Article

Reorganization of the corticospinal tract (CST) can occur in
unilateral spastic cerebral palsy (USCP). The affected hand can be controlled via
(1) typical contralateral projections from the lesioned hemisphere,
(2) ipsilateral projections from the nonlesioned hemisphere, and
(3) a combination of
contralateral and ipsilateral projections (ie, bilateral). Intensive bimanual
therapy and constraint-induced movement therapy (CIMT) improve hand function of
children with USCP. Earlier it was suggested that the CST connectivity pattern
may influence the efficacy of CIMT. OBJECTIVE: To examine whether CST projection
pattern influences the efficacy of intensive bimanual therapy in children with
USCP. PARTICIPANTS: Thirty-three children with USCP (age 8.9 +/- 2.6 years, 16
females). METHODS: Bimanual therapy was provided in a day-camp setting (90
hours). Participants were involved in different bimanual play and functional
activities actively engaging both hands. Hand function was tested before and
after the intervention with the Jebsen-Taylor Test of Hand Function, Assisting
Hand Assessment, ABILHAND-Kids, and the Canadian Occupational Performance
Measure. Single-pulse transcranial magnetic stimulation (TMS) was used to
determine each child's CST projection pattern (ie, ipsilateral, contralateral, or
bilateral). RESULTS: Children whose affected hand was controlled only by
ipsilateral CST projections had worse Jebsen-Taylor Test of Hand Function and
Assisting Hand Assessment scores than children in the contralateral group at
baseline. Bimanual hand use and functional hand use was independent of CST
projection pattern. After bimanual therapy, improvements on all outcome measures
were observed, and these improvements were independent of the CST connectivity
pattern. CONCLUSION: The efficacy of bimanual therapy on hand function in
children with USCP appears to be independent of CST connectivity pattern.

Langue : ANGLAIS