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Babik I, Cunha AB, Srinivasan S. Biological and environmental factors may affect children's executive function through motor and sensorimotor development: Preterm birth and cerebral palsy. Infant Behav Dev 2023; 73:101881. [PMID: 37643499 DOI: 10.1016/j.infbeh.2023.101881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 08/03/2023] [Accepted: 08/15/2023] [Indexed: 08/31/2023]
Abstract
Disruptive biological and environmental factors may undermine the development of children's motor and sensorimotor skills. Since the development of cognitive skills, including executive function, is grounded in early motor and sensorimotor experiences, early delays or impairments in motor and sensorimotor processing often trigger dynamic developmental cascades that lead to suboptimal executive function outcomes. The purpose of this perspective paper is to link early differences in motor/sensorimotor processing to the development of executive function in children born preterm or with cerebral palsy. Uncovering such links in clinical populations would improve our understanding of developmental pathways and key motor and sensorimotor skills that are antecedent and foundational for the development of executive function. This knowledge will allow the refinement of early interventions targeting motor and sensorimotor skills with the goal of proactively improving executive function outcomes in at-risk populations.
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Affiliation(s)
- Iryna Babik
- Department of Psychological Science, Boise State University, Boise, ID, USA.
| | - Andrea B Cunha
- Munroe-Meyer Institute, University of Nebraska Medical Center, Omaha, NE, USA
| | - Sudha Srinivasan
- Physical Therapy Program, Department of Kinesiology, University of Connecticut, Storrs, CT, USA
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2
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Doucette SM, Tang S, Kehler H, Creighton D, Lodha A. Utility of the 21-month neurodevelopmental outcome for predicting neurodevelopmental impairment at 36 months for preterm infants <29 weeks gestation. J Perinatol 2023; 43:1406-1412. [PMID: 37714894 DOI: 10.1038/s41372-023-01777-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/25/2023] [Accepted: 09/06/2023] [Indexed: 09/17/2023]
Abstract
OBJECTIVE To determine the sensitivity and specificity of the 21-month neurodevelopmental outcome for predicting the presence of neurodevelopmental impairment at 36 months corrected age in a population of preterm infants under 29 weeks gestation. STUDY DESIGN This is a retrospective observational cohort study. Preterm infants born under 29 weeks gestation who were followed up at both 18-21 months and 36 months corrected age with outcome data available were enrolled. RESULTS Overall, 713 preterm infants <29 weeks gestation and were included in the final analysis. The specificity of the 21-month assessment for predicting neurodevelopmental impairment at 36 months corrected age was 66% (95% confidence interval[CI] 62-71%) with a positive predictive value of 61% (95% CI 56-66%). CONCLUSION In preterm neonates born <29 weeks gestation, the 18-21 months corrected neurodevelopmental outcome had low specificity and positive predictive value for predicting the presence of neurodevelopmental impairment at 36 months corrected age.
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Affiliation(s)
- Stefani M Doucette
- Division of Neonatology, Department of Pediatrics, Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada
- Alberta Health Services, Calgary, Alberta, Canada
- Neonatal Follow-Up Clinic, Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Selphee Tang
- Alberta Health Services, Calgary, Alberta, Canada
- Neonatal Follow-Up Clinic, Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
- Department of Obstetrics and Gynecology, Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada
| | - Heather Kehler
- Alberta Health Services, Calgary, Alberta, Canada
- Neonatal Follow-Up Clinic, Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Dianne Creighton
- Division of Neonatology, Department of Pediatrics, Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada
| | - Abhay Lodha
- Division of Neonatology, Department of Pediatrics, Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada.
- Alberta Health Services, Calgary, Alberta, Canada.
- Neonatal Follow-Up Clinic, Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada.
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
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3
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Gelineau-Morel R, Smyser C, Leeder JS. Identifying Effective Treatments for Dystonia in Patients With Cerebral Palsy: A Precision Therapeutics Approach. Neurology 2023; 101:752-759. [PMID: 37463749 PMCID: PMC10624496 DOI: 10.1212/wnl.0000000000207593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 05/12/2023] [Indexed: 07/20/2023] Open
Abstract
Recent focus on improving the recognition of dystonia in cerebral palsy (DCP) has highlighted the need for more effective treatments. Evidence supports improved functional outcomes with early interventions for patients with cerebral palsy, but it is not known which interventions are most effective for DCP. Current pharmacologic recommendations for DCP are based largely on anecdotal evidence, with medications demonstrating minimal to moderate improvements in dystonia and variable efficacy between patients. Patients, families, and clinicians have identified the need for new and improved treatments in DCP, naming this as the top research theme in a recent Neurology® publication. Precision therapeutics focuses on providing early effective interventions that are individualized to every patient and can guide research priorities to improve treatments for DCP. This commentary outlines current obstacles to improving treatment of DCP and addresses how precision therapeutics can address each of these obstacles through 4 key components: (1) identification of predictive biomarkers to select patients likely to develop DCP in the future and for whom early intervention may be appropriate to delay or prevent full manifestation of dystonia, (2) stratification of patients with DCP into subgroups according to shared features (clinical, functional, biochemical, etc) to provide a targeted intervention based on those shared features, (3) administration of an individualized dose of an effective intervention to ensure adequate concentrations of the therapeutic entity at the site of action, and (4) monitoring of objective biomarkers of response to intervention. With implementation of each of these components of precision therapeutics, new and more effective treatments for every person with DCP can be realized.
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Affiliation(s)
- Rose Gelineau-Morel
- From the Division of Neurology (R.G.-M.), Children's Mercy Kansas City; School of Medicine (R.G.-M., J.S.L.), University of Missouri-Kansas City; Department of Pediatrics (R.G.-M., J.S.L.), University of Kansas Medical Center, Kansas City; Department of Pediatrics (C.S.), Department of Neurology (C.S.), and Mallinckrodt Institute of Radiology (C.S.), Washington University in St. Louis; and Division of Clinical Pharmacology, Toxicology & Therapeutic Innovation (J.S.L.), Children's Mercy Kansas City, MO.
| | - Christopher Smyser
- From the Division of Neurology (R.G.-M.), Children's Mercy Kansas City; School of Medicine (R.G.-M., J.S.L.), University of Missouri-Kansas City; Department of Pediatrics (R.G.-M., J.S.L.), University of Kansas Medical Center, Kansas City; Department of Pediatrics (C.S.), Department of Neurology (C.S.), and Mallinckrodt Institute of Radiology (C.S.), Washington University in St. Louis; and Division of Clinical Pharmacology, Toxicology & Therapeutic Innovation (J.S.L.), Children's Mercy Kansas City, MO
| | - J Steven Leeder
- From the Division of Neurology (R.G.-M.), Children's Mercy Kansas City; School of Medicine (R.G.-M., J.S.L.), University of Missouri-Kansas City; Department of Pediatrics (R.G.-M., J.S.L.), University of Kansas Medical Center, Kansas City; Department of Pediatrics (C.S.), Department of Neurology (C.S.), and Mallinckrodt Institute of Radiology (C.S.), Washington University in St. Louis; and Division of Clinical Pharmacology, Toxicology & Therapeutic Innovation (J.S.L.), Children's Mercy Kansas City, MO
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4
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Deng W, Anastasopoulos S, deRegnier RA, Pouppirt N, Barlow AK, Patrick C, O’Brien MK, Babula S, Sukal-Moulton T, Peyton C, Morgan C, Rogers JA, Lieber RL, Jayaraman A. Protocol for a randomized controlled trial to evaluate a year-long (NICU-to-home) evidence-based, high dose physical therapy intervention in infants at risk of neuromotor delay. PLoS One 2023; 18:e0291408. [PMID: 37725613 PMCID: PMC10508609 DOI: 10.1371/journal.pone.0291408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 08/29/2023] [Indexed: 09/21/2023] Open
Abstract
INTRODUCTION Developmental disabilities and neuromotor delay adversely affect long-term neuromuscular function and quality of life. Current evidence suggests that early therapeutic intervention reduces the severity of motor delay by harnessing neuroplastic potential during infancy. To date, most early therapeutic intervention trials are of limited duration and do not begin soon after birth and thus do not take full advantage of early neuroplasticity. The Corbett Ryan-Northwestern-Shirley Ryan AbilityLab-Lurie Children's Infant Early Detection, Intervention and Prevention Project (Project Corbett Ryan) is a multi-site longitudinal randomized controlled trial to evaluate the efficacy of an evidence-based physical therapy intervention initiated in the neonatal intensive care unit (NICU) and continuing to 12 months of age (corrected when applicable). The study integrates five key principles: active learning, environmental enrichment, caregiver engagement, a strengths-based approach, and high dosage (ClinicalTrials.gov identifier NCT05568264). METHODS We will recruit 192 infants at risk for neuromotor delay who were admitted to the NICU. Infants will be randomized to either a standard-of-care group or an intervention group; infants in both groups will have access to standard-of-care services. The intervention is initiated in the NICU and continues in the infant's home until 12 months of age. Participants will receive twice-weekly physical therapy sessions and caregiver-guided daily activities, assigned by the therapist, targeting collaboratively identified goals. We will use various standardized clinical assessments (General Movement Assessment; Bayley Scales of Infant and Toddler Development, 4th Edition (Bayley-4); Test of Infant Motor Performance; Pediatric Quality of Life Inventory Family Impact Module; Alberta Infant Motor Scale; Neurological, Sensory, Motor, Developmental Assessment; Hammersmith Infant Neurological Examination) as well as novel technology-based tools (wearable sensors, video-based pose estimation) to evaluate neuromotor status and development throughout the course of the study. The primary outcome is the Bayley-4 motor score at 12 months; we will compare scores in infants receiving the intervention vs. standard-of-care therapy.
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Affiliation(s)
- Weiyang Deng
- Shirley Ryan AbilityLab, Chicago, Illinois, United States of America
| | | | - Raye-Ann deRegnier
- Division of Neonatology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, United States of America
- Department of Pediatrics (Neonatology), Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Nicole Pouppirt
- Division of Neonatology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, United States of America
- Department of Pediatrics (Neonatology), Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Ann K. Barlow
- Shirley Ryan AbilityLab, Chicago, Illinois, United States of America
| | - Cheryl Patrick
- Division of Rehabilitative Services, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, United States of America
| | - Megan K. O’Brien
- Shirley Ryan AbilityLab, Chicago, Illinois, United States of America
- Department of Physical Medicine & Rehabilitation, Feinberg School of Medicine, Northwestern Medicine, Chicago, IL, United States of America
| | - Sarah Babula
- Pathways.org, Shirley Ryan AbilityLab, Chicago, Illinois, United States of America
| | - Theresa Sukal-Moulton
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - Colleen Peyton
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - Catherine Morgan
- Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
| | - John A. Rogers
- Department of Biomedical Engineering, Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, Illinois, United States of America
- Departments of Materials Science and Engineering, Chemistry, Mechanical Engineering, Electrical Engineering and Computer Science, Northwestern University, Evanston, Illinois, United States of America
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Richard L. Lieber
- Shirley Ryan AbilityLab, Chicago, Illinois, United States of America
- Department of Biomedical Engineering, Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, Illinois, United States of America
- Department of Neuroscience, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
- Jessie Brown Jr., Hines V.A. Medical Center, Hines, Illinois, United States of America
| | - Arun Jayaraman
- Shirley Ryan AbilityLab, Chicago, Illinois, United States of America
- Department of Physical Medicine & Rehabilitation, Feinberg School of Medicine, Northwestern Medicine, Chicago, IL, United States of America
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
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5
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Mendoza-Sengco P, Lee Chicoine C, Vargus-Adams J. Early Cerebral Palsy Detection and Intervention. Pediatr Clin North Am 2023; 70:385-398. [PMID: 37121632 DOI: 10.1016/j.pcl.2023.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Early identification of cerebral palsy (CP) facilitates optimal care, support, and outcomes for children and their families. Ideally, infants with risk factors or developmental deviations should be evaluated early using standardized assessments of neurodevelopment and brain imaging. If a diagnosis of CP or high risk for CP (HRCP) is established, specialized, evidence-informed therapy and family support should be initiated. With task-specific motor skill training and an enriched environment, infants with CP show greater gross motor and cognitive gains. These enhanced outcomes are only achievable with early diagnosis and subsequent intervention.
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Affiliation(s)
- Paola Mendoza-Sengco
- Division of Pediatric Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, MLC 4009, Cincinnati, OH 45229-3026, USA.
| | - Caitlin Lee Chicoine
- Division of Pediatric Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, MLC 4009, Cincinnati, OH 45229-3026, USA
| | - Jilda Vargus-Adams
- Division of Pediatric Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, MLC 4009, Cincinnati, OH 45229-3026, USA
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6
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Haffner DN, Bauer Huang SL. Using Telemedicine to Overcome Barriers to Neurodevelopmental Care from the Neonatal Intensive Care Unit to School Entry. Clin Perinatol 2023; 50:253-268. [PMID: 36868709 DOI: 10.1016/j.clp.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
Dedicated Neonatal Intensive Care Unit (NICU) follow-up programs are recommended for ongoing surveillance for infants at high-risk for future neurodevelopmental impairment (NDI). Systemic, socioeconomic, and psychosocial barriers remain for referrals and the continued neurodevelopmental follow-up of high-risk infants. Telemedicine can help overcome these barriers. Telemedicine allows standardization of evaluations, increased referral rates, and reduced time to follow-up as well as increased therapy engagement. Telemedicine can expand neurodevelopmental surveillance and support all NICU graduates, facilitating the early identification of NDI. However, with the recent expansion of telemedicine during the COVID-19 pandemic, new barriers related to access and technological support have arisen.
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Affiliation(s)
- Darrah N Haffner
- Division of Pediatric Neurology, Department of Pediatrics, Nationwide Children's Hospital and the Ohio State University, 700 Children's Dr, Columbus, OH 43205, USA.
| | - Sarah L Bauer Huang
- Department of Pediatric and Developmental Neurology, Department of Neurology, Washington University in Saint Louis School of Medicine, 660 S. Euclid Avenue, St. Louis, MO 63110, USA
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7
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Noritz G, Davidson L, Steingass K. Providing a Primary Care Medical Home for Children and Youth With Cerebral Palsy. Pediatrics 2022; 150:e2022060055. [PMID: 36404756 DOI: 10.1542/peds.2022-060055] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Cerebral palsy (CP) is the most common motor disorder of childhood, with prevalence estimates ranging from 1.5 to 4 in 1000 live births. This clinical report seeks to provide primary care physicians with guidance to detect children with CP; collaborate with specialists in treating the patient; manage associated medical, developmental, and behavioral problems; and provide general medical care to their patients with CP.
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Affiliation(s)
- Garey Noritz
- Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio; and
| | - Lynn Davidson
- The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Katherine Steingass
- Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio; and
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8
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McNamara L, Scott K, Boyd RN, Farmer E, Webb A, Bosanquet M, Nguyen K, Novak I. Can web-based implementation interventions improve physician early diagnosis of cerebral palsy? Protocol for a 3-arm parallel superiority randomised controlled trial and cost-consequence analysis comparing adaptive and non-adaptive virtual patient instructional designs with control to evaluate effectiveness on physician behaviour, diagnostic skills and patient outcomes. BMJ Open 2022; 12:e063558. [PMID: 36410832 PMCID: PMC9680174 DOI: 10.1136/bmjopen-2022-063558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Cerebral palsy (CP) is the most common childhood physical disability. Accurate diagnosis before 6 months is possible using predictive tools and decision-making skills. Yet diagnosis is typically made at 12-24 months of age, hindering access to early interventions that improve functional outcomes. Change in practice is required for physicians in key diagnostic behaviours. This study aims to close the identified research-practice gap and increase accurate CP diagnosis before 6 months of age through tailored web-based implementation interventions. This trial will determine whether adaptive e-learning using virtual patients, targeting CP diagnostic behaviours and clinical decision-making skills, effectively changes physician behaviour and practice compared with non-adaptive e-learning instructional design or control. METHODS AND ANALYSIS This study is a 3-arm parallel superiority randomised controlled trial of two tailored e-learning interventions developed to expedite physician CP diagnosis. The trial will compare adaptive (arm 1) and non-adaptive (arm 2) instructional designs with waitlist control (arm 3) to evaluate change in physician behaviour, skills and diagnostic practice. A sample size of 275 paediatric physicians enables detection of small magnitude effects (0.2) of primary outcomes between intervention comparators with 90% power (α=0.05), allowing for 30% attrition. Barrier analysis, Delphi survey, Behaviour Change Wheel and learning theory frameworks guided the intervention designs. Adaptive and non-adaptive video and navigation sequences utilising virtual patients and clinical practice guideline content were developed, integrating formative key features assessment targeting clinical decision-making skills relative to CP diagnosis.Physician outcomes will be evaluated based on postintervention key feature examination scores plus preintervention/postintervention behavioural intentions and practice measures. Associations with CP population registers will evaluate real-world diagnostic patient outcomes. Intervention costs will be reported in a cost-consequence analysis from funders' and societal perspectives. ETHICS AND DISSEMINATION Ethics approved from The University of Sydney (Project number 2021/386). Results will be disseminated through peer-reviewed journals and scientific conferences. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry: ACTRN 12622000184774.
