Galina V. Portnova
- Institute of Higher Nervous Activity and Neurophysiology of the Russian Academy of Science, Moscow 117485, Russia
- The Pushkin State Russian Language Institute, Moscow 117485, Russia
| | | | - Olga V. Martynova
- Institute of Higher Nervous Activity and Neurophysiology of the Russian Academy of Science, Moscow 117485, Russia
- Centre for Cognition and Decision Making, Institute for Cognitive Neuroscience, National Research University Higher School of Economics, Moscow 109028, Russia
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Sadowska M, Sarecka-Hujar B, Kopyta I. Evaluation of Risk Factors for Epilepsy in Pediatric Patients with Cerebral Palsy. Brain Sci 2020; 10:brainsci10080481. [PMID: 32722475 PMCID: PMC7463548 DOI: 10.3390/brainsci10080481] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/18/2020] [Accepted: 07/23/2020] [Indexed: 01/14/2023] Open
Abstract
Cerebral palsy (CP) is a set of etiologically diverse symptoms that change with the child's age. It is one of the most frequent causes of motor disability in children. CP occurs at a frequency of 1.5 to 3.0 per 1000 live-born children. CP often coexists with epilepsy, which is drug-resistant in a high number of cases. The aim of the present study was to analyze the associations between preconception, prenatal, perinatal, neonatal, and infancy risk factors for epilepsy in a group of pediatric patients with CP. We retrospectively analyzed 181 children with CP (aged 4-17 years at diagnosis), hospitalized at the Department of Pediatrics and Developmental Age Neurology in Katowice in the years 2008-2016. Division into particular types of CP was based on Ingram's classification. Data were analyzed using STATISTICA 13.0 (STATSOFT; Statistica, Tulsa, OK, USA). Epilepsy was diagnosed in 102 children (56.35%), of whom 44 (43%) had drug-resistant epilepsy; only in 15 cases (14.71%) was epilepsy susceptible to treatment. The incidence of epilepsy varied between the types of CP. It occurred significantly more often in children with tetraplegia (75%), ataxic form (83%), and mixed form (80%) in comparison to diplegia (32%) and hemiplegia (38%). Maternal hypertension was found to be a risk factor for epilepsy in CP patients (OR = 12.46, p < 0.001) as well as for drug-resistant epilepsy (the odds ratio (OR) = 9.86, p = 0.040). Delivery by cesarean section increased the risk of epilepsy in the CP patients over two-fold (OR = 2.17, p = 0.012). We observed also that neonatal convulsions significantly increased the risk for epilepsy (OR = 3.04, p = 0.011) as well as drug-resistant epilepsy (OR = 4.02, p = 0.002). In conclusion, maternal hypertension, neonatal convulsions, and delivery by cesarean section were the most important factors increasing the risk of epilepsy as well as drug-resistant epilepsy in the analyzed group of patients with CP.
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Affiliation(s)
- Małgorzata Sadowska
- Department of Pediatrics and Developmental Age Neurology, Upper Silesian Center for Child’s Health, 40-752 Katowice, Poland;
| | - Beata Sarecka-Hujar
- Department of Basic Biomedical Science, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia in Katowice, 41-200 Sosnowiec, Poland
- Correspondence: or ; Tel.: +48-322-699-830
| | - Ilona Kopyta
- Department of Pediatric Neurology, School of Medicine in Katowice, Medical University of Silesia in Katowice, 40-752 Katowice, Poland;
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Motor and Perceptual Recovery in Adult Patients with Mild Intellectual Disability. Neural Plast 2018. [PMID: 29849555 DOI: 10.1155/2018/3273246.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction The relationship between intellectual disability (ID) and hand motor coordination and speed-accuracy, as well as the effect of aging on fine motor performance in patients with ID, has been previously investigated. However, only a few data are available on the impact of the nonpharmacological interventions in adult patients with long-term hand motor deficit. Methods Fifty adults with mild ID were enrolled. A group of thirty patients underwent a two-month intensive ergotherapic treatment that included hand motor rehabilitation and visual-perceptual treatment (group A); twenty patients performing conventional motor rehabilitation alone (group B) served as a control group. Data on attention, perceptual abilities, hand dexterity, and functional independence were collected by a blind operator, both at entry and at the end of the study. Results After the interventions, group A showed significantly better performance than group B in all measures related to hand movement from both sides and to independence in activities of daily living. Discussion Multimodal integrated interventions targeting visual-perceptual abilities and motor skills are an effective neurorehabilitative approach in adult patients with mild ID. Motor learning and memory-mediated mechanisms of neural plasticity might underlie the observed recovery, suggesting the presence of plastic adaptive changes even in the adult brain with ID.
