Brain Functional Activity and Walking Capacity Enhancement in Children With Cerebral Palsy: A Pilot fMRI Study
Parmida Moradi Birgani1, Meghdad Ashtiyani2, Seyed Behnamedin Jameie3
1Department of Medical Physics and Biomedical Engineering, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Insights
Treatments like occupational therapy, rTMS, and AlterG training improve brain function and walking ability in children with cerebral palsy (CP). Improvements in gait correlate with enhanced activity in the corpus callosum, suggesting better interhemispheric communication.
Area of Science:
- Neuroscience
- Rehabilitation Medicine
- Pediatric Neurology
Background:
- Cerebral palsy (CP) is a permanent neurological disorder often causing gait impairment.
- Therapy-induced neuroplasticity is crucial for persistent functional improvement in CP.
- Understanding the link between brain activity and motor function is key for effective CP treatment.
Purpose of the Study:
- To determine the correlation between changes in brain functional activity and improvements in walking capacity in children with hemiplegic CP (HCP).
- To evaluate the effects of occupational therapy (OT), repetitive transcranial magnetic stimulation (rTMS), and AlterG treadmill training on brain function and gait in pediatric CP.
Main Methods:
- Twenty-one children with spastic HCP (7-12 years) were randomized into three groups: OT, rTMS, or AlterG training.
- Interventions were administered 3 times/week for 8 weeks.
- Functional magnetic resonance imaging (fMRI) quantified brain activity during passive movements; walking capacity was assessed using clinical measures pre- and post-intervention.
Main Results:
- All three interventions (OT, rTMS, AlterG) enhanced brain functional activity and walking capacity in pediatric CP.
- A significant correlation was found between functional activity changes in the corpus callosum (CC) and improvements in walking capacity.
Conclusions:
- Therapeutic interventions for CP can enhance brain functional activity and gait.
- Improved gait function in CP may be associated with increased activity in callosal neurons, potentially indicating enhanced interhemispheric coupling.
Introduction:
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).
Methods:
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.
Results:
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.
Conclusion:
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.
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