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Affiliation(s)
- Lynda McNamara
- Children's Hospital Westmead Clinical School, The University of Sydney, Westmead, New South Wales, Australia
| | - Karen Scott
- Discipline of Child and Adolescent Health, Children's Hospital Westmead Clinical School, The University of Sydney, Westmead, New South Wales, Australia
| | - Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia
| | - Elizabeth Farmer
- Graduate School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | - Annabel Webb
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Margot Bosanquet
- Paediatric Department, Townsville Hospital and Health Service District (THHS), Townsville, Queensland, Australia
| | - Kim Nguyen
- Faculty of Medicine, Centre for Health Service Research, The University of Queensland, Woolloongabba, Queensland, Australia
| | - Iona Novak
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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9
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Marchi V, Rizzi R, Nevalainen P, Melani F, Lori S, Antonelli C, Vanhatalo S, Guzzetta A. Asymmetry in sleep spindles and motor outcome in infants with unilateral brain injury. Dev Med Child Neurol 2022; 64:1375-1382. [PMID: 35445398 PMCID: PMC9790667 DOI: 10.1111/dmcn.15244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 03/17/2022] [Accepted: 03/22/2022] [Indexed: 12/30/2022]
Abstract
AIM To determine whether interhemispheric difference in sleep spindles in infants with perinatal unilateral brain injury could link to a pathological network reorganization that underpins the development of unilateral cerebral palsy (CP). METHOD This was a multicentre retrospective study of 40 infants (19 females, 21 males) with unilateral brain injury. Sleep spindles were detected and quantified with an automated algorithm from electroencephalograph records performed at 2 months to 5 months of age. The clinical outcomes after 18 months were compared to spindle power asymmetry (SPA) between hemispheres in different brain regions. RESULTS We found a significantly increased SPA in infants who later developed unilateral CP (n=13, with the most robust interhemispheric difference seen in the central spindles. The best individual-level prediction of unilateral CP was seen in the centro-occipital spindles with an overall accuracy of 93%. An empiric cut-off level for SPA at 0.65 gave a positive predictive value of 100% and a negative predictive value of 93% for later development of unilateral CP. INTERPRETATION Our data suggest that automated analysis of interhemispheric SPA provides a potential biomarker of unilateral CP at a very early age. This holds promise for guiding the early diagnostic process in infants with a perinatally identified brain injury. WHAT THIS PAPER ADDS Unilateral perinatal brain injury may affect the development of electroencephalogram (EEG) sleep spindles. Interhemispheric asymmetry in sleep spindles can be quantified with automated EEG analysis. Spindle power asymmetry can be a potential biomarker of unilateral cerebral palsy.
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Affiliation(s)
- Viviana Marchi
- Department of Developmental NeuroscienceIRCCS Stella Maris FoundationPisaItaly
| | - Riccardo Rizzi
- Department of Developmental NeuroscienceIRCCS Stella Maris FoundationPisaItaly,Department of Neuroscience, PsychologyDrug Research and Child Health NEUROFARBA, University of FlorenceFlorenceItaly
| | - Päivi Nevalainen
- Department of Clinical NeurophysiologyChildren's Hospital, HUS Diagnostic Center, Clinical Neurosciences, Helsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Federico Melani
- Neuroscience Department, Children's Hospital MeyerUniversity of FlorenceFlorence
| | - Silvia Lori
- Neurophysiology Unit, Neuro‐Musculo‐Skeletal DepartmentUniversity Hospital CareggiFlorenceItaly
| | - Camilla Antonelli
- Department of Developmental NeuroscienceIRCCS Stella Maris FoundationPisaItaly,Department of Neuroscience, PsychologyDrug Research and Child Health NEUROFARBA, University of FlorenceFlorenceItaly
| | - Sampsa Vanhatalo
- Department of Clinical Neurophysiology, BABA CenterChildren's Hospital, Neuroscience Center, HiLIFE, Helsinki University Hospital and University of HelsinkiHelsinkiFinland
| | - Andrea Guzzetta
- Department of Developmental NeuroscienceIRCCS Stella Maris FoundationPisaItaly,Department of Clinical and Experimental MedicineUniversity of PisaPisaItaly
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10
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Mukherjee P, Roy S, Ghosh D, Nandi SK. Role of animal models in biomedical research: a review. Lab Anim Res 2022; 38:18. [PMID: 35778730 PMCID: PMC9247923 DOI: 10.1186/s42826-022-00128-1] [Citation(s) in RCA: 54] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 06/21/2022] [Indexed: 02/04/2023] Open
Abstract
The animal model deals with the species other than the human, as it can imitate the disease progression, its’ diagnosis as well as a treatment similar to human. Discovery of a drug and/or component, equipment, their toxicological studies, dose, side effects are in vivo studied for future use in humans considering its’ ethical issues. Here lies the importance of the animal model for its enormous use in biomedical research. Animal models have many facets that mimic various disease conditions in humans like systemic autoimmune diseases, rheumatoid arthritis, epilepsy, Alzheimer’s disease, cardiovascular diseases, Atherosclerosis, diabetes, etc., and many more. Besides, the model has tremendous importance in drug development, development of medical devices, tissue engineering, wound healing, and bone and cartilage regeneration studies, as a model in vascular surgeries as well as the model for vertebral disc regeneration surgery. Though, all the models have some advantages as well as challenges, but, present review has emphasized the importance of various small and large animal models in pharmaceutical drug development, transgenic animal models, models for medical device developments, studies for various human diseases, bone and cartilage regeneration model, diabetic and burn wound model as well as surgical models like vascular surgeries and surgeries for intervertebral disc degeneration considering all the ethical issues of that specific animal model. Despite, the process of using the animal model has facilitated researchers to carry out the researches that would have been impossible to accomplish in human considering the ethical prohibitions.
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Affiliation(s)
- P Mukherjee
- Department of Veterinary Clinical Complex, West Bengal University of Animal and Fishery Sciences, Mohanpur, Nadia, India
| | - S Roy
- Department of Veterinary Clinical Complex, West Bengal University of Animal and Fishery Sciences, Mohanpur, Nadia, India
| | - D Ghosh
- Department of Veterinary Surgery and Radiology, West Bengal University of Animal and Fishery Sciences, Kolkata, India
| | - S K Nandi
- Department of Veterinary Surgery and Radiology, West Bengal University of Animal and Fishery Sciences, Kolkata, India.
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11
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Kuo HC, Litzenberger J, Nettel-Aguirre A, Zewdie E, Kirton A. Exploring Clinical and Neurophysiological Factors Associated with Response to Constraint Therapy and Brain Stimulation in Children with Hemiparetic Cerebral Palsy. Dev Neurorehabil 2022; 25:229-238. [PMID: 34392795 DOI: 10.1080/17518423.2021.1964103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Perinatal stroke causes hemiparetic cerebral palsy (HCP) and lifelong disability. Constraint-induced movement therapy (CIMT) and neurostimulation may enhance motor function, but the individual factors associated with responsiveness are undetermined. OBJECTIVE We explored the clinical and neurophysiological factors associated with responsiveness to CIMT and/or brain stimulation within a clinical trial. METHODS PLASTIC CHAMPS was a randomized, blinded, sham-controlled trial (n = 45) of CIMT and neurostimulation paired with intensive, goal-directed therapy. Primary outcome was the Assisting Hand Assessment (AHA). Classification trees created through recursive partitioning suggested clinical and neurophysiological profiles associated with improvement at 6-months. RESULTS Both clinical (stroke side (left) and age >14 years) and neurophysiological (intracortical inhibition/facilitation and motor threshold) were associated with responsiveness across treatment groups with positive predictive values (PPV) approaching 80%. CONCLUSION This preliminary analysis suggested sets of variables that may be associated with response to intensive therapies in HCP. Further modeling in larger trials is required.
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Affiliation(s)
- Hsing-Ching Kuo
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, Canada.,Alberta Children's Hospital Research Institute, Calgary, Canada.,Department of Pediatrics and Clinical Neurosciences, Hotchkiss Brain Institute, Calgary, Canada
| | | | - Alberto Nettel-Aguirre
- Alberta Children's Hospital Research Institute, Calgary, Canada.,Departments of Pediatrics and Community Health Sciences, Primary Institution is the University of Calgary, Calgary, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, Canada
| | - Ephrem Zewdie
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, Canada.,Alberta Children's Hospital Research Institute, Calgary, Canada.,Department of Pediatrics and Clinical Neurosciences, Hotchkiss Brain Institute, Calgary, Canada
| | - Adam Kirton
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, Canada.,Alberta Children's Hospital Research Institute, Calgary, Canada.,Department of Pediatrics and Clinical Neurosciences, Hotchkiss Brain Institute, Calgary, Canada
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12
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Kuo HC, Zewdie E, Giuffre A, Gan LS, Carlson HL, Wrightson J, Kirton A. Robotic mapping of motor cortex in children with perinatal stroke and hemiparesis. Hum Brain Mapp 2022; 43:3745-3758. [PMID: 35451540 PMCID: PMC9294290 DOI: 10.1002/hbm.25881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 03/15/2022] [Accepted: 04/05/2022] [Indexed: 11/13/2022] Open
Abstract
Brain stimulation combined with intensive therapy may improve hand function in children with perinatal stroke‐induced unilateral cerebral palsy (UCP). However, response to therapy varies and underlying neuroplasticity mechanisms remain unclear. Here, we aimed to characterize robotic motor mapping outcomes in children with UCP. Twenty‐nine children with perinatal stroke and UCP (median age 11 ± 2 years) were compared to 24 typically developing controls (TDC). Robotic, neuronavigated transcranial magnetic stimulation was employed to define bilateral motor maps including area, volume, and peak motor evoked potential (MEP). Map outcomes were compared to the primary clinical outcome of the Jebsen–Taylor Test of Hand Function (JTT). Maps were reliably obtained in the contralesional motor cortex (24/29) but challenging in the lesioned hemisphere (5/29). Within the contralesional M1 of participants with UCP, area and peak MEP amplitude of the unaffected map were larger than the affected map. When comparing bilateral maps within the contralesional M1 in children with UCP to that of TDC, only peak MEP amplitudes were different, being smaller for the affected hand as compared to TDC. We observed correlations between the unaffected map when stimulating the contralesional M1 and function of the unaffected hand. Robotic motor mapping can characterize motor cortex neurophysiology in children with perinatal stroke. Map area and peak MEP amplitude may represent discrete biomarkers of developmental plasticity in the contralesional M1. Correlations between map metrics and hand function suggest clinical relevance and utility in studies of interventional plasticity.
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Affiliation(s)
- Hsing-Ching Kuo
- Calgary Pediatric Stroke Program, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute (ACHRI), Calgary, Alberta, Canada.,Hotchkiss Brain Institute (HBI), Calgary, Alberta, Canada.,Department of Pediatrics and Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Physical Medicine & Rehabilitation, University of California Davis, Sacramento, California, USA
| | - Ephrem Zewdie
- Calgary Pediatric Stroke Program, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute (ACHRI), Calgary, Alberta, Canada.,Hotchkiss Brain Institute (HBI), Calgary, Alberta, Canada.,Department of Pediatrics and Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Adrianna Giuffre
- Calgary Pediatric Stroke Program, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute (ACHRI), Calgary, Alberta, Canada.,Hotchkiss Brain Institute (HBI), Calgary, Alberta, Canada.,Department of Pediatrics and Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Liu Shi Gan
- Hotchkiss Brain Institute (HBI), Calgary, Alberta, Canada
| | - Helen L Carlson
- Calgary Pediatric Stroke Program, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute (ACHRI), Calgary, Alberta, Canada.,Hotchkiss Brain Institute (HBI), Calgary, Alberta, Canada.,Department of Pediatrics and Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - James Wrightson
- Calgary Pediatric Stroke Program, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute (ACHRI), Calgary, Alberta, Canada.,Hotchkiss Brain Institute (HBI), Calgary, Alberta, Canada.,Department of Pediatrics and Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Adam Kirton
- Calgary Pediatric Stroke Program, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute (ACHRI), Calgary, Alberta, Canada.,Hotchkiss Brain Institute (HBI), Calgary, Alberta, Canada.,Department of Pediatrics and Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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13
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From Hemispheric Asymmetry through Sensorimotor Experiences to Cognitive Outcomes in Children with Cerebral Palsy. Symmetry (Basel) 2022. [DOI: 10.3390/sym14020345] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Recent neuroimaging studies allowed us to explore abnormal brain structures and interhemispheric connectivity in children with cerebral palsy (CP). Behavioral researchers have long reported that children with CP exhibit suboptimal performance in different cognitive domains (e.g., receptive and expressive language skills, reading, mental imagery, spatial processing, subitizing, math, and executive functions). However, there has been very limited cross-domain research involving these two areas of scientific inquiry. To stimulate such research, this perspective paper proposes some possible neurological mechanisms involved in the cognitive delays and impairments in children with CP. Additionally, the paper examines the ways motor and sensorimotor experience during the development of these neural substrates could enable more optimal development for children with CP. Understanding these developmental mechanisms could guide more effective interventions to promote the development of both sensorimotor and cognitive skills in children with CP.
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14
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Huang HB, Watt MJ, Hicks M, Zhang QS, Lin F, Wan XQ, Chow CB, Cheung PY. A Family-Centered, Multidisciplinary Clinic for Early Diagnosis of Neurodevelopmental Impairment and Cerebral Palsy in China-A Pilot Observation. Front Pediatr 2022; 10:840190. [PMID: 35372170 PMCID: PMC8968569 DOI: 10.3389/fped.2022.840190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 01/20/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Comprehensive multidisciplinary assessment of neurodevelopmental outcomes of high-risk neonates may have significant challenges in low- and middle-income countries, in addition to socio-cultural barriers. We aimed to compare the time to diagnosis of neurodevelopmental impairment (NDI) and cerebral palsy (CP) in preterm neonates (<29 weeks) at a multidisciplinary assessment and care (MDAC) clinic with that of a conventional high-risk infant follow-up clinic in China. METHODS All eligible surviving very preterm neonates born at <29 weeks gestation at the University of Hong Kong-Shenzhen Hospital between January 2015 and December 2019 were followed up in conventional (2015-2017) and MDAC (2018-2020) clinics up to 2 years corrected age with clinical demographic information collected in a prospective database. The MDAC team used standardized developmental assessments. The rates and timing of diagnosing NDI and CP in two epochs were compared. RESULTS The rates of NDI and CP were not different in two epochs [NDI: 12 (50%) vs. 12 (41%); CP: 3 (12%) vs. 2 (7%) of 24 and 29 surviving infants assessed in conventional and MDAC clinics, respectively]. Infants in the MDAC clinic were diagnosed with NDI and CP earlier than those in the pre-MDAC epoch (6 vs. 14 months corrected age, respectively, P < 0.05). CONCLUSION High-risk preterm neonates can be followed more effectively in a family-centered, child-friendly multidisciplinary clinic, leading to an earlier diagnosis of NDI and CP. Early counseling and interventions could be implemented accordingly.