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Cantone M, Catalano MA, Lanza G, La Delfa G, Ferri R, Pennisi M, Bella R, Pennisi G, Bramanti A. Motor and Perceptual Recovery in Adult Patients with Mild Intellectual Disability. Neural Plast 2018; 2018:3273246. [PMID: 29849555 PMCID: PMC5937379 DOI: 10.1155/2018/3273246] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 04/02/2018] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION The relationship between intellectual disability (ID) and hand motor coordination and speed-accuracy, as well as the effect of aging on fine motor performance in patients with ID, has been previously investigated. However, only a few data are available on the impact of the nonpharmacological interventions in adult patients with long-term hand motor deficit. METHODS Fifty adults with mild ID were enrolled. A group of thirty patients underwent a two-month intensive ergotherapic treatment that included hand motor rehabilitation and visual-perceptual treatment (group A); twenty patients performing conventional motor rehabilitation alone (group B) served as a control group. Data on attention, perceptual abilities, hand dexterity, and functional independence were collected by a blind operator, both at entry and at the end of the study. RESULTS After the interventions, group A showed significantly better performance than group B in all measures related to hand movement from both sides and to independence in activities of daily living. DISCUSSION Multimodal integrated interventions targeting visual-perceptual abilities and motor skills are an effective neurorehabilitative approach in adult patients with mild ID. Motor learning and memory-mediated mechanisms of neural plasticity might underlie the observed recovery, suggesting the presence of plastic adaptive changes even in the adult brain with ID.
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Affiliation(s)
- Mariagiovanna Cantone
- 1IRCCS Centro Neurolesi Bonino Pulejo, Via Provinciale Palermo, Contrada Casazza, 98124 Messina, Italy
| | - Maria A. Catalano
- 2Associazione Assistenziale Villa Sandra, Via per Aci Bonaccorsi 16, San Giovanni La Punta, 95037 Catania, Italy
| | - Giuseppe Lanza
- 3Oasi Research Institute-IRCCS, Via Conte Ruggero 73, Troina, 94018 Enna, Italy
| | - Gaetano La Delfa
- 2Associazione Assistenziale Villa Sandra, Via per Aci Bonaccorsi 16, San Giovanni La Punta, 95037 Catania, Italy
| | - Raffaele Ferri
- 3Oasi Research Institute-IRCCS, Via Conte Ruggero 73, Troina, 94018 Enna, Italy
| | - Manuela Pennisi
- 4Spinal Unit, Emergency Hospital “Cannizzaro”, Via Messina 829, 95126 Catania, Italy
| | - Rita Bella
- 5Department of Medical and Surgical Sciences and Advanced Technologies, Section of Neurosciences, University of Catania, Via S. Sofia 78, 95123 Catania, Italy
| | - Giovanni Pennisi
- 6Department of Surgery and Medical-Surgical Specialties, University of Catania, Via S. Sofia 78, 95123 Catania, Italy
| | - Alessia Bramanti
- 1IRCCS Centro Neurolesi Bonino Pulejo, Via Provinciale Palermo, Contrada Casazza, 98124 Messina, Italy
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Attenuation of temporal correlations of neuronal oscillations in patients with mild spastic diplegia. Sci Rep 2017; 7:14966. [PMID: 29097718 PMCID: PMC5668314 DOI: 10.1038/s41598-017-14879-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 10/19/2017] [Indexed: 11/08/2022] Open
Abstract
The aim of this study was to investigate the temporal correlations of neuronal oscillations in patients with mild spastic diplegia (MSD). Resting-state electroencephalography (EEG) was recorded from 15 male adolescent and young adult patients with MSD and 15 healthy controls. We characterized the temporal correlations of neuronal oscillations, both on long temporal scale (i.e., >1 second) and short-to-intermediate temporal scale (i.e., <≈1 second) using detrended fluctuation analysis (DFA) and an analysis of the life- and waiting-time statistics of oscillation bursts respectively. The DFA exponents at alpha and beta bands, the life-time biomarker of alpha oscillation, and the life- and waiting-time biomarkers of beta oscillation were significantly attenuated in the patients compared with controls. Moreover, altered scalp distributions of some temporal correlation measures were found at alpha and beta bands in these patients. All these findings suggest that MSD is associated with highly volatile neuronal states of alpha and beta oscillations on short-to-intermediate and much longer time scales, which may be related to cognitive dysfunction in patients with MSD.
