Targeted transcranial direct current stimulation combined with bimanual training for children with cerebral palsy

靶向经颅直流电刺激联合双手训练治疗脑瘫患儿

• 批准号: 9917446
• 负责人: Kathleen Margaret Friel
• 金额: $ 70.95万
• 依托单位: WINIFRED MASTERSON BURKE MED RES INST
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-26 至 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/9917446
• 关键词: Activities of Daily Living; Adoption; Adult; Affect; Anodes; Area; Brain; Cerebral Palsy; Child; Childhood; Clinical; Contralateral; Corticospinal Tracts; Data; Development; Effectiveness; Family; Financial cost; Funding; Future; Goals; Hand; Hand functions; Handedness; Heterogeneity; Hour; Impairment; Individual; Ipsilateral; Lead; Maps; Measures; Methods; Motor; Motor Cortex; Movement; Movement Disorders; Muscle; Neuronal Plasticity; Outcome; Pathway interactions; Pediatric Brain Injury; Physical Rehabilitation; Physiologic pulse; Physiology; Randomized; Randomized Clinical Trials; Rehabilitation therapy; Research; Resources; Side; Spastic Cerebral Palsy; Stroke; Testing; Time; Training; Transcranial magnetic stimulation; Treatment Cost; Treatment Efficacy; Upper Extremity; Work; base; constraint induced movement therapy; cost; dosage; effective intervention; evidence base; hemisphere damage; improved; innovation; low socioeconomic status; motor control; motor impairment; nervous system disorder; novel; personalized approach; personalized intervention; relating to nervous system; response; skills

PROJECT SUMMARY/ABSTRACT Unilateral spastic cerebral palsy (USCP) is characterized by movement deficits, particularly upper extremity (UE) impairments on one side of the body. Although strides have been made to improve UE rehabilitation approaches, even the best available therapies fail to fully ameliorate UE impairments, are costly, and require large amounts of time. Thus, there is an urgent need to optimize the effectiveness and cost of UE therapies. Our long-term goal is to develop evidence-based strategies to improve movement in children with USCP. Early damage to the developing brain can result in a re-wiring of the direct corticospinal tract (CST) projections innervating UE function. In many children with USCP, there are no CST connections from the damaged hemisphere, and instead ipsilateral (same-sided) CST pathways control movement of the affected UE. Previously, this type of reorganization was believed to be maladaptive and unresponsive to treatment. However, during the first funding period of this R01, we determined that UE therapy efficacy is independent of CST laterality. Importantly, we found that the hemisphere containing CST connectivity to the affected hand showed neuroplastic changes in response to intensive therapy. Nonetheless, this heterogeneity in the brain connectivity means it is unlikely that a one-size-fits-all rehabilitation approach will be suitable. Therefore, our next goal is to leverage these findings using an individualized approach to obtain the same or greater changes using a fraction of the dosage by enhancing the neuroplastic changes with transcranial direct current stimulation (tDCS). Our preliminary results show that tDCS enhances the efficacy of UE training only if it is targeted to an individual’s CST laterality determined with single-pulse transcranial magnetic stimulation (TMS). The overall objective for this renewal is to vertically extend what has been learned under our prior R01 by determining how to optimally target tDCS to enhance the efficacy of UE training in children with USCP. Our central hypothesis is that bimanual training (BT) combined with a tDCS montage targeting the hemisphere with CST connectivity to the impaired UE muscles will improve UE function more than BT plus sham stimulation. We will test this by conducting a randomized clinical trial (RCT) to determine the efficacy of targeted tDCS/BT for improving UE function and interactions between tDCS/BT and motor cortex physiology in children with USCP. Our working hypotheses are that children who receive targeted anodal tDCS will show the most robust changes in hand function and motor cortex physiology. Determination of the synergistic effects of tDCS and BT may substantially reduce the required rehabilitation time and cost necessary to improve UE function. The proposed work is innovative because it may increase accessibility of treatment, particularly for centers that serve families of lower socio-economic status, due to the reduced cost of therapy.

项目摘要/摘要 单侧痉挛性脑瘫（USCP）的特征是运动定义，尤其是上肢 （UE）身体一侧的损伤。尽管已经大步改善UE康复 方法，即使是最好的可用疗法也无法完全改善UE损伤，这是昂贵的，并且需要 大量时间。这是迫切需要优化UE疗法的有效性和成本。 我们的长期目标是制定基于证据的策略来改善USCP儿童的运动。 早期对发育中的大脑的损害可能导致直接皮质脊髓区域（CST）重新侵蚀 投影神经UE功能。在许多USCP的孩子中，没有CST的联系 损坏的半球，而同侧（相同侧）CST途径控制受影响的运动 UE。以前，这种重组被认为是适应不良的，对治疗无反应。 但是，在此R01的第一个资金期间，我们确定UE治疗效率与 CST的横向性。重要的是，我们发现包含与受影响的手的CST连接性的半球 显示出对强化治疗的响应神经塑性变化。尽管如此，大脑的这种异质性 连通性意味着不太可能将万能的康复方法适合使用。因此，我们的 下一个目标是使用个性化方法来利用这些发现来获得相同或更大的变化 通过使用trancranial直流来增强神经塑性变化，使用剂量的一部分 刺激（TDC）。我们的初步结果表明，只有当时，TDCS才能提高UE培训的效率 针对单个CST的侧向，由单脉冲经颅磁刺激（TMS）确定。 这种续约的总体目标是垂直扩展我们先前R01所学到的内容 确定如何最佳地靶向TDC，以提高USCP儿童UE培训的效率。我们的 中心假设是双人训练（BT）与针对半球的TDCS型号结合 CST连接到受损的UE肌肉将比BT和假手术刺激更多地提高UE功能。 我们将通过进行随机临床试验（RCT）来确定目标的有效性 TDC/BT用于改善UE功能以及TDC/BT与运动皮层生理学之间的相互作用 USCP的孩子。我们的工作假设是，收到有针对性的阳极TDC的孩子将显示 手部功能和运动皮层生理学最强大的变化。确定协同作用 TDC和BT可能会大大减少改善UE所需的康复时间和成本 功能。拟议的工作具有创新性，因为它可能会增加治疗的可及性，特别是对于 由于治疗成本降低，服务于社会经济地位较低的家庭的中心。