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Affiliation(s)
- Hai-Bo Huang
- Department of Pediatrics, University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Man Joe Watt
- Department of Pediatrics, University of Hong Kong-Shenzhen Hospital, Shenzhen, China.,Department of Pediatrics, Glenrose Rehabilitation Hospital, University of Alberta, Edmonton, AB, Canada.,Department of Physical Medicine and Rehabilitation, Glenrose Rehabilitation Hospital, University of Alberta, Edmonton, AB, Canada
| | - Matthew Hicks
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Qian-Shen Zhang
- Department of Pediatrics, University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Fang Lin
- Department of Pediatrics, University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Xue-Qing Wan
- Department of Pediatrics, University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Chun-Bong Chow
- Department of Pediatrics, University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Po-Yin Cheung
- Department of Pediatrics, University of Hong Kong-Shenzhen Hospital, Shenzhen, China.,Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
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15
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Mailleux L, De Beukelaer N, Carbone MB, Ortibus E. Early interventions in infants with unilateral cerebral palsy: A systematic review and narrative synthesis. RESEARCH IN DEVELOPMENTAL DISABILITIES 2021; 117:104058. [PMID: 34412011 DOI: 10.1016/j.ridd.2021.104058] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 08/02/2021] [Accepted: 08/04/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Recent systematic reviews have already provided an overview of the impact of early interventions on developmental outcomes in infants at risk for cerebral palsy. However, none has thus far focused specifically on how early interventions might improve motor outcome in infants diagnosed with unilateral cerebral palsy (uCP). Hence, the aim of this systematic review was to provide an overview of early intervention programs used in infants with uCP to improve motor outcome. METHODS A systematic literature search was performed in PubMed, Embase, Cochrane Central Register of Controlled trials, CINAHL and Web of Science following the PRISMA-statement guidelines. Risk of bias was assessed using the Cochrane risk-of-bias 2 tool. RESULTS Three single-blinded randomized controlled trials (RCTs) were identified, including 88 infants with uCP. These RCTs suggest that modified constraint-induced movement therapy (mCIMT) is effective and safe for improving upper limb function in infants with uCP. Bimanual training compared to mCIMT was found to be equally effective in one study. No clinical or neurological predictors of treatment response could be identified yet. CONCLUSION Although more high-quality RCTs are urgently needed, early interventions seem effective, safe and feasible to apply in infants with uCP for improving upper limb motor function. This underlines the importance of prompt referral to diagnostic-specific centres to start up such early interventions.
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Affiliation(s)
- Lisa Mailleux
- Centre For Developmental Disabilities, Leuven, Belgium; KU Leuven, Department of Rehabilitation Sciences, Leuven, Belgium.
| | - Nathalie De Beukelaer
- KU Leuven, Department of Rehabilitation Sciences, Leuven, Belgium; University Hospitals Leuven, Clinical Motion Analysis Laboratory, Leuven, Belgium
| | | | - Els Ortibus
- Centre For Developmental Disabilities, Leuven, Belgium; KU Leuven, Department of Development and Regeneration, Leuven, Belgium
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16
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Early Intervention in Unilateral Cerebral Palsy: Let's Listen to the Families! What Are Their Desires and Perspectives? A Preliminary Family-Researcher Co-Design Study. CHILDREN-BASEL 2021; 8:children8090750. [PMID: 34572182 PMCID: PMC8467316 DOI: 10.3390/children8090750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/26/2021] [Accepted: 08/27/2021] [Indexed: 11/17/2022]
Abstract
Cerebral palsy (CP) is a clinical diagnosis based on a combination of clinical and neurological signs, which occurs between the ages of 12 and 24 months. Cerebral palsy or a high risk of cerebral palsy can be accurately predicted before 5–6 months, which is the corrected age. This would allow the initiation of intervention at an early stage. Parents must be more involved in the development and implementation of the early therapy, increasing opportunities for parent–child interaction. The aim of this study was to learn from the perspectives of families with children under 12 months with unilateral cerebral palsy (UCP), what ingredients (barriers and facilitators) should be involved in early intervention so that we could co-design (researchers and families) a multidisciplinary guideline for a global intervention addressed to the needs of the child and the family. Semi-structured interviews were conducted at a time and venue convenient for the families. A total of ten families with experience in early intervention were invited to attend the interview with open questions: (1) What components should early intervention have for a baby diagnosed with UCP? (2) What components should early intervention have for the family? (3) What should the involvement of the family be in early intervention? (4) What barriers included in early intervention should be removed? From the data analysis, three key topics emerged and were subsequently named by focus group participants: (1) UCP early intervention components, (2) family involvement in early intervention of UCP, and (3) removing barriers and creating facilitators within early intervention. The participation of the families (mothers) in the co-design of the necessary ingredients within the scope of a multidisciplinary early intervention guide aimed at children with UCP under 12 months allows learning about their reality and not that of the therapist. The following list highlights the present barriers as perceived by the parents: intervention as spectators, therapeutic goals, clinic environment, and lack of empathy, and the possible facilitators determined by the parents during the implementation comprised teamwork, the family’s goals, motivation during the intervention, and learning at home. Thus, an early intervention program to improve global functionality should address family involvement through multidisciplinary coaching and the modification of the environment, encouraging family goals and family support through the family–therapist team.
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17
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Willerslev-Olsen M, Lorentzen J, Røhder K, Ritterband-Rosenbaum A, Justiniano M, Guzzetta A, Lando AV, Jensen AMB, Greisen G, Ejlersen S, Pedersen LZ, Andersen B, Lipthay Behrend P, Nielsen JB. COpenhagen Neuroplastic TRaining Against Contractures in Toddlers (CONTRACT): protocol of an open-label randomised clinical trial with blinded assessment for prevention of contractures in infants with high risk of cerebral palsy. BMJ Open 2021; 11:e044674. [PMID: 34230015 PMCID: PMC8261878 DOI: 10.1136/bmjopen-2020-044674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Contractures are frequent causes of reduced mobility in children with cerebral palsy (CP) already at the age of 2-3 years. Reduced muscle use and muscle growth have been suggested as key factors in the development of contractures, suggesting that effective early prevention may have to involve stimuli that can facilitate muscle growth before the age of 1 year. The present study protocol was developed to assess the effectiveness of an early multicomponent intervention, CONTRACT, involving family-oriented and supervised home-based training, diet and electrical muscle stimulation directed at facilitating muscle growth and thus reduce the risk of contractures in children at high risk of CP compared with standard care. METHODS AND ANALYSIS A two-group, parallel, open-label randomised clinical trial with blinded assessment (n=50) will be conducted. Infants diagnosed with CP or designated at high risk of CP based on abnormal neuroimaging or absent fidgety movement determined as part of General Movement Assessment, age 9-17 weeks corrected age (CA) will be recruited. A balanced 1:1 randomisation will be made by a computer. The intervention will last for 6 months aiming to support parents in providing daily individualised, goal-directed activities and primarily in lower legs that may stimulate their child to move more and increase muscle growth. Guidance and education of the parents regarding the nutritional benefits of docosahexaenic acid (DHA) and vitamin D for the developing brain and muscle growth will be provided. Infants will receive DHA drops as nutritional supplements and neuromuscular stimulation to facilitate muscle growth. The control group will receive standard care as offered by their local hospital or community. Outcome measures will be taken at 9, 12, 18, 24, 36 and 48 months CA. Primary and secondary outcome measure will be lower leg muscle volume and stiffness of the triceps surae musculotendinous unit together with infant motor profile, respectively. ETHICS AND DISSEMINATION Full approval from the local ethics committee, Danish Committee System on Health Research Ethics, Region H (H-19041562). Experimental procedures conform with the Declaration of Helsinki. TRIAL REGISTRATION NUMBER NCT04250454. EXPECTED RECRUITMENT PERIOD 1 January 2021-1 January 2025.
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Affiliation(s)
- Maria Willerslev-Olsen
- Department of Neuroscience, University of Copenhagen Faculty of Health Sciences, Copenhagen, Denmark
- Department of Research, Elsass Fonden, Charlottenlund, Denmark
| | - Jakob Lorentzen
- Department of Neuroscience, University of Copenhagen Faculty of Health Sciences, Copenhagen, Denmark
| | - Katrine Røhder
- Department of Psychology, Unversity of Copenhagen, Copenhagen, Denmark
| | - Anina Ritterband-Rosenbaum
- Department of Neuroscience, University of Copenhagen Faculty of Health Sciences, Copenhagen, Denmark
- Elsass Foundation, Charlottenlund, Denmark
| | - Mikkel Justiniano
- Department of Neuroscience, University of Copenhagen Faculty of Health Sciences, Copenhagen, Denmark
- Elsass Foundation, Charlottenlund, Denmark
| | - Andrea Guzzetta
- Department of Neurology, Stella Maris Institute, Pisa, Italy
| | | | | | - Gorm Greisen
- Neonatatal Department, Rigshospitalet, Kobenhavn, Denmark
| | - Sofie Ejlersen
- Department of Research, Elsass Fonden, Charlottenlund, Denmark
| | | | - Britta Andersen
- Department of Research, Elsass Fonden, Charlottenlund, Denmark
| | | | - Jens Bo Nielsen
- Department of Neuroscience, University of Copenhagen Faculty of Health Sciences, Copenhagen, Denmark
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18
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Sohn WJ, Sanger TD. Constraint-induced intervention as an emergent phenomenon from synaptic competition in biological systems. J Comput Neurosci 2021; 49:175-188. [PMID: 33825082 PMCID: PMC8046695 DOI: 10.1007/s10827-021-00782-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 11/20/2020] [Accepted: 02/10/2021] [Indexed: 01/03/2023]
Abstract
The principle of constraint-induced therapy is widely practiced in rehabilitation. In hemiplegic cerebral palsy (CP) with impaired contralateral corticospinal projection due to unilateral injury, function improves after imposing a temporary constraint on limbs from the less affected hemisphere. This type of partially-reversible impairment in motor control by early brain injury bears a resemblance to the experience-dependent plastic acquisition and modification of neuronal response selectivity in the visual cortex. Previously, such mechanism was modeled within the framework of BCM (Bienenstock-Cooper-Munro) theory, a rate-based synaptic modification theory. Here, we demonstrate a minimally complex yet sufficient neural network model which provides a fundamental explanation for inter-hemispheric competition using a simplified spike-based model of information transmission and plasticity. We emulate the restoration of function in hemiplegic CP by simulating the competition between cells of the ipsilateral and contralateral corticospinal tracts. We use a high-speed hardware neural simulation to provide realistic numbers of spikes and realistic magnitudes of synaptic modification. We demonstrate that the phenomenon of constraint-induced partial reversal of hemiplegia can be modeled by simplified neural descending tracts with 2 layers of spiking neurons and synapses with spike-timing-dependent plasticity (STDP). We further demonstrate that persistent hemiplegia following unilateral cortical inactivation or deprivation is predicted by the STDP-based model but is inconsistent with BCM model. Although our model is a highly simplified and limited representation of the corticospinal system, it offers an explanation of how constraint as an intervention can help the system to escape from a suboptimal solution. This is a display of an emergent phenomenon from the synaptic competition.
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Affiliation(s)
- Won J Sohn
- Department of Neurology, University of California at Irvine, 200 S. Manchester Ave, Orange, CA, 92868, USA
| | - Terence D Sanger
- Department of Biomedical Engineering, University of Southern California, 1042 Downey Way, Los Angeles, CA, 90089, USA. .,Department of Biokinesiology, University of Southern California, 1042 Downey Way, Los Angeles, CA, 90089, USA. .,Department of Neurology, University of Southern California, 1042 Downey Way, Los Angeles, CA, 90089, USA.
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19
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Sakzewski L, Reedman S, McLeod K, Thorley M, Burgess A, Trost S, Ahmadi M, Rowell D, Chatfield M, Bleyenheuft Y, Boyd RN. Preschool HABIT-ILE: study protocol for a randomised controlled trial to determine efficacy of intensive rehabilitation compared with usual care to improve motor skills of children, aged 2-5 years, with bilateral cerebral palsy. BMJ Open 2021; 11:e041542. [PMID: 33653745 PMCID: PMC7929797 DOI: 10.1136/bmjopen-2020-041542] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Young children with bilateral cerebral palsy (BCP) often experience difficulties with gross motor function, manual ability and posture, impacting developing independence in daily life activities, participation and quality of life. Hand Arm Bimanual Intensive Training Including Lower Extremity (HABIT-ILE) is a novel intensive motor intervention integrating upper and lower extremity training that has been developed and tested in older school-aged children with unilateral and BCP. This study aims to compare an adapted preschool version of HABIT-ILE to usual care in a randomised controlled trial. METHODS AND ANALYSIS 60 children with BCP aged 2-5 years, Gross Motor Function Classification System (GMFCS) II-IV will be recruited. Children will be stratified by GMFCS and randomised using concealed allocation to either receive Preschool HABIT-ILE or usual care. Preschool HABIT-ILE will be delivered in groups of four to six children, for 3 hours/day for 10 days (total 30 hours). Children receiving Preschool HABIT-ILE be provided a written home programme with the aim of achieving an additional 10 hours of home practice (total dose 40 hours). Outcomes will be assessed at baseline, immediately following intervention and then retention of effects will be tested at 26 weeks. The primary outcome will be the Peabody Developmental Motors Scales-Second Edition to evaluate gross and fine motor skills. Secondary outcomes will be gross motor function (Gross Motor Function Measure-66), bimanual hand performance (Both Hands Assessment), self-care and mobility (Pediatric Evaluation of Disability Inventory-Computer Adapted Test), goal attainment (Canadian Occupational Performance Measure), global performance of daily activities (ACTIVLIM-CP), cognition and adaptive function (Behavior Rating Inventory of Executive Function-Preschool Version), habitual physical activity (ActiGraph GT3X+) and quality of life (Infant Toddler Quality of Life Questionnaire and Child Health Utility Index-9). Analyses will follow standard principles for RCTs using two-group comparisons on all participants on an intention-to-treat basis. Comparisons between groups for primary and secondary outcomes will be conducted using regression models. ETHICS AND DISSEMINATION Ethics approval has been granted by the Medical Research Ethics Committee Children's Health Queensland Hospital and Health Service Human Research Ethics Committee (HREC/19/QCHQ/59444) and The University of Queensland (2020000336/HREC/19/QCHQ/59444). TRIAL REGISTRATION NUMBER ACTRN126200000719.
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Affiliation(s)
- Leanne Sakzewski
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland Faculty of Medicine, Herston, Queensland, Australia
| | - Sarah Reedman
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland Faculty of Medicine, Herston, Queensland, Australia
| | - Kate McLeod
- Queensland Paediatric Rehabilitation Service, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Megan Thorley
- Queensland Paediatric Rehabilitation Service, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Andrea Burgess
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland Faculty of Medicine, Herston, Queensland, Australia
| | - Stewart Trost
- Institute of Health and Biomedical Innovation, Centre for Children's Health Research, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Matthew Ahmadi
- Faculty of Medicine and Health, School of Health Sciences, Charles Perkins Centre, Camperdown, New South Wales, Australia
| | - David Rowell
- Faculty of Business, Economics and Law, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Mark Chatfield
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland Faculty of Medicine, Herston, Queensland, Australia
| | - Yannick Bleyenheuft
- Institute of Neuroscience, Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland Faculty of Medicine, Herston, Queensland, Australia
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20
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Peyton C, Sukal Moulton T, Carroll AJ, Anderson E, Brozek A, Davis MM, Horowitz J, Jayaraman A, O'Brien M, Patrick C, Pouppirt N, Villamar J, Xu S, Lieber RL, Wakschlag LS, Krogh-Jespersen S. Starting at Birth: An Integrative, State-of-the-Science Framework for Optimizing Infant Neuromotor Health. Front Pediatr 2021; 9:787196. [PMID: 35141178 PMCID: PMC8820372 DOI: 10.3389/fped.2021.787196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 12/17/2021] [Indexed: 11/18/2022] Open
Abstract
Numerous conditions and circumstances place infants at risk for poor neuromotor health, yet many are unable to receive treatment until a definitive diagnosis is made, sometimes several years later. In this integrative perspective, we describe an extensive team science effort to develop a transdiagnostic approach to neuromotor health interventions designed to leverage the heightened neuroplasticity of the first year of life. We undertook the following processes: (1) conducted a review of the literature to extract common principles and strategies underlying effective neuromotor health interventions; (2) hosted a series of expert scientific exchange panels to discuss common principles, as well as practical considerations and/or lessons learned from application in the field; and (3) gathered feedback and input from diverse stakeholders including infant caregivers and healthcare providers. The resultant framework was a pragmatic, evidence-based, transdiagnostic approach to optimize neuromotor health for high-risk infants based on four principles: (a) active learning, (b) environmental enrichment, (c) caregiver engagement, and (d) strength-based approaches. In this perspective paper, we delineate these principles and their potential applications. Innovations include: engagement of multiple caregivers as critical drivers of the intervention; promoting neuromotor health in the vulnerability phase, rather than waiting to treat neuromotor disease; integrating best practices from adjacent fields; and employing a strengths-based approach. This framework holds promise for implementation as it is scalable, pragmatic, and holistically addresses both the needs of the infant and their family.