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Rich TL, Menk JS, Rudser KD, Chen M, Meekins GD, Peña E, Feyma T, Bawroski K, Bush C, Gillick BT. Determining Electrode Placement for Transcranial Direct Current Stimulation: A Comparison of EEG- Versus TMS-Guided Methods. Clin EEG Neurosci 2017; 48:367-375. [PMID: 28530154 PMCID: PMC5933436 DOI: 10.1177/1550059417709177] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Transcranial direct current stimulation (tDCS) is increasingly researched as an adjuvant to motor rehabilitation for children with hemiparesis. The optimal method for the primary motor cortex (M1) somatotopic localization for tDCS electrode placement has not been established. The objective, therefore, was to determine the location of the M1 derived using the 10/20 electroencephalography (EEG) system and transcranial magnetic stimulation (TMS) in children with hemiparesis (CWH) and a comparison group of typically developing children (TDC). We hypothesized a difference in location for CWH but not for TDC. The 2 locations were evaluated in 47 children (21 CWH, 26 TDC). Distances between the locations were measured pending presence of a motor evoked potential. Distances between the EEG and TMS locations that exceeded the 2.5 cm × 2.5 cm rubber electrode area are reported in percentages [95% confidence interval] in CWH-nonlesioned hemisphere was 68.8% [41.3-89.0], lesioned: 85.7% [57.2-98.2]; TDC-dominant hemisphere 73.9% [51.6-89.8], nondominant: 82.6% [61.2-95.0]. Distances that exceeded the 3 × 5 cm electrode sponge area in CWH-nonlesioned was 25.0% [7.3-52.4], lesioned was 28.6% [8.4-58.1]; TDC-dominant was 52.2% [30.6-73.2], nondominant was 43.5 [23.2-65.5]). Distances that exceeded the 5 × 7 cm electrode sponge area in CWH-nonlesioned was 18.8% [4.0-45.6] and lesioned was 21.4% [4.7-50.8]; TDC-dominant was 21.7% [7.5-43.7] and nondominant was 26.1% [10.2-48.4]. Individual variability in brain somatotopic organization may influence surface scalp localization of underlying M1 in children regardless of neurologic impairment. Findings suggest further investigation of optimal tDCS electrode placement. EEG and TMS methods reveal variability in localizing M1 in children regardless of stroke diagnosis. This study was registered on clinicaltrials.gov NCT02015338.
