IMPACT OF MOTOR CONNECTIVITY ON EFFICACY OF HAND THERAPY IN CONGENITAL HEMIPLEGIA

运动连接对先天性偏瘫手部治疗效果的影响

• 批准号: 8653096
• 负责人: Kathleen Margaret Friel
• 金额: $ 9.25万
• 依托单位: WINIFRED MASTERSON BURKE MED RES INST
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-04-05 至 2014-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8653096
• 关键词: Affect; Bilateral; Brain Injuries; Categories; Cerebral Palsy; Child; Clinical Treatment; Contralateral; Development; Goals; Hand; Hand functions; Handedness; Hemiplegia; Injury; Ipsilateral; Life; Motor; Motor Cortex; Motor Pathways; Movement; Pattern; Physiologic pulse; Physiology; Recovery; Reporting; Role; Severities; Shapes; Side; Spinal Cord; System; Testing; Therapeutic; Training; Transcranial magnetic stimulation; Upper Extremity; arm; base; constraint induced movement therapy; improved; interest; motor deficit; nervous system disorder; neurophysiology; public health relevance; repaired; skills

DESCRIPTION (provided by applicant): Intensive hand training can improve dexterity in children with hemiplegic cerebral palsy. Two categories of training paradigms have been tested. In constraint-induced movement therapy (CIMT), the less-affected upper extremity (UE) is restrained while the affected UE is trained. Intensive bimanual training (e.g., Hand-arm bimanual intensive training (HABIT)) encourages children to use both UEs in bimanual tasks. However, it has been reported that children whose impaired UE is controlled via ipsilateral corticospinal (CS) connections show less recovery in CIMT than children whose impaired UE is controlled by contralateral CS connections. This raises the interesting possibility that there is a interaction between treatment type and CS connection pattern. Limited use of an UE drives down activity in the contralateral motor cortex (M1). In children with contralateral control of the affected UE, decreasing activity in the healthy M1 gives the affected side a competitive advantage over the other side. In contrast, in children with ipsilateral control of the affected UE the healthy M1 controls the affected UE. Constraining the less-affected UE drives down activity in the healthy M1, which may impede recovery of the impaired UE. The PIs will further investigate this important issue. They will use single-pulse transcranial magnetic stimulation to probe M1 function in children who have previously received HABIT or CIMT. The PIs hypothesize that children with ipsilateral connectivity of the affected hand showed greater improvement in dexterity after HABIT, compared to CIMT. Importantly, they will help determine whether children with ipsilateral CS projections would best benefit from bimanual therapy vs. CIMT.

描述（由申请人提供）：强化手工训练可以改善偏瘫性脑瘫儿童的灵巧性。已经测试了两类培训范例。在约束诱导的运动疗法（CIMT）中，受影响的UE经过训练，受影响的上肢较低的上肢（UE）受到限制。密集的双人培训（例如，手臂的双重强化培训（习惯））鼓励儿童在双层任务中使用两个UES。然而，据报道，与受损害UE受到对比CS连接控制的儿童相比，通过同侧皮层（CS）连接受损的儿童在CIMT中的恢复率较小。这提出了一种有趣的可能性，即治疗类型与CS连接模式之间存在相互作用。 在对侧运动皮层（M1）中，UE的使用有限驱动活性。在对侧控制的儿童中 受影响的UE，健康M1的活性减少使受影响的一侧比另一侧具有竞争优势。相反，在受影响UE的同侧控制的儿童中，健康的M1控制了受影响的UE。限制受影响较小的UE在健康M1中驱动活性，这可能阻碍了受损UE的恢复。 PI将进一步研究这个重要问题。他们将使用单脉冲经颅磁刺激来探测以前习惯或CIMT的儿童的M1功能。 PIS假设与CIMT相比，习惯后，患有同侧连通性的儿童在习惯后表现出更大的提高。重要的是，它们将有助于确定患有同侧CS预测的儿童是否最能通过双人疗法与CIMT受益。