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Affiliation(s)
- Colleen Peyton
- Department of Physical Therapy and Human Movement Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, United States.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Theresa Sukal Moulton
- Department of Physical Therapy and Human Movement Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, United States.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Allison J Carroll
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, United States.,Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Erica Anderson
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, United States
| | - Alexandra Brozek
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, United States.,Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Matthew M Davis
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, United States.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Ann and Robert H. Lurie Children's Hospital, Stanley Manne Children's Research Institute, Chicago, IL, United States
| | - Jessica Horowitz
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, United States.,Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | | | | | - Cheryl Patrick
- Division of Rehabilitative Services, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Nicole Pouppirt
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, United States.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Juan Villamar
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, United States.,Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Shuai Xu
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Richard L Lieber
- Shirley Ryan AbilityLab, Chicago, IL, United States.,Department of Physiology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Lauren S Wakschlag
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, United States.,Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Sheila Krogh-Jespersen
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, United States.,Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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21
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Finlayson F, Olsen J, Dusing SC, Guzzetta A, Eeles A, Spittle A. Supporting Play, Exploration, and Early Development Intervention (SPEEDI) for preterm infants: A feasibility randomised controlled trial in an Australian context. Early Hum Dev 2020; 151:105172. [PMID: 33137579 DOI: 10.1016/j.earlhumdev.2020.105172] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 08/23/2020] [Accepted: 08/30/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND An early intervention that enhances early development in infants born preterm, called 'Supporting Play, Exploration and Early Development Intervention' (SPEEDI) has been shown to be feasible in Virginia, United States, in a pilot study. Infants receive 10 therapy sessions until 3 months' corrected age (CA) (Phase 1[5 hospital sessions] and Phase 2[5 home-based sessions]) in addition to usual care. AIMS To determine the feasibility of SPEEDI for very preterm infants in an Australian context. STUDY DESIGN Prospective pilot feasibility randomised controlled trial. SUBJECTS Infants born <30 weeks' gestation (GA), recruited between 34 and 38+6 weeks' postmenstrual age. OUTCOME MEASURES Primary outcome was feasibility of SPEEDI, including recruitment rate, participant retention, sessions delivered, and therapy fidelity. Secondary outcome measures were developmental outcomes, including the Bayley Scales of Infant and Toddler Development - 3rd Edition (BSID-III) at 4 months' CA. RESULTS Of 19 eligible infants, 17 consented, SPEEDI n = 8 and usual care n = 9 (mean GA = 26.7 weeks [SD 1.4], male n = 10). All participants completed the study, with 80% of SPEEDI therapy sessions completed (90% Phase 1; 72% Phase 2). On average, therapists and parents used 78% and 77% of SPEEDI strategies in each session respectively. Infants in the SPEEDI group had higher scores on the BSID-III for gross motor, and expressive and receptive language subscales at 4 months' CA. CONCLUSIONS SPEEDI is a feasible intervention to deliver, and preliminary results suggest that SPEEDI may lead to improved motor and language outcomes at 4 months' CA, with results supporting future larger clinical trials.
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Affiliation(s)
- Francyne Finlayson
- The University of Melbourne, 161 Barry St, Carlton, Victoria 3053, Australia; The Royal Women's Hospital, 20 Flemington Rd, Parkville, Victoria 3052, Australia.
| | - Joy Olsen
- Murdoch Children's Research Institute, 50 Flemington Rd, Parkville, Victoria 3052, Australia; The Royal Women's Hospital, 20 Flemington Rd, Parkville, Victoria 3052, Australia
| | - Stacey C Dusing
- University of Southern California, 1540 Alcazar St #155, Los Angeles, California 90033, USA
| | - Andrea Guzzetta
- IRCCS Fondazione Stella Maris, Viale del Tirreno, 331, 56128 Calambrone, Pisa, Italy
| | - Abbey Eeles
- The University of Melbourne, 161 Barry St, Carlton, Victoria 3053, Australia; Murdoch Children's Research Institute, 50 Flemington Rd, Parkville, Victoria 3052, Australia; The Royal Women's Hospital, 20 Flemington Rd, Parkville, Victoria 3052, Australia
| | - Alicia Spittle
- The University of Melbourne, 161 Barry St, Carlton, Victoria 3053, Australia; The Royal Women's Hospital, 20 Flemington Rd, Parkville, Victoria 3052, Australia
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22
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Löwing K, Holmström L, Almeida R, Eliasson AC. Do Infants at Risk of Developing Cerebral Palsy or Other Neurodevelopmental Disorders Learn What They Practice? J Clin Med 2020; 9:jcm9072041. [PMID: 32610634 PMCID: PMC7409007 DOI: 10.3390/jcm9072041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 06/24/2020] [Accepted: 06/26/2020] [Indexed: 12/04/2022] Open
Abstract
Through secondary analyses of the Small Step. Randomized Control Trial, we tested the hypothesis that children at risk of developing cerebral palsy (CP) or other neurodevelopmental disorders would learn what they practice, i.e., that they would have a more rapid development within the specifically trained foci (hand use or mobility) of each time period compared to the development rate within the foci not trained at that time. Nineteen infants (6.3 (1.62) months corrected age) included in the Small Step program were assessed at six time points during the intervention. For statistical analysis, general and mixed linear models were used, and the independent variables were the Peabody Developmental Motor scale (stationary, locomotion, grasping and visuomotor sub scales), the Gross Motor Function Measure-66 and the Hand Assessment for Infants. Outcomes related to gross motor function improved significantly more after mobility training than after hand use training, while fine motor function was improved to the same extent following both training types. Significantly higher improvements after the first training period were seen in one out of three outcome measures in both gross and fine motor assessments. The improvements observed were all independent of diagnosis at two years. The concept “you learn what you practice” was most clearly confirmed in the case of gross motor development.
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Affiliation(s)
- Kristina Löwing
- Neuropediatric Unit, Department of Women’s and Children’s Health, Karolinska Institutet, SE-171 76 Stockholm, Sweden; (K.L.); (L.H.)
| | - Linda Holmström
- Neuropediatric Unit, Department of Women’s and Children’s Health, Karolinska Institutet, SE-171 76 Stockholm, Sweden; (K.L.); (L.H.)
| | - Rita Almeida
- Stockholm University Brain Imaging Center (SUBIC), Stockholm University, SE-106 91 Stockholm, Sweden;
| | - Ann-Christin Eliasson
- Neuropediatric Unit, Department of Women’s and Children’s Health, Karolinska Institutet, SE-171 76 Stockholm, Sweden; (K.L.); (L.H.)
- Correspondence: ; Tel.: +46702538648
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23
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Hollis A, Zewdie E, Nettel-Aguirre A, Hilderley A, Kuo HC, Carlson HL, Kirton A. Transcranial Static Magnetic Field Stimulation of the Motor Cortex in Children. Front Neurosci 2020; 14:464. [PMID: 32508570 PMCID: PMC7248312 DOI: 10.3389/fnins.2020.00464] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 04/15/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Non-invasive neuromodulation is an emerging therapy for children with early brain injury but is difficult to apply to preschoolers when windows of developmental plasticity are optimal. Transcranial static magnetic field stimulation (tSMS) decreases primary motor cortex (M1) excitability in adults but effects on the developing brain are unstudied. OBJECTIVE/HYPOTHESIS We aimed to determine the effects of tSMS on cortical excitability and motor learning in healthy children. We hypothesized that tSMS over right M1 would reduce cortical excitability and inhibit contralateral motor learning. METHODS This randomized, sham-controlled, double-blinded, three-arm, cross-over trial enrolled 24 healthy children aged 10-18 years. Transcranial Magnetic Stimulation (TMS) assessed cortical excitability via motor-evoked potential (MEP) amplitude and paired pulse measures. Motor learning was assessed via the Purdue Pegboard Test (PPT). A tSMS magnet (677 Newtons) or sham was held over left or right M1 for 30 min while participants trained the non-dominant hand. A linear mixed effect model was used to examine intervention effects. RESULTS All 72 tSMS sessions were well tolerated without serious adverse effects. Neither cortical excitability as measured by MEPs nor paired-pulse intracortical neurophysiology was altered by tSMS. Possible behavioral effects included contralateral tSMS inhibiting early motor learning (p < 0.01) and ipsilateral tSMS facilitating later stages of motor learning (p < 0.01) in the trained non-dominant hand. CONCLUSION tSMS is feasible in pediatric populations. Unlike adults, tSMS did not produce measurable changes in MEP amplitude. Possible effects of M1 tSMS on motor learning require further study. Our findings support further exploration of tSMS neuromodulation in young children with cerebral palsy.
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Affiliation(s)
- Asha Hollis
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Ephrem Zewdie
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Alberto Nettel-Aguirre
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Alicia Hilderley
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Hsing-Ching Kuo
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Helen L. Carlson
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Adam Kirton
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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24
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Jackman M, Lannin N, Galea C, Sakzewski L, Miller L, Novak I. What is the threshold dose of upper limb training for children with cerebral palsy to improve function? A systematic review. Aust Occup Ther J 2020; 67:269-280. [DOI: 10.1111/1440-1630.12666] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 03/26/2020] [Accepted: 04/01/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Michelle Jackman
- Paediatric Occupational Therapy Department John Hunter Children’s Hospital Newcastle NSW Australia
| | - Natasha Lannin
- Occupational Therapy Department La Trobe University (School of Allied Health)The Alfred Prahran Vic Australia
| | - Claire Galea
- Cerebral Palsy Alliance Research Institute, Child and Adolescent HealthThe University of Sydney Frenchs Forest NSW Australia
| | - Leanne Sakzewski
- Centre for Children’s Health ResearchQueensland Cerebral Palsy and Rehabilitation Research CentreThe University of Queensland South Brisbane Qld Australia
| | - Laura Miller
- Australian Catholic University Banyo Qld Australia
| | - Iona Novak
- Cerebral Palsy Alliance Research Institute, Child and Adolescent HealthThe University of Sydney Frenchs Forest NSW Australia
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25
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Wolter S, Haberl H, Spies C, Sargut TA, Martin JH, Tafelski S, van Riesen A, Küchler I, Wegner B, Scholtz K, Thomale UW, Michael T, Murphy JF, Schulz M. Frequency distribution in intraoperative stimulation-evoked EMG responses during selective dorsal rhizotomy in children with cerebral palsy-part 2: gender differences and left-biased asymmetry. Childs Nerv Syst 2020; 36:1955-1965. [PMID: 32588175 PMCID: PMC7434795 DOI: 10.1007/s00381-020-04735-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 06/08/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Spinal reflexes reorganize in cerebral palsy (CP), producing hyperreflexia and spasticity. CP is more common among male infants, and gender might also influence brain and spinal-cord reorganization. This retrospective study investigated the frequency of higher-graded EMG responses elicited by electrical nerve-root stimulation during selective dorsal rhizotomy (SDR), prior to partial nerve- root deafferentation, considering not only segmental level and body side, but also gender. METHODS Intraoperative neuromonitoring (IOM) was used in SDR to pinpoint the rootlets most responsible for exacerbated stimulation-evoked EMG patterns recorded from lower-limb muscle groups. Responses were graded according to an objective response-classification system, ranging from no abnormalities (grade 0) to highly abnormal (grade 4+), based on ipsilateral spread and contralateral involvement. Non-parametric analysis of data with repeated measures was primarily used in investigating the frequency distribution of these various EMG response grades. Over 7000 rootlets were stimulated, and the results for 65 girls and 81 boys were evaluated, taking changes in the composition of patient groups into account when considering GMFCS levels. RESULTS The distribution of graded EMG responses varied according to gender, laterality, and level. Higher-graded EMG responses were markedly more frequent in the boys and at lower segmental levels (L5, S1). Left-biased asymmetry in higher-graded rootlets was also more noticeable in the boys and in patients with GMFCS level I. A close link was observed between higher-grade assessments and left-biased asymmetry. CONCLUSIONS Detailed insight into the patient's initial spinal-neurofunctional state prior to deafferentation suggests that differences in asymmetrical spinal reorganization might be attributable to a hemispheric imbalance.
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Affiliation(s)
- Simone Wolter
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Hannes Haberl
- Division of Pediatric Neurosurgery, Universitätsklinikum Bonn, 53127, Bonn, Germany
| | - Claudia Spies
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - T Alp Sargut
- Division of Pediatric Neurosurgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353, Berlin, Germany
| | - John H Martin
- Department of Molecular, Cellular, and Basic Medical Sciences, Center for Discovery and Innovation, City University of New York School of Medicine, New York, NY, USA
- Neuroscience Program, Graduate Center of the City University of New York, New York, NY, USA
| | - Sascha Tafelski
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Anne van Riesen
- Center for Chronically Sick Children (SPZ), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353, Berlin, Germany
| | - Ingeborg Küchler
- Institute of Medical Biometry, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117, Berlin, Germany
| | - Brigitte Wegner
- Institute of Medical Biometry, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117, Berlin, Germany
| | - Kathrin Scholtz
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Ulrich-W Thomale
- Division of Pediatric Neurosurgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353, Berlin, Germany
| | - Theodor Michael
- Division of Pediatric Neurosurgery, Universitätsklinikum Bonn, 53127, Bonn, Germany
| | - James F Murphy
- Dahlem Research School, Freie Universität Berlin, 14195, Berlin, Germany
| | - Matthias Schulz
- Division of Pediatric Neurosurgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353, Berlin, Germany
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26
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Boychuck Z, Andersen J, Fehlings D, Kirton A, Oskoui M, Shevell M, Majnemer A, Burko B, Dagenais E, Dagenais L, Darsaklis VB, Leduc D, Li P, Shiller M, Snider L, Thibault J, Ahmed S, Bussières A, Rodriguez R, Shikako Thomas K. Current Referral Practices for Diagnosis and Intervention for Children with Cerebral Palsy: A National Environmental Scan. J Pediatr 2020; 216:173-180.e1. [PMID: 31843111 DOI: 10.1016/j.jpeds.2019.09.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 08/20/2019] [Accepted: 09/13/2019] [Indexed: 01/29/2023]
Abstract
OBJECTIVES To describe current physician referral practices with respect to age at referral to medical specialists for initial diagnosis of cerebral palsy (CP) and rehabilitation specialists for intervention and to identify factors associated with delayed referral. STUDY DESIGN National environmental scan of 455 children diagnosed with CP who were born in Canada between 2008 and 2011, selected from 4 sites within the Canadian CP Registry (Edmonton, Calgary, Toronto, and Montreal). Two sources of information were used-children's medical charts and the population-based registry, which provided corresponding data for each child. Primary outcomes extracted from the charts were age at referral for diagnostic assessment, age at diagnosis, age at referral for rehabilitation services, and age at initial rehabilitation intervention. Twelve variables were explored as potential predictors. Descriptive statistics, bivariate analyses, and multiple linear regressions were conducted. RESULTS Median age (in months) at referral for diagnostic assessment was 8 (mean: 12.7 ± 14.3), diagnosis 16 (mean: 18.9 ± 12.8), referral for rehabilitation services 10 (mean: 13.4 ± 13.5), and rehabilitation initiation 12 (mean: 15.9 ± 12.9). Lower maternal education, mild severity of motor dysfunction, type of CP, early discharge after birth, and region of residence explained between 20% and 32% of the variance in age at referral for assessment, diagnosis, referral for rehabilitation, and rehabilitation initiation. CONCLUSIONS Findings suggest wide variability exists in the age at which young children with CP are referred to specialists for diagnosis and intervention. User-friendly tools are therefore needed to enhance early detection and referral strategies by primary care practitioners, to ensure early interventions to optimize developmental outcomes and enhance opportunities for neural repair at a younger age.
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Affiliation(s)
- Zachary Boychuck
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada; Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Quebec, Canada; Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - John Andersen
- Glenrose Rehabilitation Hospital, Edmonton, Alberta, Canada; Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Darcy Fehlings
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada; Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Adam Kirton
- Department of Pediatrics and Clinical Neurosciences, University of Calgary, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Maryam Oskoui
- Division of Child Neurology, Department of Pediatrics, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - Michael Shevell
- Division of Child Neurology, Department of Pediatrics, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - Annette Majnemer
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada; Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Quebec, Canada; Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.