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Affiliation(s)
- Tonya L. Rich
- Department of Physical Medicine and Rehabilitation, Program in Rehabilitation Science, University of Minnesota, Minneapolis, MN, USA
| | - Jeremiah S. Menk
- Biostatistical Design and Analysis Center, Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN, USA
| | - Kyle D. Rudser
- Biostatistical Design and Analysis Center, Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN, USA
| | - Mo Chen
- Non-Invasive Neuromodulation Laboratory, Institute for Engineering in Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Gregg D. Meekins
- Department of Neurology, University of Minnesota, Medical School, Minneapolis, MN, USA
| | - Edgar Peña
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, USA
| | - Timothy Feyma
- Gillette Children’s Specialty Healthcare, St Paul, MN, USA
| | - Kay Bawroski
- Gillette Children’s Specialty Healthcare, St Paul, MN, USA
| | - Christina Bush
- Gillette Children’s Specialty Healthcare, St Paul, MN, USA
| | - Bernadette T. Gillick
- Department of Physical Medicine and Rehabilitation, Program in Rehabilitation Science, University of Minnesota, Minneapolis, MN, USA
- Department of Physical Medicine and Rehabilitation, Program in Physical Therapy, University of Minnesota, Minneapolis, MN, USA
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Pavão SL, Rocha NACF. Sensory processing disorders in children with cerebral palsy. Infant Behav Dev 2017; 46:1-6. [DOI: 10.1016/j.infbeh.2016.10.007] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 08/04/2016] [Accepted: 10/28/2016] [Indexed: 12/14/2022]
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Kinney-Lang E, Auyeung B, Escudero J. Expanding the (kaleido)scope: exploring current literature trends for translating electroencephalography (EEG) based brain–computer interfaces for motor rehabilitation in children. J Neural Eng 2016; 13:061002. [DOI: 10.1088/1741-2560/13/6/061002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Altered Resting-State EEG Microstate Parameters and Enhanced Spatial Complexity in Male Adolescent Patients with Mild Spastic Diplegia. Brain Topogr 2016; 30:233-244. [DOI: 10.1007/s10548-016-0520-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 09/09/2016] [Indexed: 10/21/2022]
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Manning KY, Fehlings D, Mesterman R, Gorter JW, Switzer L, Campbell C, Menon RS. Resting State and Diffusion Neuroimaging Predictors of Clinical Improvements Following Constraint-Induced Movement Therapy in Children With Hemiplegic Cerebral Palsy. J Child Neurol 2015; 30:1507-14. [PMID: 25762587 DOI: 10.1177/0883073815572686] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 01/15/2015] [Indexed: 11/17/2022]
Abstract
The aim was to identify neuroimaging predictors of clinical improvements following constraint-induced movement therapy. Resting state functional magnetic resonance and diffusion tensor imaging data was acquired in 7 children with hemiplegic cerebral palsy. Clinical and magnetic resonance imaging (MRI) data were acquired at baseline and 1 month later following a 3-week constraint therapy regimen. A more negative baseline laterality index characterizing an atypical unilateral sensorimotor resting state network significantly correlated with an improvement in the Canadian Occupational Performance Measure score (r = -0.81, P = .03). A more unilateral network with decreased activity in the affected hemisphere was associated with greater improvements in clinical scores. Higher mean diffusivity in the posterior limb of the internal capsule of the affect tract correlated significantly with improvements in the Jebsen-Taylor score (r = -0.83, P = .02). Children with more compromised networks and tracts improved the most following constraint therapy.
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Affiliation(s)
- Kathryn Y Manning
- Department of Medical Biophysics, University of Western Ontario, London, Ontario, Canada
| | - Darcy Fehlings
- Holland Bloorview Kids Rehabilitation Hospital, Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Ronit Mesterman
- CanChild Centre for Childhood Disability Research, McMaster University and McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Jan Willem Gorter
- CanChild Centre for Childhood Disability Research, McMaster University and McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Lauren Switzer
- Holland Bloorview Kids Rehabilitation Hospital, Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Craig Campbell
- Department of Paediatrics, University of Western Ontario, London, Ontario, Canada
| | - Ravi S Menon
- Department of Medical Biophysics, University of Western Ontario, London, Ontario, Canada Centre for Functional and Metabolic Mapping, the University of Western Ontario, London, Ontario, Canada
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15
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Cao J, Khan B, Hervey N, Tian F, Delgado MR, Clegg NJ, Smith L, Roberts H, Tulchin-Francis K, Shierk A, Shagman L, MacFarlane D, Liu H, Alexandrakis G. Evaluation of cortical plasticity in children with cerebral palsy undergoing constraint-induced movement therapy based on functional near-infrared spectroscopy. JOURNAL OF BIOMEDICAL OPTICS 2015; 20:046009. [PMID: 25900145 PMCID: PMC4479242 DOI: 10.1117/1.jbo.20.4.046009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 03/30/2015] [Indexed: 05/04/2023]
Abstract
Sensorimotor cortex plasticity induced by constraint-induced movement therapy (CIMT) in six children (10.2±2.1 years old) with hemiplegic cerebral palsy was assessed by functional near-infrared spectroscopy (fNIRS). The activation laterality index and time-to-peak/duration during a finger-tapping task and the resting-state functional connectivity were quantified before, immediately after, and 6 months after CIMT. These fNIRS-based metrics were used to help explain changes in clinical scores of manual performance obtained concurrently with imaging time points. Five age-matched healthy children (9.8±1.3 years old) were also imaged to provide comparative activation metrics for normal controls. Interestingly, the activation time-to-peak/duration for all sensorimotor centers displayed significant normalization immediately after CIMT that persisted 6 months later. In contrast to this improved localized activation response, the laterality index and resting-state connectivity metrics that depended on communication between sensorimotor centers improved immediately after CIMT, but relapsed 6 months later. In addition, for the subjects measured in this work, there was either a trade-off between improving unimanual versus bimanual performance when sensorimotor activation patterns normalized after CIMT, or an improvement occurred in both unimanual and bimanual performance but at the cost of very abnormal plastic changes in sensorimotor activity.
