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Skilled Bimanual Training Drives Motor Cortex Plasticity in Children With Unilateral Cerebral Palsy.

Publication ,  Journal Article
Friel, KM; Kuo, H-C; Fuller, J; Ferre, CL; Brandão, M; Carmel, JB; Bleyenheuft, Y; Gowatsky, JL; Stanford, AD; Rowny, SB; Luber, B; Bassi, B ...
Published in: Neurorehabil Neural Repair
October 2016

Background Intensive bimanual therapy can improve hand function in children with unilateral spastic cerebral palsy (USCP). We compared the effects of structured bimanual skill training versus unstructured bimanual practice on motor outcomes and motor map plasticity in children with USCP. Objective We hypothesized that structured skill training would produce greater motor map plasticity than unstructured practice. Methods Twenty children with USCP (average age 9.5; 12 males) received therapy in a day camp setting, 6 h/day, 5 days/week, for 3 weeks. In structured skill training (n = 10), children performed progressively more difficult movements and practiced functional goals. In unstructured practice (n = 10), children engaged in bimanual activities but did not practice skillful movements or functional goals. We used the Assisting Hand Assessment (AHA), Jebsen-Taylor Test of Hand Function (JTTHF), and Canadian Occupational Performance Measure (COPM) to measure hand function. We used single-pulse transcranial magnetic stimulation to map the representation of first dorsal interosseous and flexor carpi radialis muscles bilaterally. Results Both groups showed significant improvements in bimanual hand use (AHA; P < .05) and hand dexterity (JTTHF; P < .001). However, only the structured skill group showed increases in the size of the affected hand motor map and amplitudes of motor evoked potentials (P < .01). Most children who showed the most functional improvements (COPM) had the largest changes in map size. Conclusions These findings uncover a dichotomy of plasticity: the unstructured practice group improved hand function but did not show changes in motor maps. Skill training is important for driving motor cortex plasticity in children with USCP.

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Published In

Neurorehabil Neural Repair

DOI

EISSN

1552-6844

Publication Date

October 2016

Volume

30

Issue

9

Start / End Page

834 / 844

Location

United States

Related Subject Headings

  • Transcranial Magnetic Stimulation
  • Rehabilitation
  • Practice, Psychological
  • Physical Therapy Modalities
  • Motor Skills
  • Motor Cortex
  • Male
  • Magnetic Resonance Imaging
  • Image Processing, Computer-Assisted
  • Humans
 

Citation

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Friel, K. M., Kuo, H.-C., Fuller, J., Ferre, C. L., Brandão, M., Carmel, J. B., … Gordon, A. M. (2016). Skilled Bimanual Training Drives Motor Cortex Plasticity in Children With Unilateral Cerebral Palsy. Neurorehabil Neural Repair, 30(9), 834–844. https://doi.org/10.1177/1545968315625838
Friel, Kathleen M., Hsing-Ching Kuo, Jason Fuller, Claudio L. Ferre, Marina Brandão, Jason B. Carmel, Yannick Bleyenheuft, et al. “Skilled Bimanual Training Drives Motor Cortex Plasticity in Children With Unilateral Cerebral Palsy.Neurorehabil Neural Repair 30, no. 9 (October 2016): 834–44. https://doi.org/10.1177/1545968315625838.
Friel KM, Kuo H-C, Fuller J, Ferre CL, Brandão M, Carmel JB, et al. Skilled Bimanual Training Drives Motor Cortex Plasticity in Children With Unilateral Cerebral Palsy. Neurorehabil Neural Repair. 2016 Oct;30(9):834–44.
Friel, Kathleen M., et al. “Skilled Bimanual Training Drives Motor Cortex Plasticity in Children With Unilateral Cerebral Palsy.Neurorehabil Neural Repair, vol. 30, no. 9, Oct. 2016, pp. 834–44. Pubmed, doi:10.1177/1545968315625838.
Friel KM, Kuo H-C, Fuller J, Ferre CL, Brandão M, Carmel JB, Bleyenheuft Y, Gowatsky JL, Stanford AD, Rowny SB, Luber B, Bassi B, Murphy DLK, Lisanby SH, Gordon AM. Skilled Bimanual Training Drives Motor Cortex Plasticity in Children With Unilateral Cerebral Palsy. Neurorehabil Neural Repair. 2016 Oct;30(9):834–844.
Journal cover image

Published In

Neurorehabil Neural Repair

DOI

EISSN

1552-6844

Publication Date

October 2016

Volume

30

Issue

9

Start / End Page

834 / 844

Location

United States

Related Subject Headings

  • Transcranial Magnetic Stimulation
  • Rehabilitation
  • Practice, Psychological
  • Physical Therapy Modalities
  • Motor Skills
  • Motor Cortex
  • Male
  • Magnetic Resonance Imaging
  • Image Processing, Computer-Assisted
  • Humans