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Riddell M, Kuo HC, Zewdie E, Kirton A. Mirror movements in children with unilateral cerebral palsy due to perinatal stroke: clinical correlates of plasticity reorganization. Dev Med Child Neurol 2019; 61:943-949. [PMID: 30690708 DOI: 10.1111/dmcn.14155] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/27/2018] [Indexed: 11/29/2022]
Abstract
AIM We aimed to determine if the mirror movements that often result in children with unilateral cerebral palsy (CP) after perinatal stroke represent a clinical biomarker of developmental plasticity. METHOD This was a prospective, controlled cohort study. Mirror movements in children with unilateral CP from a population-based cohort were compared to those of typically developing controls. The population with stroke was assessed further via electromyography (EMG), motor function, and corticospinal organization investigations. Mirror movements were quantified (0-5) bidirectionally. EMG mirror movements were quantified during voluntary contraction. Motor function was quantified by validated measures including the Assisting Hand Assessment (AHA). Corticospinal organization was categorized as ipsilateral or contralateral using transcranial magnetic stimulation (TMS). The relationships between mirror movements, function, and corticospinal organization were assessed (t-tests, Pearson rank correlation coefficients). RESULTS Ninety-two participants were scored (55 males, 37 females, mean [SD] 12y [5y 6mo], range 4-17y), 63 with complete motor outcomes and 39 with TMS data. EMG ratios correlated with clinical mirror movements (r=0.562, p=0.008). Mild mirror activity in controls declined with age (r=-0.459, p<0.001). Mirroring was stronger with tasks performed by the affected hand (p<0.001). Mirror movements correlated with AHA scores (r=-0.255, p=0.04) and poor motor outcome (p<0.001). Unaffected hand mirror activity was higher in children with ipsilateral corticospinal tract arrangements (p<0.001). INTERPRETATION Clinical mirror movements correlate with disability and corticospinal organization in children with unilateral CP with perinatal stroke. This simple bedside biomarker could facilitate patient selection for personalized rehabilitation. WHAT THIS PAPER ADDS Mirror movements are a clinical indicator of corticospinal organization in children with unilateral cerebral palsy with perinatal stroke. Mirroring is strongest in children with ipsilateral corticospinal tract reorganization. The concept of a 'directionality factor' to mirror movements highlights additional, clinically relevant functional correlations.
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Affiliation(s)
- Madison Riddell
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Hsing-Ching Kuo
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, Calgary, Alberta, Canada
| | - Ephrem Zewdie
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, Alberta, Canada.,Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Adam Kirton
- Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, Calgary, Alberta, Canada.,Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Ryll UC, Wagenaar N, Verhage CH, Blennow M, de Vries LS, Eliasson AC. Early prediction of unilateral cerebral palsy in infants with asymmetric perinatal brain injury - Model development and internal validation. Eur J Paediatr Neurol 2019; 23:621-628. [PMID: 31078397 DOI: 10.1016/j.ejpn.2019.04.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 03/20/2019] [Accepted: 04/19/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Early diagnosis of unilateral cerebral palsy is important after asymmetric perinatal brain injury (APBI). Our objective is to estimate the risk of unilateral cerebral palsy (UCP) in infants with APBI during the first months of life using neuroimaging and clinical assessment. PATIENTS AND METHODS Prognostic multivariable prediction modeling study including 52 infants (27 males), median gestational age 39.3 weeks with APBI from Sweden (n = 33) and the Netherlands (n = 19). INCLUSION CRITERIA (1) neonatal MRI within one month after term equivalent age (TEA), (2) Hand Assessment for Infants (HAI) between 3.5 and 4.5 months of (corrected) age. UCP was diagnosed ≥24 months of age. Firth regression with cross-validation was used to construct and internally validate the model to estimate the risk for UCP based on the predictors corticospinal tract (CST) and basal ganglia/thalamus (BGT) involvement, contralesional HAI Each hand sum score (EaHS), gestational age and sex. RESULTS UCP was diagnosed in 18 infants (35%). Infants who developed UCP more often had involvement of the CST and BGT on neonatal MRI and had lower contralesional HAI EaHS compared to those who did not develop UCP. The final model showed excellent accuracy for UCP prediction between 3.5 and 4.5 months (area under the curve, AUC = 0.980; 95% CI 0.95-1.00). CONCLUSIONS Combining neonatal MRI, the HAI, gestational age and sex accurately identify the prognostic risk of UCP at 3.5-4.5 months in infants with APBI.
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Affiliation(s)
- Ulrike C Ryll
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
| | - Nienke Wagenaar
- University Medical Center Utrecht, Department of Neonatology, Utrecht, the Netherlands
| | - Cornelia H Verhage
- University Medical Center Utrecht, Child Development and Exercise Center, Utrecht, the Netherlands
| | - Mats Blennow
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Linda S de Vries
- University Medical Center Utrecht, Department of Neonatology, Utrecht, the Netherlands
| | - Ann-Christin Eliasson
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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Zhang W, Yang B, Weng H, Liu T, Shi L, Yu P, So KF, Qu Y, Zhou L. Wheel Running Improves Motor Function and Spinal Cord Plasticity in Mice With Genetic Absence of the Corticospinal Tract. Front Cell Neurosci 2019; 13:106. [PMID: 30941019 PMCID: PMC6433830 DOI: 10.3389/fncel.2019.00106] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 03/04/2019] [Indexed: 12/13/2022] Open
Abstract
Our previous studies showed that mutant mice with congenital absence of the corticospinal tract (CST) undergo spontaneous remodeling of motor networks to partially compensate for absent CST function. Here, we asked whether voluntary wheel running could further improve locomotor plasticity in CST-deficient mice. Adult mutant mice were randomly allocated to a “runners” group with free access to a wheel, or a “non-runners” group with no access to a wheel. In comparison with non-runners, there was a significant motor improvement including fine movement, grip strength, decreased footslip errors in runners after 8-week training, which was supported by the elevated amplitude of electromyography recording and increased neuromuscular junctions in the biceps. In runners, terminal ramifications of monoaminergic and rubrospinal descending axons were significantly increased in spinal segments after 12 weeks of exercise compared to non-runners. 5-ethynyl-2′-deoxyuridine (EDU) labeling showed that proliferating cells, 90% of which were Olig2-positive oligodendrocyte progenitors, were 4.8-fold more abundant in runners than in non-runners. In 8-week runners, RNAseq analysis of spinal samples identified 404 genes up-regulated and 398 genes down-regulated, and 69 differently expressed genes involved in signal transduction, among which the NF-κB, PI3K-Akt and cyclic AMP (cAMP) signaling were three top pathways. Twelve-week training induced a significant elevation of postsynaptic density protein 95 (PSD95), synaptophysin 38 and myelin basic protein (MBP), but not of brain derived neurotrophic factor (BDNF), glial cell line-derived neurotrophic factor (GDNF) and insulin like growth factor-1 (IGF-1). Thus, locomotor training activates multiple signaling pathways, contributes to neural plasticity and functional improvement, and might palliate locomotor deficits in patients.
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Affiliation(s)
- Wei Zhang
- Guangdong-Hongkong-Macau Institute of CNS Regeneration, Ministry of Education CNS Regeneration Collaborative Joint Laboratory, Jinan University, Guangzhou, China
| | - Bin Yang
- Guangdong-Hongkong-Macau Institute of CNS Regeneration, Ministry of Education CNS Regeneration Collaborative Joint Laboratory, Jinan University, Guangzhou, China
| | - Huandi Weng
- Guangdong-Hongkong-Macau Institute of CNS Regeneration, Ministry of Education CNS Regeneration Collaborative Joint Laboratory, Jinan University, Guangzhou, China
| | - Tao Liu
- Guangdong-Hongkong-Macau Institute of CNS Regeneration, Ministry of Education CNS Regeneration Collaborative Joint Laboratory, Jinan University, Guangzhou, China
| | - Lingling Shi
- Guangdong-Hongkong-Macau Institute of CNS Regeneration, Ministry of Education CNS Regeneration Collaborative Joint Laboratory, Jinan University, Guangzhou, China
| | - Panpan Yu
- Guangdong-Hongkong-Macau Institute of CNS Regeneration, Ministry of Education CNS Regeneration Collaborative Joint Laboratory, Jinan University, Guangzhou, China
| | - Kwok-Fai So
- Guangdong-Hongkong-Macau Institute of CNS Regeneration, Ministry of Education CNS Regeneration Collaborative Joint Laboratory, Jinan University, Guangzhou, China
| | - Yibo Qu
- Guangdong-Hongkong-Macau Institute of CNS Regeneration, Ministry of Education CNS Regeneration Collaborative Joint Laboratory, Jinan University, Guangzhou, China
| | - Libing Zhou
- Guangdong-Hongkong-Macau Institute of CNS Regeneration, Ministry of Education CNS Regeneration Collaborative Joint Laboratory, Jinan University, Guangzhou, China.,Co-innovation Center of Neuroregeneration, Nantong University, Jiangsu, China.,Key Laboratory of Neuroscience, School of Basic Medical Sciences, Institute of Neuroscience, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
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Hansen SL, Lorentzen J, Pedersen LT, Hendrich FL, Jorsal M, Pingel J, Nielsen JB, Kiens B. Suboptimal Nutrition and Low Physical Activity Are Observed Together with Reduced Plasma Brain-Derived Neurotrophic Factor (BDNF) Concentration in Children with Severe Cerebral Palsy (CP). Nutrients 2019; 11:E620. [PMID: 30875771 PMCID: PMC6470501 DOI: 10.3390/nu11030620] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 02/28/2019] [Accepted: 03/08/2019] [Indexed: 01/08/2023] Open
Abstract
Brain-derived neurotrophic factor (BDNF) is a mediator of exercise and nutrition-induced neural plasticity. In children with cerebral palsy (CP), neuromuscular deficits and mobility impairment have a negative impact on their physical activity level and nutritional status, but whether these children have reduced BDNF concentrations is unknown. Therefore, the aim of the present study was to investigate the plasma BDNF concentration, nutritional status, and physical activity level in children with mild to severe CP. Blood sampling, dietary registration, and questionnaires were completed for children with mild CP (gross motor function classification system (GMFCS) I⁻II, n = 31, age 10.6 ± 0.6 years), severe CP (GMFCS IV⁻V, n = 14, age 10.9 ± 1.1 years) and typically developed (TD) children (n = 22, age 10.9 ± 0.6 years). Children with severe CP had ~40% lower plasma BDNF concentration than TD children (p < 0.05). Furthermore, children with severe CP had lower daily physical activity level than TD children (p < 0.01), and a daily intake of energy, n-3 fatty acids, and dietary fibers that was only ~50% of TD (p > 0.001). Reduced plasma BDNF concentrations were observed in children with severe CP. This may be of significance for optimal neural growth and plasticity. This was observed together with low physical activity levels and a suboptimal intake of energy, n-3 fatty acids, and dietary fibers.
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Affiliation(s)
- Solvejg L Hansen
- Molecular Physiology Section, Department of Nutrition, Exercise and Sports, University of Copenhagen, 2100 Copenhagen Ø, Denmark.
- Department of Neuroscience, University of Copenhagen, 2200 Copenhagen N, Denmark.
| | - Jakob Lorentzen
- Department of Neuroscience, University of Copenhagen, 2200 Copenhagen N, Denmark.
- Elsass Institute, 2920 Charlottenlund, Denmark.
| | - Lin T Pedersen
- Molecular Physiology Section, Department of Nutrition, Exercise and Sports, University of Copenhagen, 2100 Copenhagen Ø, Denmark.
| | - Frederikke L Hendrich
- Molecular Physiology Section, Department of Nutrition, Exercise and Sports, University of Copenhagen, 2100 Copenhagen Ø, Denmark.
| | - Martin Jorsal
- Geelsgårdskolen, Region Hovedstaden, 2830 Virum, Denmark.
| | - Jessica Pingel
- Department of Neuroscience, University of Copenhagen, 2200 Copenhagen N, Denmark.
| | - Jens B Nielsen
- Department of Neuroscience, University of Copenhagen, 2200 Copenhagen N, Denmark.
- Elsass Institute, 2920 Charlottenlund, Denmark.
| | - Bente Kiens
- Molecular Physiology Section, Department of Nutrition, Exercise and Sports, University of Copenhagen, 2100 Copenhagen Ø, Denmark.
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Sensory-motor network functional connectivity in children with unilateral cerebral palsy secondary to perinatal stroke. NEUROIMAGE-CLINICAL 2019; 21:101670. [PMID: 30642756 PMCID: PMC6412078 DOI: 10.1016/j.nicl.2019.101670] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 12/23/2018] [Accepted: 01/07/2019] [Indexed: 11/24/2022]
Abstract
Background Perinatal stroke is the most common cause of unilateral cerebral palsy. Mechanisms of post-stroke developmental plasticity in children are poorly understood. To better understand the relationship between functional connectivity and disability, we used resting-state fMRI to compare sensorimotor connectivity with clinical dysfunction. Methods School-aged children with periventricular venous infarction (PVI) and unilateral cerebral palsy were compared to controls. Resting-state BOLD signal was acquired on 3 T MRI and analyzed using CONN in SPM12. Functional connectivity was computed between S1, M1, supplementary motor area (SMA), and thalamus of the left/non-lesioned and right/lesioned hemisphere. Primary outcome was connectivity expressed as a Fisher-transformed correlation coefficient. Motor function was measured using the Assisting Hand Assessment (AHA), and Melbourne Assessment (MA). Proprioceptive function was measured using a robotic position matching task (VarXY). Results Participants included 15 PVI and 21 controls. AHA and MA in stroke patients were negatively correlated with connectivity (increased connectivity = poorer performance). Position sense was inversely correlated with connectivity (increased connectivity = improved performance) between the non-lesioned S1 and thalamus/SMA. In controls, VarXY was positively correlated with connectivity between the thalamus and bilateral sensorimotor regions. Conclusions Resting state fMRI measures of sensorimotor connectivity are associated with clinical sensorimotor function in children with unilateral cerebral palsy secondary to PVI. Greater insight into understanding reorganization of brain networks following perinatal stroke may facilitate personalized rehabilitation. Sensorimotor resting-state networks can be measured in children with PVI. Thalamic connectivity appears to be altered by PVI. Resting state connectivity is associated with motor performance in PVI.
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Marcroft C, Tsutsumi A, Pearse J, Dulson P, Embleton ND, Basu AP. Current Therapeutic Management of Perinatal Stroke with a Focus on the Upper Limb: A Cross-Sectional Survey of UK Physiotherapists and Occupational Therapists. Phys Occup Ther Pediatr 2019; 39:151-167. [PMID: 30211625 DOI: 10.1080/01942638.2018.1503212] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
AIM To determine current UK pediatric physiotherapist (PT) and occupational therapist (OT) management of perinatal stroke. DESIGN Web-based cross-sectional survey. METHODS Participants were members of the Association of Paediatric Chartered Physiotherapists and Occupational Therapists specialist section: children young people and families working with infants. Items covered prioritization of referrals, assessments, therapy approaches aimed at the upper limb, and parental support. RESULTS 179 therapists responded. 87.2% of PTs and 63.0% of OTs managed infants with perinatal stroke. Infants with clinical signs of motor dysfunction at referral were prioritized for early initial assessment. The most frequently used assessments were the Alberta Infant Motor Scale (AIMS) and Bayley Scales of Infant Development (BSID). Of PTs and OTs, 41.9 and 40.0% used no standardized assessments. Frequently used therapy interventions were Bobath/Neurodevelopmental Therapy (NDT), positioning aids and passive movements. 88.1% of therapists would choose a bilateral rather than unilateral (affected side) therapy approach for infants with perinatal stroke aged up to 6 months. Of PTs and OTs, 56.9 and 57.1% provided psychological support to families. CONCLUSIONS Assessment and provision of therapy services following perinatal stroke is variable. Increased use of standardized assessments and centralized data collection regarding service provision for high-risk infants is recommended.
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Affiliation(s)
- Claire Marcroft
- a Newcastle upon Tyne Hospitals NHS Foundation Trust , Newcastle Neonatal Service , Newcastle upon Tyne , UK
| | | | - Janice Pearse
- c Newcastle upon Tyne Hospitals NHS Foundation Trust , Paediatric Occupational Therapy Services , Newcastle upon Tyne , UK
| | - Pat Dulson
- a Newcastle upon Tyne Hospitals NHS Foundation Trust , Newcastle Neonatal Service , Newcastle upon Tyne , UK
| | - Nicholas D Embleton
- a Newcastle upon Tyne Hospitals NHS Foundation Trust , Newcastle Neonatal Service , Newcastle upon Tyne , UK.,d Institute of Health and Society, Newcastle University , Newcastle upon Tyne , UK
| | - Anna P Basu
- e Institute of Neuroscience, Newcastle University , Newcastle upon Tyne , UK.,f Department of Paediatric Neurology , Newcastle upon Tyne Hospitals NHS Foundation Trust , Newcastle upon Tyne , UK
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Novak I, Morgan C. High-risk follow-up: Early intervention and rehabilitation. HANDBOOK OF CLINICAL NEUROLOGY 2019; 162:483-510. [PMID: 31324326 DOI: 10.1016/b978-0-444-64029-1.00023-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Early detection of childhood disability is possible using clinically available tools and procedures. Early detection of disability enables early intervention that maximizes the child's outcome, prevents the onset of complications, and supports parents. In this chapter, first we summarize the best-available tools for accurately predicting major childhood disabilities early, including autism spectrum disorder, cerebral palsy, developmental coordination disorder, fetal alcohol spectrum disorder, intellectual disability, hearing impairment, and visual impairment. Second, we provide an overview of the preclinical and clinical evidence for inducing neuroplasticity following brain injury. Third, we describe and appraise the evidence base for: (a) training-based interventions that induce neuroplasticity, (b) rehabilitation interventions not focused on inducing neuroplasticity, (c) complementary and alternative interventions, (d) environmental enrichment interventions in the neonatal intensive care and community settings, and (e) parent-child interaction interventions in the neonatal intensive care and community settings. Fourth, we explore emergent treatment options at clinical trial, designed to induce brain repair following injury. In conclusion, early diagnosis enables early intervention, which improves child and parent outcomes. We now know which interventions provide the biggest gains and the information can be used to help inform parental decision making when designing treatment plans for their children.
