Anterior cingulate and its role in enhancing gait training outcomes in persons with cerebral palsy

Persons with cerebral palsy (CP) exhibit diminished somatosensory cortical activity and this has been linked with the extent of their muscular performance and mobility impairments. However, the influence of physical therapy paradigms on such diminished cortical activity remains unclear. The current study evaluated the extent of mobility changes and somatosensory cortical activity in persons with CP (n = 28; Age = 21.57 ± 7.1 yr; Gross Motor Function Classification Score levels I-III) following 8 weeks of a gait training protocol that involved exploratory activities that were directed at enhancing the somatosensory experience through rich/novel movement. A paired-pulse somatosensory paradigm during magnetoencephalography was used to assess the cortical changes after undergoing the physical therapy protocol. Consistent with the literature, the group with CP had weaker somatosensory cortical responses compared to the neurotypical controls. While the participants with CP demonstrated clinically relevant mobility improvements, there were no changes in the somatosensory cortical activity. However, there was a prominent increase in neural activity within the anterior cingulate. This implies that the novel gait training protocol used here may drive beneficial improvements in the ability of persons with CP to monitor their motor errors, attend to the available sensory feedback, and discriminate different sensory intensities during gait.