Brain Functional Activity and Walking Capacity Enhancement in Children With Cerebral Palsy: A Pilot fMRI Study

Gait impairment is one of the consequences of cerebral palsy (CP) as a permanent neurological disorder. The therapy-induced neuroplasticity should be accompanied by functional improvement to have a persistent treatment effect. In this regard, we aimed to determine the correlation between brain functional activity changes and walking capacity improvement following treatments in children with hemiplegic CP (HCP).

Twenty-one spastic HCP children (7-12 years old) were randomly divided into 3 groups. Occupational therapy (OT) was performed for the first group. The second group received repetitive transcranial magnetic stimulation (rTMS) treatment, and the third group underwent anti-gravity treadmill (AlterG system) training. AlterG training and OT were provided for 45 minutes, and rTMS was applied for 20 minutes per session, 3 times per week for 8 weeks. Brain functional activity while executing passive tasks involving knee flexion/extension and ankle plantarflexion/dorsiflexion over the range of motion was quantified using functional magnetic resonance imaging (fMRI). Walking capacity was indexed by clinical measures. Clinical and fMRI evaluations were performed pre- and post-training.

Our results indicate that intensive OT, rTMS, and AlterG training enhance brain functional activity and walking capacity in pediatrics with CP. Also, our results reveal a robust correlation between the corpus callosum (CC) functional activity changes and walking capacity improvement.

Regardless of the type of treatment, the improvement in gait function in children with CP may reflect an increase in brain functional activity in callosal neurons, which may reveal an increase in interhemispheric coupling.