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Affiliation(s)
- Iona Novak
- Cerebral Palsy Alliance, Discipline of Child and Adolescent Health, University of Sydney, Sydney, NSW, Australia.
| | - Catherine Morgan
- Cerebral Palsy Alliance, Discipline of Child and Adolescent Health, University of Sydney, Sydney, NSW, Australia
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Dusing SC, Tripathi T, Marcinowski EC, Thacker LR, Brown LF, Hendricks-Muñoz KD. Supporting play exploration and early developmental intervention versus usual care to enhance development outcomes during the transition from the neonatal intensive care unit to home: a pilot randomized controlled trial. BMC Pediatr 2018; 18:46. [PMID: 29426320 PMCID: PMC5809115 DOI: 10.1186/s12887-018-1011-4] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 01/25/2018] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND While therapy services may start in the Neonatal Intensive Care Unit (NICU) there is often a gap in therapy after discharge. Supporting Play Exploration and Early Development Intervention (SPEEDI) supports parents, helping them build capacity to provide developmentally supportive opportunities starting in the NICU and continuing at home. The purpose of this single blinded randomized pilot clinical trial was to evaluate the initial efficacy of SPEEDI to improve early reaching and exploratory problem solving behaviors. METHODS Fourteen infants born very preterm or with neonatal brain injury were randomly assigned to SPEEDI or Usual Care. The SPEEDI group participated in 5 collaborative parent, therapist, and infant interventions sessions in the NICU (Phase 1) and 5 at home (Phase 2). Parents provided daily opportunities designed to support the infants emerging motor control and exploratory behaviors. Primary outcome measures were assessed at the end of the intervention, 1 and 3 months after the intervention ended. Reaching was assessed with the infant supported in an infant chair using four 30 s trials. The Early Problem Solving Indicator was used to evaluate the frequency of behaviors during standardized play based assessment. Effect sizes are including for secondary outcomes including the Test of Infant Motor Performance and Bayley Scales of Infant and Toddler Development. RESULTS No group differences were found in the duration of toy contact. There was a significant group effect on (F1,8 = 4.04, p = 0.08) early exploratory problem-solving behaviors with infants in the SPEEDI group demonstrating greater exploration with effect sizes of 1.3, 0.6, and 0.9 at the end of the intervention, 1 and 3 months post-intervention. CONCLUSIONS While further research is needed, this initial efficacy study showed promising results for the ability of SPEEDI to impact early problem solving behaviors at the end of intervention and at least 3 months after the intervention is over. While reaching did not show group differences, a ceiling effect may have contributed to this finding. This single blinded pilot RCT was registered prior to subject enrollment on 5/27/14 at ClinicalTrials.Gov with number NCT02153736.
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Affiliation(s)
- Stacey C. Dusing
- Department of Physical Therapy, Motor Development Lab, Virginia Commonwealth University, Office: 1200 E Broad St. B106, PO BOX 980224, Richmond, VA 23298 USA
| | - Tanya Tripathi
- Rehabilitation and Movement Sciences Program, Virginia Commonwealth University, Richmond, USA
| | - Emily C. Marcinowski
- Department of Physical Therapy, Motor Development Lab, Virginia Commonwealth University, Office: 1200 E Broad St. B106, PO BOX 980224, Richmond, VA 23298 USA
| | - Leroy R. Thacker
- Schools of Nursing and Medicine, Virginia Commonwealth University, Richmond, USA
| | - Lisa F. Brown
- School of Nursing, Virginia Commonwealth University, Richmond, USA
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Musselman KE, Manns P, Dawe J, Delgado R, Yang JF. The Feasibility of Functional Electrical Stimulation to Improve Upper Extremity Function in a Two-year-old Child with Perinatal Stroke: A Case Report. Phys Occup Ther Pediatr 2018; 38:97-112. [PMID: 28071962 DOI: 10.1080/01942638.2016.1255291] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AIMS To evaluate the effectiveness and feasibility (i.e. tolerability, adherence) of functional electrical stimulation (FES) for the upper extremity (UE) in a two-year-old child with perinatal stroke. METHODS Forty hours of FES over eight weeks was prescribed. FES to the hemiplegic triceps, extensor carpi radialis longus and brevis, extensor carpi ulnaris and extensor digitorum was timed with reaching during play. Assessments were performed before, during, and two months post-intervention. UE function (Melbourne Assessment 2 (MA2), Assisting Hand Assessment (AHA)) and spasticity (Modified Tardieu with electrogoniometry and electromyography) were measured. The mother completed a semi-structured interview post-intervention. Descriptive statistics were used for adherence and UE measures. A repeated-measures ANOVA compared Modified Tardieu parameters (e.g. catch angle) over time. Conventional content analysis was used for the interview data. RESULTS The child completed 39.2/40 hours. Immediately post-intervention, improvements were observed on MA2's Range of Motion subscale and catch angle (Modified Tardieu, p < 0.001). Two months post-intervention, improvements were observed on MA2's Accuracy and Fluency subscales. No change in AHA score occurred. Three themes emerged from the interview: (1) Ingredients for program success; (2) Information about the FES device; and (3) The child's response. CONCLUSIONS UE FES was feasible in a two-year-old child with hemiplegia.
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Affiliation(s)
- Kristin E Musselman
- a Toronto Rehabilitation Institute-University Health Network , Toronto , ON , Canada.,b Department of Physical Therapy , Faculty of Medicine, University of Toronto , Toronto , ON , Canada.,c School of Physical Therapy, College of Medicine, University of Saskatchewan , Saskatoon , SK , Canada.,d Rehabilitation Sciences Institute, University of Toronto , Toronto , ON , Canada
| | - Patricia Manns
- e Department of Physical Therapy , Faculty of Rehabilitation Medicine, University of Alberta , Edmonton , AB , Canada
| | - Jaclyn Dawe
- d Rehabilitation Sciences Institute, University of Toronto , Toronto , ON , Canada
| | - Rhina Delgado
- f University of Alberta Hospital , Edmonton , AB , Canada
| | - Jaynie F Yang
- e Department of Physical Therapy , Faculty of Rehabilitation Medicine, University of Alberta , Edmonton , AB , Canada.,g Neuroscience & Mental Health Institute, University of Alberta , Edmonton , AB , Canada
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Eliasson AC, Nordstrand L, Ek L, Lennartsson F, Sjöstrand L, Tedroff K, Krumlinde-Sundholm L. The effectiveness of Baby-CIMT in infants younger than 12 months with clinical signs of unilateral-cerebral palsy; an explorative study with randomized design. RESEARCH IN DEVELOPMENTAL DISABILITIES 2018; 72:191-201. [PMID: 29175749 DOI: 10.1016/j.ridd.2017.11.006] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 11/10/2017] [Accepted: 11/14/2017] [Indexed: 06/07/2023]
Abstract
AIM To explore the effectiveness of baby-CIMT (constraint-induced movement therapy) and baby-massage for improving the manual ability of infants younger than 12 months with unilateral cerebral palsy (CP). METHOD Infants eligible for inclusion were 3-8 months old with asymmetric hand function and at high risk of developing unilateral CP. Thirty-seven infants were assigned randomly to receive baby-CIMT or baby-massage. At one year of age 31 children were diagnosed with unilateral CP, 18 (8 boys, 6.1±1.7months) of these had received baby-CIMT and 13 (8 boys, 5.0±1.6months) baby-massage. There were two 6-week training periods separated by a 6-week pause. The Hand Assessment for Infants (HAI), Assisting Hand Assessment (AHA), the Parenting Sense of Competence Scale (PSCS) and a questionnaire concerning feasibility were applied. RESULTS There was improvement in the "Affected hand score" of HAI from median 10 (6;13 IQR) to 13 (7;17 IQR) raw score in the baby-CIMT group and from 5 (4;11 IQR) to 6 (3;12 IQR) for baby-massage with a significant between group difference (p=0.041). At 18-month of age, the median AHA score were 51 (38;72 IQR) after baby-CIMT (n=18) compared to 24 (19;43 IQR) baby-massage (n=9). The PSCS revealed an enhanced sense of competence of being a parent among fathers in the baby-CIMT group compared to fathers in the baby-massage (p=0.002). Parents considered both interventions to be feasible. CONCLUSION Baby-CIMT appears to improve the unimanual ability of young children with unilateral CP more than massage.
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Affiliation(s)
- Ann-Christin Eliasson
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
| | - Linda Nordstrand
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Linda Ek
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Finn Lennartsson
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden; Department of Clinical Neurosciences, Karolinska Institutet, Stockholm, Sweden
| | - Lena Sjöstrand
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Kristina Tedroff
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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Gordon AM. Impaired Voluntary Movement Control and Its Rehabilitation in Cerebral Palsy. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 957:291-311. [PMID: 28035572 DOI: 10.1007/978-3-319-47313-0_16] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
Cerebral palsy is caused by early damage to the developing brain, as the most common pediatric neurological disorder. Hemiplegia (unilateral spastic cerebral palsy) is the most common subtype, and the resulting impairments, lateralized to one body side, especially affect the upper extremity, limiting daily function. This chapter first describes the pathophysiology and mechanisms underlying impaired upper extremity control of cerebral palsy. It will be shown that the severity of impaired hand function closely relates to the integrity of the corticospinal tract innervating the affected hand. It will also shown that the developing corticospinal tract can reorganize its connectivity depending on the timing and location of CNS injury, which also has implications for the severity of hand impairments and rehabilitation. The mechanisms underlying impaired motor function will be highlighted, including deficits in movement execution and planning and sensorimotor integration. It will be shown that despite having unimanual hand impairments, bimanual movement control deficits and mirror movements also impact function. Evidence for motor learning-based therapies including Constraint-Induced Movement Therapy and Bimanual Training, and the possible pathophysiological predictors of treatment outcome and plasticity will be described. Finally, future directions for rehabilitations will be presented.
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Affiliation(s)
- Andrew M Gordon
- Department of Biobehavioral Sciences, Teachers College, Columbia University, 525 West 120th Street, New York, New York, Box 93, 10027, USA.
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38
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Boyd RN, Ziviani J, Sakzewski L, Novak I, Badawi N, Pannek K, Elliott C, Greaves S, Guzzetta A, Whittingham K, Valentine J, Morgan C, Wallen M, Eliasson AC, Findlay L, Ware R, Fiori S, Rose S. REACH: study protocol of a randomised trial of rehabilitation very early in congenital hemiplegia. BMJ Open 2017; 7:e017204. [PMID: 28928195 PMCID: PMC5623522 DOI: 10.1136/bmjopen-2017-017204] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 06/22/2017] [Accepted: 06/29/2017] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES Congenital hemiplegia is the most common form of cerebral palsy (CP). Children with unilateral CP show signs of upper limb asymmetry by 8 months corrected age (ca) but are frequently not referred to therapy until after 12 months ca. This study compares the efficacy of infant-friendly modified constraint-induced movement therapy (Baby mCIMT) to infant friendly bimanual therapy (Baby BIM) on upper limb, cognitive and neuroplasticity outcomes in a multisite randomised comparison trial. METHODS AND ANALYSIS 150 infants (75 in each group), aged between 3 and 6 months ca, with asymmetric brain injury and clinical signs of upper extremity asymmetry will be recruited. Children will be randomised centrally to receive equal doses of either Baby mCIMT or Baby BIM. Baby mCIMT comprises restraint of the unimpaired hand using a simple restraint (eg, glove, sock), combined with intensive parent implemented practice focusing on active use of the impaired hand in a play-based context. In contrast, Baby BIM promotes active play requiring both hands in a play-based context. Both interventions will be delivered by parents at home with monthly home visits and interim telecommunication support by study therapists. Assessments will be conducted at study entry; at 6, 12 months ca immediately postintervention (primary outcome) and 24 months ca (retention). The primary outcome will be the Mini-Assisting Hand Assessment. Secondary outcomes include the Bayley Scale for Infant and Toddler Development (cognitive and motor domains) and the Hand Assessment of Infants. A subset of children will undertake MRI scans at 24 months ca to evaluate brain lesion severity and brain (re)organisation after intervention. ETHICS AND DISSEMINATION Full ethical approvals for this study have been obtained from the relevant sites. The findings will be disseminated in peer-reviewed publications. TRIAL REGISTRATION NUMBER Australian and New Zealand Clinical Trials Registry: ACTRN12615000180516, Pre results.
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Affiliation(s)
- Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Centre for Children's Health Research, The University of Queensland, Brisbane, Australia
| | - Jenny Ziviani
- Children's Allied Health Research, Children's Health Queensland, Brisbane, Queensland, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Leanne Sakzewski
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Centre for Children's Health Research, The University of Queensland, Brisbane, Australia
| | - Iona Novak
- Cerebral Palsy Alliance, The University of Sydney, Sydney, Australia
| | - Nadia Badawi
- Cerebral Palsy Alliance, The University of Sydney, Sydney, Australia
| | - Kerstin Pannek
- The Australian E-Health Research Centre, Health and Biosecurity, CSIRO, Brisbane, Australia
| | - Catherine Elliott
- School of Occupational Therapy and Social Work, Curtin University, Perth, Australia
- Perth Children's Hospital, Perth, Western Australia, Australia
| | | | | | - Koa Whittingham
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Centre for Children's Health Research, The University of Queensland, Brisbane, Australia
| | - Jane Valentine
- Perth Children's Hospital, Perth, Western Australia, Australia
| | - Cathy Morgan
- Cerebral Palsy Alliance, The University of Sydney, Sydney, Australia
| | - Margaret Wallen
- Cerebral Palsy Alliance, The University of Sydney, Sydney, Australia
- School of Allied Health, Australian Catholic University, North Sydney, Australia
| | - Ann-Christin Eliasson
- Department of Women's and Children's Health, Neuropediatric Unit, Karolinska Institutet, Stockholm, Sweden
| | - Lisa Findlay
- Children's Allied Health Research, Children's Health Queensland, Brisbane, Queensland, Australia
| | - Robert Ware
- Menzies Health Institute Queensland, Griffith University Gold Coast, Nathan, Australia
| | - Simona Fiori
- IRCCS Stella Maris and The University of Pisa, Pisa, Italy
| | - Stephen Rose
- CSIRO Mathematical and Information Sciences Biomedical Imaging Group, Australian e-Health Research Centre
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Novak I, Morgan C, Adde L, Blackman J, Boyd RN, Brunstrom-Hernandez J, Cioni G, Damiano D, Darrah J, Eliasson AC, de Vries LS, Einspieler C, Fahey M, Fehlings D, Ferriero DM, Fetters L, Fiori S, Forssberg H, Gordon AM, Greaves S, Guzzetta A, Hadders-Algra M, Harbourne R, Kakooza-Mwesige A, Karlsson P, Krumlinde-Sundholm L, Latal B, Loughran-Fowlds A, Maitre N, McIntyre S, Noritz G, Pennington L, Romeo DM, Shepherd R, Spittle AJ, Thornton M, Valentine J, Walker K, White R, Badawi N. Early, Accurate Diagnosis and Early Intervention in Cerebral Palsy: Advances in Diagnosis and Treatment. JAMA Pediatr 2017; 171:897-907. [PMID: 28715518 PMCID: PMC9641643 DOI: 10.1001/jamapediatrics.2017.1689] [Citation(s) in RCA: 773] [Impact Index Per Article: 110.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Cerebral palsy describes the most common physical disability in childhood and occurs in 1 in 500 live births. Historically, the diagnosis has been made between age 12 and 24 months but now can be made before 6 months' corrected age. OBJECTIVES To systematically review best available evidence for early, accurate diagnosis of cerebral palsy and to summarize best available evidence about cerebral palsy-specific early intervention that should follow early diagnosis to optimize neuroplasticity and function. EVIDENCE REVIEW This study systematically searched the literature about early diagnosis of cerebral palsy in MEDLINE (1956-2016), EMBASE (1980-2016), CINAHL (1983-2016), and the Cochrane Library (1988-2016) and by hand searching. Search terms included cerebral palsy, diagnosis, detection, prediction, identification, predictive validity, accuracy, sensitivity, and specificity. The study included systematic reviews with or without meta-analyses, criteria of diagnostic accuracy, and evidence-based clinical guidelines. Findings are reported according to the PRISMA statement, and recommendations are reported according to the Appraisal of Guidelines, Research and Evaluation (AGREE) II instrument. FINDINGS Six systematic reviews and 2 evidence-based clinical guidelines met inclusion criteria. All included articles had high methodological Quality Assessment of Diagnostic Accuracy Studies (QUADAS) ratings. In infants, clinical signs and symptoms of cerebral palsy emerge and evolve before age 2 years; therefore, a combination of standardized tools should be used to predict risk in conjunction with clinical history. Before 5 months' corrected age, the most predictive tools for detecting risk are term-age magnetic resonance imaging (86%-89% sensitivity), the Prechtl Qualitative Assessment of General Movements (98% sensitivity), and the Hammersmith Infant Neurological Examination (90% sensitivity). After 5 months' corrected age, the most predictive tools for detecting risk are magnetic resonance imaging (86%-89% sensitivity) (where safe and feasible), the Hammersmith Infant Neurological Examination (90% sensitivity), and the Developmental Assessment of Young Children (83% C index). Topography and severity of cerebral palsy are more difficult to ascertain in infancy, and magnetic resonance imaging and the Hammersmith Infant Neurological Examination may be helpful in assisting clinical decisions. In high-income countries, 2 in 3 individuals with cerebral palsy will walk, 3 in 4 will talk, and 1 in 2 will have normal intelligence. CONCLUSIONS AND RELEVANCE Early diagnosis begins with a medical history and involves using neuroimaging, standardized neurological, and standardized motor assessments that indicate congruent abnormal findings indicative of cerebral palsy. Clinicians should understand the importance of prompt referral to diagnostic-specific early intervention to optimize infant motor and cognitive plasticity, prevent secondary complications, and enhance caregiver well-being.
