Article

Motor-learning interventions may improve hand function in children
with unilateral cerebral palsy (UCP) but with inconsistent outcomes across
participants. Objective To examine if pre-intervention brain imaging predicts
benefit from bimanual intervention. Method Twenty children with UCP with Manual
Ability Classification System levels I to III, aged 7-16 years, participated in
an intensive bimanual intervention. Assessments included the Assisting Hand
Assessment (AHA), Jebsen Taylor Test of Hand Function (JTTHF) and Children's Hand
Experience Questionnaire (CHEQ) at baseline (T1), completion (T2) and 8-10 weeks
post-intervention (T3). Imaging at baseline included conventional structural
(radiological score), functional (fMRI) and diffusion tensor imaging (DTI).
Results Improvements were seen across assessments; AHA (P = 0.04), JTTHF (P <
.001) and CHEQ (P < 0.001). Radiological score significantly correlated with
improvement at T2; AHA (r = .475) and CHEQ (r = .632), but negatively with
improvement on unimanual measures at T3 (JTTFH r = -.514). fMRI showed negative
correlations between contralesional brain activation when moving the affected
hand and AHA improvements (T2: r = -.562, T3: r = -0.479). Fractional Anisotropy
in the affected posterior limb of the internal capsule correlated negatively with
increased bimanual use on CHEQ at T2 (r = -547) and AHA at T3 (r = -.656).
Conclusions Children with greater structural, functional and connective brain
damage showed enhanced responses to bimanual intervention. Baseline imaging may
identify parameters predicting response to intervention in children with UCP.
CI - (c) The Author(s) 2015.

Langue : ANGLAIS