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Improved Myelination following Camp Leg Power, a Selective Motor Control Intervention for Children with Spastic
A Vuong1,2,3, S H Joshi4,5, L A Staudt2,3
1From the Departments of Bioengineering (A.V., S.H.J.) andyvuong@ucla.edu.
Insights
Intensive lower extremity motor control training improved myelination in the corticospinal tracts of children with spastic cerebral palsy. This neuroplasticity suggests that targeted exercises can enhance white matter integrity in affected individuals.
Area of Science:
- Neuroscience
- Pediatric Neurology
- Rehabilitation Medicine
Background:
- Children with spastic cerebral palsy often exhibit motor deficits due to white matter (WM) damage, particularly in corticospinal tracts.
- Periventricular leukomalacia is a common cause of WM damage in this population, impacting motor function.
Purpose of the Study:
- To investigate if intensive practice of skilled lower extremity selective motor control movements can induce neuroplasticity in children with spastic cerebral palsy.
- To assess changes in white matter integrity using diffusion-weighted imaging (DWI) after a motor intervention.
Main Methods:
- Twelve children with spastic bilateral cerebral palsy and periventricular leukomalacia underwent a 1-month intensive lower extremity selective motor control intervention (Camp Leg Power).
- The intervention included isolated joint movements, isokinetic exercises, gaming, gait training, and sensorimotor activities.
- Diffusion-weighted imaging (DWI) scans were analyzed using Tract-Based Spatial Statistics to evaluate changes in fractional anisotropy, radial diffusivity, axial diffusivity, and mean diffusivity.
Main Results:
- Significant reductions in radial diffusivity and mean diffusivity were observed in corticospinal tract regions, including the posterior limb of the internal capsule and superior corona radiata.
- Decreased radial diffusivity was also noted in the left primary motor cortex.
- Other white matter tracts, such as the anterior limb of the internal capsule and corpus callosum, showed reduced radial and mean diffusivity.
Conclusions:
- The Camp Leg Power intervention led to improved myelination of corticospinal tracts in children with spastic cerebral palsy.
- Observed WM changes suggest the recruitment of additional tracts, indicating neuroplasticity.
- Intensive, skilled lower extremity motor control practice effectively promotes neuroplasticity in this pediatric population.
Background And Purpose:
Children with spastic cerebral palsy have motor deficits associated with periventricular leukomalacia indicating WM damage to the corticospinal tracts. We investigated whether practice of skilled lower extremity selective motor control movements would elicit neuroplasticity.
Materials And Methods:
Twelve children with spastic bilateral cerebral palsy and periventricular leukomalacia born preterm (mean age, 11.5 years; age range, 7.3-16.6 years) participated in a lower extremity selective motor control intervention, Camp Leg Power. Activities promoted isolated joint movement including isokinetic knee exercises, ankle-controlled gaming, gait training, and sensorimotor activities (3 hours/day, 15 sessions, 1 month). DWI scans were collected pre- and postintervention. Tract-Based Spatial Statistics was used to analyze changes in fractional anisotropy, radial diffusivity, axial diffusivity, and mean diffusivity.
Results:
Significantly reduced radial diffusivity (P < . 05) was found within corticospinal tract ROIs, including 28.4% of the left and 3.6% of the right posterior limb of the internal capsule and 14.1% of the left superior corona radiata. Reduced mean diffusivity was found within the same ROIs (13.3%, 11.6%, and 6.6%, respectively). Additionally, decreased radial diffusivity was observed in the left primary motor cortex. Additional WM tracts had decreased radial diffusivity and mean diffusivity, including the anterior limb of the internal capsule, external capsule, anterior corona radiata, and corpus callosum body and genu.
Conclusions:
Myelination of the corticospinal tracts improved following Camp Leg Power. Neighboring WM changes suggest recruitment of additional tracts involved in regulating neuroplasticity of the motor regions. Intensive practice of skilled lower extremity selective motor control movements promotes neuroplasticity in children with spastic bilateral cerebral palsy.
