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Changes in diffusion tensor tractographic findings associated with constraint-induced movement therapy in young
Jeong-Yi Kwon1, Won Hyuk Chang2, Hyun Jung Chang3
1Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Republic of Korea.
Insights
Constraint-induced movement therapy (CIMT) improved arm function in young children with unilateral cerebral palsy (CP). Diffusion tensor tractography (DTT) showed changes in the corticospinal tract (CST) after CIMT, suggesting neural reorganization.
Area of Science:
- Neuroscience
- Pediatric Rehabilitation
- Medical Imaging
Background:
- Unilateral cerebral palsy (CP) affects motor function in young children.
- Constraint-induced movement therapy (CIMT) is a promising rehabilitation approach.
- Diffusion tensor tractography (DTT) can visualize white matter tracts like the corticospinal tract (CST).
Purpose of the Study:
- To investigate if CIMT alters DTT in children with unilateral CP.
- To correlate DTT changes with clinical improvements in motor function.
Main Methods:
- Ten children under 5 years with unilateral CP received a 4-week CIMT protocol.
- DTT was performed on five participants pre- and post-intervention.
- Clinical outcomes were assessed using PMAL, QUEST, and PEDI self-care scales.
Main Results:
- DTT showed increased prominence or emergence of the affected CST in some participants post-CIMT.
- Significant improvements in arm function were observed in the CIMT group compared to controls.
- The PMAL-HO score showed significant differences between CIMT and control groups.
Conclusions:
- Changes in CST properties on DTT were associated with improved arm function after CIMT.
- CIMT may induce neuroplasticity and reorganization of the CST in young children with CP.
Objective:
The objective of the study was to determine whether constraint-induced movement therapy (CIMT) could lead to changes in diffusion tensor tractography (DTT) associated with clinical improvement in young children with unilateral cerebral palsy (CP).
Methods:
A standardized pediatric CIMT protocol (4weeks, 120h of constraint) was used on 10 children with unilateral CP who were younger than 5years. DTT was performed in five participants before and after the intervention. Clinical outcome was measured by using the Pediatric Motor Activity Log (PMAL), Quality of Upper Extremity Skills Test (QUEST), and self-care domain of the Pediatric Evaluation of Disability Inventory.
Results:
In two patients, the affected corticospinal tract (CST) visible on pretreatment DTT became more prominent on posttreatment DTT. In one patient, the affected CST was not visible on pretreatment DTT, but was visible on posttreatment DTT. All the clinical outcomes significantly improved in the CIMT group compared with the control group. Changes in the PMAL how often scale (PMAL-HO) score significantly differed between the CIMT and control groups.
Conclusions:
Changes in the properties of the affected CST on DTT were accompanied with improved arm function after CIMT in the children with CP.
Significance:
CIMT might lead to CST reorganization in young children with CP.