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Affiliation(s)
- Jianwei Cao
- University of Texas at Arlington and University of Texas Southwestern Medical Center at Dallas, Joint Graduate Program in Biomedical Engineering, Arlington, Texas 76010, United States
| | - Bilal Khan
- University of Texas at Arlington and University of Texas Southwestern Medical Center at Dallas, Joint Graduate Program in Biomedical Engineering, Arlington, Texas 76010, United States
| | - Nathan Hervey
- University of Texas at Arlington and University of Texas Southwestern Medical Center at Dallas, Joint Graduate Program in Biomedical Engineering, Arlington, Texas 76010, United States
| | - Fenghua Tian
- University of Texas at Arlington and University of Texas Southwestern Medical Center at Dallas, Joint Graduate Program in Biomedical Engineering, Arlington, Texas 76010, United States
| | - Mauricio R. Delgado
- Texas Scottish Rite Hospital for Children, Department of Neurology, Dallas, Texas 75219, United States
- University of Texas Southwestern Medical Center at Dallas, Department of Neurology, Dallas, Texas 75235, United States
| | - Nancy J. Clegg
- Texas Scottish Rite Hospital for Children, Department of Neurology, Dallas, Texas 75219, United States
| | - Linsley Smith
- Texas Scottish Rite Hospital for Children, Department of Neurology, Dallas, Texas 75219, United States
| | - Heather Roberts
- Texas Scottish Rite Hospital for Children, Department of Neurology, Dallas, Texas 75219, United States
| | - Kirsten Tulchin-Francis
- Texas Scottish Rite Hospital for Children, Department of Neurology, Dallas, Texas 75219, United States
| | - Angela Shierk
- Texas Scottish Rite Hospital for Children, Department of Neurology, Dallas, Texas 75219, United States
| | - Laura Shagman
- University of Texas at Dallas, Department of Electrical Engineering, Richardson, Texas 75080, United States
| | - Duncan MacFarlane
- University of Texas at Dallas, Department of Electrical Engineering, Richardson, Texas 75080, United States
| | - Hanli Liu
- University of Texas at Arlington and University of Texas Southwestern Medical Center at Dallas, Joint Graduate Program in Biomedical Engineering, Arlington, Texas 76010, United States
| | - George Alexandrakis
- University of Texas at Arlington and University of Texas Southwestern Medical Center at Dallas, Joint Graduate Program in Biomedical Engineering, Arlington, Texas 76010, United States
- Address all correspondence to: George Alexandrakis, E-mail:
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16
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Fan HC, Ho LI, Chi CS, Cheng SN, Juan CJ, Chiang KL, Lin SZ, Harn HJ. Current proceedings of cerebral palsy. Cell Transplant 2015; 24:471-85. [PMID: 25706819 DOI: 10.3727/096368915x686931] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Cerebral palsy (CP) is a complicated disease with varying causes and outcomes. It has created significant burden to both affected families and societies, not to mention the quality of life of the patients themselves. There is no cure for the disease; therefore, development of effective therapeutic strategies is in great demand. Recent advances in regenerative medicine suggest that the transplantation of stem cells, including embryonic stem cells, neural stem cells, bone marrow mesenchymal stem cells, induced pluripotent stem cells, umbilical cord blood cells, and human embryonic germ cells, focusing on the root of the problem, may provide the possibility of developing a complete cure in treating CP. However, safety is the first factor to be considered because some stem cells may cause tumorigenesis. Additionally, more preclinical and clinical studies are needed to determine the type of cells, route of delivery, cell dose, timing of transplantation, and combinatorial strategies to achieve an optimal outcome.