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Affiliation(s)
- Iona Novak
- Cerebral Palsy Alliance, The University of Sydney, Sydney, Australia
| | - Cathy Morgan
- Cerebral Palsy Alliance, The University of Sydney, Sydney, Australia
| | - Lars Adde
- Norwegian University of Science and Technology, St Olavs University Hospital, Trondheim
| | - James Blackman
- Cerebral Palsy Alliance Research Foundation, New York, New York
| | | | | | - Giovanni Cioni
- Stella Maris Scientific Institute, University of Pisa, Pisa, Italy
| | | | - Johanna Darrah
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | | | | | | | | | - Darcy Fehlings
- Holland Bloorview Kids Rehabilitation Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Simona Fiori
- Stella Maris Scientific Institute, University of Pisa, Pisa, Italy
| | | | | | | | - Andrea Guzzetta
- Stella Maris Scientific Institute, University of Pisa, Pisa, Italy
| | - Mijna Hadders-Algra
- Department of Pediatrics, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | | | - Petra Karlsson
- Cerebral Palsy Alliance, The University of Sydney, Sydney, Australia
| | | | - Beatrice Latal
- University Children’s Hospital Zurich, Zurich, Switzerland
| | | | - Nathalie Maitre
- Nationwide Children’s Hospital, The Ohio State University, Columbus
| | - Sarah McIntyre
- Cerebral Palsy Alliance, The University of Sydney, Sydney, Australia
| | - Garey Noritz
- Nationwide Children’s Hospital, The Ohio State University, Columbus
| | | | - Domenico M. Romeo
- Pediatric Neurology Unit, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Alicia J. Spittle
- Murdoch Childrens Research Institute, University of Melbourne, Melbourne, Australia
| | - Marelle Thornton
- Cerebral Palsy Alliance, The University of Sydney, Sydney, Australia
| | - Jane Valentine
- Princess Margaret Hospital, University of Western Australia, Perth
| | - Karen Walker
- Cerebral Palsy Alliance, The University of Sydney, Sydney, Australia22Children’s Hospital Westmead, The University of Sydney, Sydney, Australia
| | - Robert White
- Cerebral Palsy Alliance, The University of Sydney, Sydney, Australia
| | - Nadia Badawi
- Cerebral Palsy Alliance, The University of Sydney, Sydney, Australia22Children’s Hospital Westmead, The University of Sydney, Sydney, Australia
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Gennaro M, Mattiello A, Mazziotti R, Antonelli C, Gherardini L, Guzzetta A, Berardi N, Cioni G, Pizzorusso T. Focal Stroke in the Developing Rat Motor Cortex Induces Age- and Experience-Dependent Maladaptive Plasticity of Corticospinal System. Front Neural Circuits 2017; 11:47. [PMID: 28706475 PMCID: PMC5489564 DOI: 10.3389/fncir.2017.00047] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 06/13/2017] [Indexed: 12/16/2022] Open
Abstract
Motor system development is characterized by an activity-dependent competition between ipsilateral and contralateral corticospinal tracts (CST). Clinical evidence suggests that age is crucial for developmental stroke outcome, with early lesions inducing a “maladaptive” strengthening of ipsilateral projections from the healthy hemisphere and worse motor impairment. Here, we investigated in developing rats the relation between lesion timing, motor outcome and CST remodeling pattern. We induced a focal ischemia into forelimb motor cortex (fM1) at two distinct pre-weaning ages: P14 and P21. We compared long-term motor outcome with changes in axonal sprouting of contralesional CST at red nucleus and spinal cord level using anterograde tracing. We found that P14 stroke caused a more severe long-term motor impairment than at P21, and induced a strong and aberrant contralesional CST sprouting onto denervated spinal cord and red nucleus. The mistargeted sprouting of CST, and the worse motor outcome of the P14 stroke rats were reversed by an early skilled motor training, underscoring the potential of early activity-dependent plasticity in modulating lesion outcome. Thus, changes in the mechanisms controlling CST plasticity occurring during the third postnatal week are associated with age-dependent regulation of the motor outcome after stroke.
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Affiliation(s)
- Mariangela Gennaro
- Department of Neuroscience, Psychology, Drug Research and Child Health NEUROFARBA, University of FlorenceFlorence, Italy.,Institute of Neuroscience, National Research Council (CNR)Pisa, Italy
| | - Alessandro Mattiello
- Department of Neuroscience, Psychology, Drug Research and Child Health NEUROFARBA, University of FlorenceFlorence, Italy.,Institute of Neuroscience, National Research Council (CNR)Pisa, Italy
| | - Raffaele Mazziotti
- Department of Neuroscience, Psychology, Drug Research and Child Health NEUROFARBA, University of FlorenceFlorence, Italy.,Institute of Neuroscience, National Research Council (CNR)Pisa, Italy
| | - Camilla Antonelli
- Department of Clinical and Experimental Medicine, University of PisaPisa, Italy.,Department of Developmental Neuroscience, IRCCS Stella Maris Scientific InstitutePisa, Italy
| | - Lisa Gherardini
- Institute of Neuroscience, National Research Council (CNR)Pisa, Italy.,Institute of Clinical Physiology, National Research Council (CNR)Siena, Italy
| | - Andrea Guzzetta
- Department of Clinical and Experimental Medicine, University of PisaPisa, Italy.,Department of Developmental Neuroscience, IRCCS Stella Maris Scientific InstitutePisa, Italy
| | - Nicoletta Berardi
- Department of Neuroscience, Psychology, Drug Research and Child Health NEUROFARBA, University of FlorenceFlorence, Italy.,Institute of Neuroscience, National Research Council (CNR)Pisa, Italy
| | - Giovanni Cioni
- Department of Clinical and Experimental Medicine, University of PisaPisa, Italy.,Department of Developmental Neuroscience, IRCCS Stella Maris Scientific InstitutePisa, Italy
| | - Tommaso Pizzorusso
- Department of Neuroscience, Psychology, Drug Research and Child Health NEUROFARBA, University of FlorenceFlorence, Italy.,Institute of Neuroscience, National Research Council (CNR)Pisa, Italy
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41
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Basu AP, Pearse JE, Baggaley J, Watson RM, Rapley T. Participatory design in the development of an early therapy intervention for perinatal stroke. BMC Pediatr 2017; 17:33. [PMID: 28114899 PMCID: PMC5259952 DOI: 10.1186/s12887-017-0797-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 01/18/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Perinatal stroke is the leading cause of unilateral (hemiparetic) cerebral palsy, with life-long personal, social and financial consequences. Translational research findings indicate that early therapy intervention has the potential for significant improvements in long-term outcome in terms of motor function. By involving families and health professionals in the development and design stage, we aimed to produce a therapy intervention which they would engage with. METHODS Nine parents of children with hemiparesis and fourteen health professionals involved in the care of infants with perinatal stroke took part in peer review and focus groups to discuss evolving therapy materials, with revisions made iteratively. The materials and approach were also discussed at a meeting of the London Child Stroke Research Reference Group. Focus group data were coded using Normalisation Process Theory constructs to explore potential barriers and facilitators to routine uptake of the intervention. RESULTS We developed the Early Therapy in Perinatal Stroke (eTIPS) program - a parent-delivered, home-based complex intervention addressing a current gap in practice for infants in the first 6 months of life after unilateral perinatal stroke and with the aim of improving motor outcome. Parents and health professionals saw the intervention as different from usual practice, and valuable (high coherence). They were keen to engage (high cognitive participation). They considered the tasks for parents to be achievable (high collective action). They demonstrated trust in the approach and felt that parents would undertake the recommended activities (high collective action). They saw the approach as flexible and adaptable (high reflexive monitoring). Following suggestions made, we added a section on involving the extended family, and obtained funding for a website and videos to supplement written materials. CONCLUSIONS Focus groups with parents and health professionals provided meaningful feedback to iteratively improve the intervention materials prior to embarking on a pilot study. The intervention has a high potential to normalize and become a routine part of parents' interactions with their child following unilateral perinatal stroke.
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Affiliation(s)
- Anna Purna Basu
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK. .,Department of Paediatric Neurology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE7 7DN, UK.
| | - Janice Elizabeth Pearse
- Therapy Services, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE7 7DN, UK
| | - Jessica Baggaley
- Medical Sciences Graduate School, Newcastle University, Newcastle upon Tyne, NE1 7RU, UK
| | - Rose Mary Watson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, NE2 4AX, UK
| | - Tim Rapley
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, NE2 4AX, UK
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42
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Eliasson AC, Holmström L, Aarne P, Nakeva von Mentzer C, Weiland AL, Sjöstrand L, Forssberg H, Tedroff K, Löwing K. Efficacy of the small step program in a randomised controlled trial for infants below age 12 months with clinical signs of CP; a study protocol. BMC Pediatr 2016; 16:175. [PMID: 27809886 PMCID: PMC5093986 DOI: 10.1186/s12887-016-0711-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 10/18/2016] [Indexed: 11/12/2022] Open
Abstract
Background Children with cerebral palsy (CP) have life-long motor disorders, and they are typically subjected to extensive treatment throughout their childhood. Despite this, there is a lack of evidence supporting the effectiveness of early interventions aiming at improving motor function, activity, and participation in daily life. The study will evaluate the effectiveness of the newly developed Small Step Program, which is introduced to children at risk of developing CP during their first year of life. The intervention is based upon theories of early learning-induced brain plasticity and comprises important components of evidence-based intervention approaches used with older children with CP. Method and design A two-group randomised control trial will be conducted. Invited infants at risk of developing CP due to a neonatal event affecting the brain will be randomised to either the Small Step Program or to usual care. They will be recruited from Astrid Lindgren Children’s Hospital at regular check-up and included at age 3–8 months. The Small Step Program was designed to provide individualized, goal directed, and intensive intervention focusing on hand use, mobility, and communication in the child’s own home environment and carried out by their parents who have been trained and coached by therapists. The primary endpoint will be approximately 35 weeks after the start of the intervention, and the secondary endpoint will be at 2 years of age. The primary outcome measure will be the Peabody Developmental Motor Scale (second edition). Secondary assessments will measure and describe the children’s general and specific development and brain pathology. In addition, the parents’ perspective of the program will be evaluated. General linear models will be used to compare outcomes between groups. Discussion This paper presents the background and rationale for developing the Small-Step Program and the design and protocol of a randomized controlled trial. The aim of the Small Step Program is to influence development by enabling children to function on a higher level than if not treated by the program and to evaluate whether the program will affect parent’s ability to cope with stress and anxiety related to having a child at risk of developing CP. Trial registration ClinicalTrials.gov Identifier NCT02166801. Registered June 12, 2014.
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Affiliation(s)
- Ann-Christin Eliasson
- Department of Women's and Children's Health, Karolinska Institutet, 171 76, Stockholm, Sweden.
| | - Linda Holmström
- Department of Women's and Children's Health, Karolinska Institutet, 171 76, Stockholm, Sweden
| | - Päivikki Aarne
- Division of Speech and Language Pathology, Department of CLINTEC, Karolinska Institutet, Stockholm, Sweden.,Department of Speech and Language Pathology, Karolinska University Hospital, Stockholm, Sweden
| | | | - Ann-Louise Weiland
- Department of Women's and Children's Health, Karolinska Institutet, 171 76, Stockholm, Sweden
| | - Lena Sjöstrand
- Department of Women's and Children's Health, Karolinska Institutet, 171 76, Stockholm, Sweden
| | - Hans Forssberg
- Department of Women's and Children's Health, Karolinska Institutet, 171 76, Stockholm, Sweden
| | - Kristina Tedroff
- Department of Women's and Children's Health, Karolinska Institutet, 171 76, Stockholm, Sweden
| | - Kristina Löwing
- Department of Women's and Children's Health, Karolinska Institutet, 171 76, Stockholm, Sweden
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Baranello G, Rossi Sebastiano D, Pagliano E, Visani E, Ciano C, Fumarola A, Arnoldi MT, Corlatti A, Foscan M, Marchi A, Erbetta A, Riva D. Hand function assessment in the first years of life in unilateral cerebral palsy: Correlation with neuroimaging and cortico-spinal reorganization. Eur J Paediatr Neurol 2016; 20:114-24. [PMID: 26439103 DOI: 10.1016/j.ejpn.2015.09.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Revised: 02/09/2015] [Accepted: 09/08/2015] [Indexed: 11/16/2022]
Abstract
AIM The purpose of the present study was to correlate early hand function assessment during the first years of life with neuroimaging findings and the different patterns of cortico-motor reorganization in children with unilateral cerebral palsy (UCP). METHODS We conducted a long prospective observational study, in which 17 children with UCP (8 left-sided hemiplegia; Manual Ability Classification System level 1-3) were first assessed at a mean age of 24 months (range 18-28), and followed up by means of the Besta Scale, a new standardized protocol assessing both unimanual and bimanual hand function. They also underwent Melbourne Assessment of Unilateral Upper Limb Function (MUUL) and single-pulse Transcranial Magnetic Stimulation (TMS) at a mean age of 10 years 5 months (range 9 y 1 m-12 y 8 m). Brain MRIs of all the 17 children were independently assessed and scored by two blinded observers, according to a defined protocol. Possible correlations between hand function at first assessment, neuroimaging and TMS data were analyzed. RESULTS Early hand function impairment significantly correlated with the extension of brain damage (ρ = -0.531, p = 0.028), number of involved areas (ρ = -0.608, p = 0.010), presence of radiological signs of cortico-spinal degeneration (ρ = -0.628, p = 0.007), and basal ganglia involvement (ρ = -0.485, p = 0.049). Additionally, higher hand function scores (i.e. better hand function) at first assessment significantly correlated with contralateral cortico-spinal projections, while lower scores significantly correlated with either mixed or ipsilateral cortico-spinal projections to the affected hand (χ(2)(2) = 11.418, p = 0.003; post-hoc tests: contralateral TMS group versus ipsilateral: Z = -2.943, p = 0.002 and contralateral TMS group versus mixed: Z = -2.775, p = 0.006). CONCLUSIONS To our knowledge, this is the first study correlating hand function assessment in the first years of life, and its evolution over time, with neuroimaging and cortico-spinal projection patterns in children with UCP. These findings could contribute to an improved prediction of prognosis and a better delineation of therapeutic interventions in young children with UCP.