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Affiliation(s)
- Hueng-Chuen Fan
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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17
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Functional recovery in cerebral palsy may be potentiated by administration of selective serotonin reuptake inhibitors. Med Hypotheses 2011; 77:386-8. [DOI: 10.1016/j.mehy.2011.05.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Accepted: 05/25/2011] [Indexed: 11/24/2022]
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18
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Śmigielska-Kuzia J, Boćkowski L, Sobaniec W, Kułak W, Sendrowski K. Amino acid metabolic processes in the temporal lobes assessed by proton magnetic resonance spectroscopy (1H MRS) in children with Down syndrome. Pharmacol Rep 2011; 62:1070-7. [PMID: 21273664 DOI: 10.1016/s1734-1140(10)70369-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Revised: 05/02/2010] [Indexed: 11/17/2022]
Abstract
Down syndrome (DS), or trisomy 21, is one of the most common autosomal mutations. The overexpression of the β-amyloid precursor protein gene, located on chromosome 21, causes an increased production of the specific amyloid. The current study is a continuation of our earlier investigations relating to the profile of metabolic changes in the frontal lobes of DS patients as assessed by proton magnetic resonance spectroscopy ((1)H MRS). The aims of the study were the morphological assessment of the brain using magnetic resonance imaging (MRI) and the evaluation of metabolic disorders of the temporal lobes using (1)H MRS in DS children. The study group included 20 children with DS aged 3-15 years and treated in the Department of Pediatric Neurology and Rehabilitation, Medical University of Białystok. The control group included healthy children (n = 20). MRI scans of the heads of DS children were performed using a 1.5 T MR scanner under standard conditions. (1)H MRS investigations were also carried out to assess metabolic changes in the temporal lobes. Metabolites, such as N-acetylaspartate (NAA), glutamate-glutamine complex (Glx), choline (Cho), myoinositol (mI) and γ-aminobutyric acid (GABA), were determined in both temporal lobes with reference to the internal marker creatine (Cr). Results were compared with the control group.We found a statistically significant decrease in NAA/Cr, Cho/Cr, mI/Cr and GABA/Cr ratios. The Glx/Cr ratio in both temporal lobes of DS patients did not differ from the control group. Our results indicate metabolic neurotransmitter disorders in the central nervous system in children with DS.
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Affiliation(s)
- Joanna Śmigielska-Kuzia
- Department of Pediatric Neurology and Rehabilitation, Medical University of Białystok, Waszyngtona 17, PL 15-274 Białystok, Poland.
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19
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Thordstein M, Hallböök T, Lundgren J, van Westen D, Elam M. Transfer of cortical motor representation after a perinatal cerebral insult. Pediatr Neurol 2011; 44:131-4. [PMID: 21215913 DOI: 10.1016/j.pediatrneurol.2010.08.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Revised: 06/29/2010] [Accepted: 08/18/2010] [Indexed: 01/26/2023]
Abstract
In a 16-year-old boy with hemiplegia and severe, intractable epilepsy after a neonatal cerebral ischemic insult, cortical motor control was only equivocally assessed by functional magnetic resonance imaging. Therefore, high-precision navigated transcranial magnetic stimulation was performed, which demonstrated that cortical control of muscles on the paretic side was selectively affected. Leg muscle control was located in the contralateral hemisphere, as expected in healthy individuals, whereas forearm muscles were controlled from both hemispheres, and hand muscles were controlled only from the hemisphere ipsilateral to the paresis.