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Affiliation(s)
- Giovanni Baranello
- Developmental Neurology Unit, "Carlo Besta" Neurological Institute Foundation, Via Celoria 11, 20133 Milan, Italy.
| | - Davide Rossi Sebastiano
- Department of Neurophysiology-Epilepsy Centre, "Carlo Besta" Neurological Institute Foundation, Via Celoria 11, 20133 Milan, Italy.
| | - Emanuela Pagliano
- Developmental Neurology Unit, "Carlo Besta" Neurological Institute Foundation, Via Celoria 11, 20133 Milan, Italy.
| | - Elisa Visani
- Department of Neurophysiology-Epilepsy Centre, "Carlo Besta" Neurological Institute Foundation, Via Celoria 11, 20133 Milan, Italy.
| | - Claudia Ciano
- Department of Neurophysiology-Epilepsy Centre, "Carlo Besta" Neurological Institute Foundation, Via Celoria 11, 20133 Milan, Italy.
| | - Adriana Fumarola
- Developmental Neurology Unit, "Carlo Besta" Neurological Institute Foundation, Via Celoria 11, 20133 Milan, Italy.
| | - Maria Teresa Arnoldi
- Developmental Neurology Unit, "Carlo Besta" Neurological Institute Foundation, Via Celoria 11, 20133 Milan, Italy.
| | - Alice Corlatti
- Developmental Neurology Unit, "Carlo Besta" Neurological Institute Foundation, Via Celoria 11, 20133 Milan, Italy.
| | - Maria Foscan
- Developmental Neurology Unit, "Carlo Besta" Neurological Institute Foundation, Via Celoria 11, 20133 Milan, Italy.
| | - Alessia Marchi
- Developmental Neurology Unit, "Carlo Besta" Neurological Institute Foundation, Via Celoria 11, 20133 Milan, Italy.
| | - Alessandra Erbetta
- Neuroradiology Unit, "Carlo Besta" Neurological Institute Foundation, Via Celoria 11, 20133 Milan, Italy.
| | - Daria Riva
- Developmental Neurology Unit, "Carlo Besta" Neurological Institute Foundation, Via Celoria 11, 20133 Milan, Italy.
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Choe AS, Jones CK, Joel SE, Muschelli J, Belegu V, Caffo BS, Lindquist MA, van Zijl PCM, Pekar JJ. Reproducibility and Temporal Structure in Weekly Resting-State fMRI over a Period of 3.5 Years. PLoS One 2015; 10:e0140134. [PMID: 26517540 PMCID: PMC4627782 DOI: 10.1371/journal.pone.0140134] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 09/22/2015] [Indexed: 11/18/2022] Open
Abstract
Resting-state functional MRI (rs-fMRI) permits study of the brain’s functional networks without requiring participants to perform tasks. Robust changes in such resting state networks (RSNs) have been observed in neurologic disorders, and rs-fMRI outcome measures are candidate biomarkers for monitoring clinical trials, including trials of extended therapeutic interventions for rehabilitation of patients with chronic conditions. In this study, we aim to present a unique longitudinal dataset reporting on a healthy adult subject scanned weekly over 3.5 years and identify rs-fMRI outcome measures appropriate for clinical trials. Accordingly, we assessed the reproducibility, and characterized the temporal structure of, rs-fMRI outcome measures derived using independent component analysis (ICA). Data was compared to a 21-person dataset acquired on the same scanner in order to confirm that the values of the single-subject RSN measures were within the expected range as assessed from the multi-participant dataset. Fourteen RSNs were identified, and the inter-session reproducibility of outcome measures—network spatial map, temporal signal fluctuation magnitude, and between-network connectivity (BNC)–was high, with executive RSNs showing the highest reproducibility. Analysis of the weekly outcome measures also showed that many rs-fMRI outcome measures had a significant linear trend, annual periodicity, and persistence. Such temporal structure was most prominent in spatial map similarity, and least prominent in BNC. High reproducibility supports the candidacy of rs-fMRI outcome measures as biomarkers, but the presence of significant temporal structure needs to be taken into account when such outcome measures are considered as biomarkers for rehabilitation-style therapeutic interventions in chronic conditions.
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Affiliation(s)
- Ann S. Choe
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
- F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, United States of America
- International Center for Spinal Cord Injury, Kennedy Krieger Institute, Baltimore, MD, United States of America
- * E-mail:
| | - Craig K. Jones
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
- F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, United States of America
| | - Suresh E. Joel
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
- F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, United States of America
| | - John Muschelli
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America
| | - Visar Belegu
- International Center for Spinal Cord Injury, Kennedy Krieger Institute, Baltimore, MD, United States of America
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Brian S. Caffo
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America
| | - Martin A. Lindquist
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America
| | - Peter C. M. van Zijl
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
- F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, United States of America
| | - James J. Pekar
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
- F. M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, United States of America
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Panteliadis CP, Hagel C, Karch D, Heinemann K. Cerebral Palsy: A Lifelong Challenge Asks for Early Intervention. Open Neurol J 2015; 9:45-52. [PMID: 26191093 PMCID: PMC4503828 DOI: 10.2174/1874205x01509010045] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 03/09/2015] [Accepted: 04/05/2015] [Indexed: 01/03/2023] Open
Abstract
One of the oldest and probably well-known examples of cerebral palsy is the mummy of the Pharaoh Siptah about 1196-1190 B.C., and a letter from Hippocrates (460-390 B.C.). Cerebral palsy (CP) is one of the most common congenital or acquired neurological impairments in paediatric patients, and refers to a group of children with motor disability and related functional defects. The visible core of CP is characterized by abnormal coordination of movements and/or muscle tone which manifest very early in the development. Resulting from pre- or perinatal brain damage CP is not a progressive condition per se. However, without systematic medical and physiotherapeutic support the dystonia leads to muscle contractions and to deterioration of the handicap. Here we review the three general spastic manifestations of CP hemiplegia, diplegia and tetraplegia, describe the diagnostic procedures and delineate a time schedule for an early intervention.
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Affiliation(s)
- Christos P Panteliadis
- Paediatric, Division of Paediatric Neurology and Developmental Medicine, Aristotle University of Thessaloniki, Greece
| | - Christian Hagel
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Germany
| | - Dieter Karch
- Clinic of Paediatric Neurology and Social Paediatrics, Children Centre Maulbronn, Germany
| | - Karl Heinemann
- Clinic of Paediatric Neurology and Social Paediatrics, Children Centre Maulbronn, Germany
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Nordstrand L, Holmefur M, Kits A, Eliasson AC. Improvements in bimanual hand function after baby-CIMT in two-year old children with unilateral cerebral palsy: A retrospective study. RESEARCH IN DEVELOPMENTAL DISABILITIES 2015; 41-42:86-93. [PMID: 26100242 DOI: 10.1016/j.ridd.2015.05.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 04/13/2015] [Accepted: 05/07/2015] [Indexed: 06/04/2023]
Abstract
The common assumption that early-onset intensive intervention positively affects motor development has rarely been investigated for hand function in children with unilateral cerebral palsy (CP). This retrospective study explored the possible impact of baby constraint-induced movement therapy (baby-CIMT) on hand function at two years of age. We hypothesized that baby-CIMT in the first year of life would lead to better bimanual hand use at two years of age than would not receiving baby-CIMT. The Assisting Hand Assessment (AHA) was administered at age 21 months (SD 2.4 months) in 72 children with unilateral CP, 31 of who received baby-CIMT. When dividing the children into four functional levels based on AHA, the proportional distribution differed between the groups in favour of baby-CIMT. Logistic regression analysis indicated that children in the baby-CIMT group were more likely than were children in the no baby-CIMT group to have a high functional level, even when controlling for the effect of brain lesion type (OR 5.83, 95% CI 1.44-23.56, p = 0.001). However, no difference was found between groups in the odds of having a very low functional level (OR 0.31, 95% CI 0.08-1.17, p = 0.084). The result shows that baby-CIMT at early age can have a positive effect. Children who received baby-CIMT were six times more likely to have a high functional level at two years of age than were children in the no baby-CIMT group.
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Affiliation(s)
- Linda Nordstrand
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
| | - Marie Holmefur
- School of Health and Medical Sciences, Örebro University, Sweden
| | - Annika Kits
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Ann-Christin Eliasson
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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47
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Krumlinde-Sundholm L, Ek L, Eliasson AC. What assessments evaluate use of hands in infants? A literature review. Dev Med Child Neurol 2015; 57 Suppl 2:37-41. [PMID: 25690115 DOI: 10.1111/dmcn.12684] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/05/2014] [Indexed: 01/23/2023]
Abstract
AIM To identify assessments, applicable to infants aged 3 months to 12 months, measuring hand function, and to discuss their usefulness in assessing infants at risk of developing unilateral cerebral palsy (CP). METHOD Instruments described in two previous systematic reviews were scrutinized for inclusion of fine motor components. Additionally, a new literature search was performed in Medline, PsychInfo, PubMed, and Cinahl (2007-2013) to identify newly developed assessments of infant motor functioning. RESULTS Five assessments from the two previous systematic reviews included fine motor components but only three provided separate measures of fine motor performance: the Peabody Developmental Motor Scales--version 2 (PDMS-2), the Bayley Scale of Infant and Toddler Development--version III, and the Posture and Fine Motor Assessment of Infants, each of which provided measures of the preferred hand only. From 531 papers retrieved, 10 new assessments were found, three of which met our inclusion criteria: the Infant Motor Profile (IMP), the Grasping and Reaching Assessment of Brisbane (GRAB), and the Hand Assessment for Infants (HAI). Only the GRAB and the HAI provide measures relevant for assessing infants at risk of developing unilateral cerebral palsy; however, both measures are still under construction. INTERPRETATION No currently available assessment for infants aged 3 to 12 months old measures aspects of hand function suitable for quantifying asymmetry between hands or quality of bimanual performance.
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Affiliation(s)
- Lena Krumlinde-Sundholm
- Department of Women's and Children's Health, Astrid Lindgren Children's Hospital, Karolinska Institutet, Stockholm, Sweden
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48
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Willerslev-Olsen M, Petersen TH, Farmer SF, Nielsen JB. Gait training facilitates central drive to ankle dorsiflexors in children with cerebral palsy. ACTA ACUST UNITED AC 2015; 138:589-603. [PMID: 25623137 DOI: 10.1093/brain/awu399] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Foot drop and toe walking are frequent concerns in children with cerebral palsy. The main underlying cause of these problems is early damage and lack of maturation of the corticospinal tract. In the present study we investigated whether 4 weeks of daily treadmill training with an incline may facilitate corticospinal transmission and improve the control of the ankle joint in children with cerebral palsy. Sixteen children with cerebral palsy (Gross Motor Classification System I:6, II:6, III:4) aged 5-14 years old, were recruited for the study. Evaluation of gait ability and intramuscular coherence was made twice before and twice after training with an interval of 1 month. Gait kinematics were recorded by 3D video analysis during treadmill walking with a velocity chosen by the child at the first evaluation. Foot pressure was measured by force sensitive foot soles during treadmill and over ground walking. EMG-EMG coherence was calculated from two separate electrode recordings placed over the tibialis anterior muscle. Training involved 30 min of walking daily on a treadmill with an incline for 30 days. Gait training was accompanied by significant increases in gait speed, incline on the treadmill, the maximal voluntary dorsiflexion torque, the number and amplitude of toe lifts late in the swing phase during gait and the weight exerted on the heel during the early stance phase of the gait cycle. EMG-EMG coherence in the beta and gamma frequency bands recorded from tibialis anterior muscle increased significantly when compared to coherence before training. The largest changes in coherence with training were observed for children <10 years of age. Importantly, in contrast to training-induced EMG increases, the increase in coherence was maintained at the follow-up measurement 1 month after training. Changes in the strength of coherence in the beta and gamma band were positively correlated with improvements in the subjects' ability to lift the toes in the swing phase. These data show that daily intensive gait training increases beta and gamma oscillatory drive to ankle dorsiflexor motor neurons and that it improves toe lift and heel strike in children with cerebral palsy. We propose that intensive gait training may produce plastic changes in the corticospinal tract, which are responsible for improvements in gait function.
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Affiliation(s)
- Maria Willerslev-Olsen
- 1 Department of Nutrition, Exercise and Sport & Department of Neuroscience and Pharmacology, University of Copenhagen, Copenhagen, Denmark 2 Helene Elsass Centre, Charlottenlund, Denmark
| | - Tue Hvass Petersen
- 3 Research Unit on Brain Injury Neurorehabilitation Copenhagen (RUBRIC), Department of Neurorehabilitation, TBI Unit, Copenhagen, Denmark
| | - Simon Francis Farmer
- 4 Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London and Department of Clinical Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1 3BG, UK
| | - Jens Bo Nielsen
- 1 Department of Nutrition, Exercise and Sport & Department of Neuroscience and Pharmacology, University of Copenhagen, Copenhagen, Denmark
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49
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Sakzewski L, Gordon A, Eliasson AC. The state of the evidence for intensive upper limb therapy approaches for children with unilateral cerebral palsy. J Child Neurol 2014; 29:1077-90. [PMID: 24820334 DOI: 10.1177/0883073814533150] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 04/03/2014] [Indexed: 11/16/2022]
Abstract
Children with unilateral cerebral palsy experience difficulties with unimanual and bimanual upper limb function, impacting independence in daily life. Targeted upper limb therapies such as constraint-induced movement therapy, bimanual training, and combined approaches have emerged in the last decade. This article reviews the scientific rationale underpinning these treatments and current evidence to improve upper limb outcomes and goal attainment. Intensive models of therapy achieved modest to strong effects to improve upper limb function compared to usual care. Dose-matched comparisons of bimanual and unimanual training demonstrated similar gains in upper limb outcomes. The optimum timing, dose and impact of repeat episodes of intensive upper limb therapies require further investigation. Characteristics of children who achieve clinically meaningful outcomes remain unclear. Key components of intervention include collaborative goal setting with families and intensive repetitive, incrementally challenging, task practice. Choice of treatment approach should be governed by child/family goals and preferences, individual, and contextual factors.
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Affiliation(s)
- Leanne Sakzewski
- Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine, University of Queensland, Queensland, Australia
| | - Andrew Gordon
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA
| | - Ann-Christin Eliasson
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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Eliasson AC, Sjöstrand L, Ek L, Krumlinde-Sundholm L, Tedroff K. Efficacy of baby-CIMT: study protocol for a randomised controlled trial on infants below age 12 months, with clinical signs of unilateral CP. BMC Pediatr 2014; 14:141. [PMID: 24903062 PMCID: PMC4062504 DOI: 10.1186/1471-2431-14-141] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 05/22/2014] [Indexed: 01/26/2023] Open
Abstract
Background Infants with unilateral brain lesions are at high risk of developing unilateral cerebral palsy (CP). Given the great plasticity of the young brain, possible interventions for infants at risk of unilateral CP deserve exploration. Constraint-induced movement therapy (CIMT) is known to be effective for older children with unilateral CP but is not systematically used for infants. The development of CIMT for infants (baby-CIMT) is described here, as is the methodology of an RCT comparing the effects on manual ability development of baby-CIMT versus baby-massage. The main hypothesis is that infants receiving baby-CIMT will develop manual ability in the involved hand faster than will infants receiving baby-massage in the first year of life. Method and design The study will be a randomised, controlled, prospective parallel-group trial. Invited infants will be to be randomised to either the baby-CIMT or the baby-massage group if they: 1) are at risk of developing unilateral CP due to a known neonatal event affecting the brain or 2) have been referred to Astrid Lindgren Children’s Hospital due to asymmetric hand function. The inclusion criteria are age 3–8 months and established asymmetric hand use. Infants in both groups will receive two 6-weeks training periods separated by a 6-week pause, for 12 weeks in total of treatment. The primary outcome measure will be the new Hand Assessment for Infants (HAI) for evaluating manual ability. In addition, the Parenting Sense of Competence scale and Alberta Infant Motor Scale will be used. Clinical neuroimaging will be utilized to characterise the brain lesion type. To compare outcomes between treatment groups generalised linear models will be used. Discussion The model of early intensive intervention for hand function, baby-CIMT evaluated by the Hand Assessment for Infants (HAI) will have the potential to significantly increase our understanding of how early intervention of upper limb function in infants at risk of developing unilateral CP can be performed and measured. Trial registration SFO-V4072/2012, 05/22/2013
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Affiliation(s)
- Ann-Christin Eliasson
- Neuropediatric Unit, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
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