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Affiliation(s)
- Magnus Thordstein
- Department of Clinical Neurophysiology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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20
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Khan B, Tian F, Behbehani K, Romero MI, Delgado MR, Clegg NJ, Smith L, Reid D, Liu H, Alexandrakis G. Identification of abnormal motor cortex activation patterns in children with cerebral palsy by functional near-infrared spectroscopy. JOURNAL OF BIOMEDICAL OPTICS 2010; 15:036008. [PMID: 20615010 PMCID: PMC4588376 DOI: 10.1117/1.3432746] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2009] [Revised: 03/09/2010] [Accepted: 03/23/2010] [Indexed: 05/09/2023]
Abstract
We demonstrate the utility of functional near-infrared spectroscopy (fNIRS) as a tool for physicians to study cortical plasticity in children with cerebral palsy (CP). Motor cortex activation patterns were studied in five healthy children and five children with CP (8.4+/-2.3 years old in both groups) performing a finger-tapping protocol. Spatial (distance from center and area difference) and temporal (duration and time-to-peak) image metrics are proposed as potential biomarkers for differentiating abnormal cortical activation in children with CP from healthy pediatric controls. In addition, a similarity image-analysis concept is presented that unveils areas that have similar activation patterns as that of the maximum activation area, but are not discernible by visual inspection of standard activation images. Metrics derived from the images presenting areas of similarity are shown to be sensitive identifiers of abnormal activation patterns in children with CP. Importantly, the proposed similarity concept and related metrics may be applicable to other studies for the identification of cortical activation patterns by fNIRS.
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Affiliation(s)
- Bilal Khan
- University of Texas at Arlington and University of Texas Southwestern Medical Center at Dallas, Joint Graduate Program in Biomedical Engineering, Arlington, Texas 76019, USA
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21
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Cascio CJ. Somatosensory processing in neurodevelopmental disorders. J Neurodev Disord 2010; 2:62-9. [PMID: 22127855 PMCID: PMC3164038 DOI: 10.1007/s11689-010-9046-3] [Citation(s) in RCA: 126] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2010] [Accepted: 04/07/2010] [Indexed: 12/15/2022] Open
Abstract
The purpose of this article is to review the role of somatosensory perception in typical development, its aberration in a range of neurodevelopmental disorders, and the potential relations between tactile processing abnormalities and central features of each disorder such as motor, communication, and social development. Neurodevelopmental disorders that represent a range of symptoms and etiologies, and for which multiple peer-reviewed articles on somatosensory differences have been published, were chosen to include in the review. Relevant studies in animal models, as well as conditions of early sensory deprivation, are also included. Somatosensory processing plays an important, yet often overlooked, role in typical development and is aberrant in various neurodevelopmental disorders. This is demonstrated in studies of behavior, sensory thresholds, neuroanatomy, and neurophysiology in samples of children with Fragile X syndrome, autism spectrum disorders (ASD), attention deficit hyperactivity disorder (ADHD), and cerebral palsy (CP). Impaired somatosensory processing is found in a range of neurodevelopmental disorders and is associated with deficits in communication, motor ability, and social skills in these disorders. Given the central role of touch in early development, both experimental and clinical approaches should take into consideration the role of somatosensory processing in the etiology and treatment of neurodevelopmental disorders.
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Affiliation(s)
- Carissa J Cascio
- Vanderbilt Kennedy Center for Research on Human Development, Vanderbilt University Department of Psychiatry, 1601 23rd Avenue South, Suite 3057, Nashville, TN, 37212, USA,
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22
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Pilato F, Dileone M, Capone F, Profice P, Caulo M, Battaglia D, Ranieri F, Oliviero A, Florio L, Graziano A, Di Rocco C, Massimi L, Di Lazzaro V. Unaffected motor cortex remodeling after hemispherectomy in an epileptic cerebral palsy patient. A TMS and fMRI study. Epilepsy Res 2009; 85:243-51. [DOI: 10.1016/j.eplepsyres.2009.03.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2009] [Revised: 03/06/2009] [Accepted: 03/22/2009] [Indexed: 11/25/2022]
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23
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Flanagan D, Valentín A, García Seoane JJ, Alarcón G, Boyd SG. Single-pulse electrical stimulation helps to identify epileptogenic cortex in children. Epilepsia 2009; 50:1793-803. [PMID: 19453705 DOI: 10.1111/j.1528-1167.2009.02056.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Danny Flanagan
- Department of Clinical Neurophysiology, Great Ormond Street Hospital for Children, London, UK
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