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A journal article from DMCN. The combined structural neuroimaging (DTI- MRI) and functional neurophysiological (TMS) study of motor pathways in children with unilateral CP demonstrates good coherence. Preserved pathway as demonstrated with those techniques appears to be associated with better clinical functioning. This is ready to be used in research, e.g. to identify groups of patients in studies, or study plasticity (and perhaps in the future to provide insights into prognosis and help individualise intervention).

Using diffusion tensor imaging to identify corticospinal tract projection patterns in children with unilateral spastic cerebral palsy

Knowledge Hub

A journal article from DMCN. The combined structural neuroimaging (DTI- MRI) and functional neurophysiological (TMS) study of motor pathways in children with unilateral CP demonstrates good coherence. Preserved pathway as demonstrated with those techniques appears to be associated with better clinical functioning. This is ready to be used in research, e.g. to identify groups of patients in studies, or study plasticity (and perhaps in the future to provide insights into prognosis and help individualise intervention).

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Synopsis of resource:

Unilateral spastic CP is the most common subtype of CP characterized by motor deficits lateralized to one side of the body. Cortico spinal tracts (CST) project bilaterally in TD infant during prenatal phase & Ipsi lateral projections are  pruned by 6 months so that contralateral crossed CST  is reinforced in the spinal cord.

In children with unilateral spastic CP, damage to the more‐affected motor cortex weakens the contralateral/crossed projection. The Ipsi-lateral CST projecting from the less‐affected motor cortex is hence strengthened. These can be studied both by Diffusion tensor imaging Tractography (DTI) as well as Trans-cranial magnetic simulation (TMS). The control can be either unilateral, contra lateral or both.

In this study authors studied 21 children with unilateral cerebral palsy as per MACS 1-3 levels without seizures by both TMS & DTI and found that the integrity of the more affected CST is compromised and detected with DTI [Sensitivity81.8% and Specificity77.8%]

They discuss these implications with reference to Constraint induced movement therapy.

Key learning outcomes

  • Development and pruning of CST in pre & postnatal ages in Td children
  • Type of CST projections in Unilateral CP can be – Ipsilateral, contralateral & Mixed.
  • DTI & TMS are methods to study these projections
  • Knowing the type of control by contralateral or ipsilateral CST has implications to EBM proved intervention like Constraint induced therapy where the less affected or near normal hand is immobilised .If the control is ipsilateral , CIMT may not benefit as much as when it is contralateral

Authors

Cherie Kuo is a 5th year PhD student working with both Dr. Kathleen Friel at Burke Rehabilitation Center and Dr. Andrew Gordon at Teachers College, Columbia University. She has clinical training background as a physical therapist for her undergraduate in National Taiwan University (NTU) in Taipei, Taiwan. She got her Master’s of Science from the Neuroscience & Education program in Teachers College, Columbia University in 2009. Cherie has extensive experience in supervising therapeutic camps and data analysis for our clinical trials.

Her research interests encompass: (a) using DTI (diffusion tensor imaging) & TMS (transcranial magnetic stimulation) to investigate corticospinal pathway in children with unilateral cerebral palsy (UCP), (b) intensive hand therapy to improve hand function in a camp setting in children with unilateral CP. More recently she is focusing on investigating the tactile and stereognosis function, and studying the relationship between mirror movements and corticospinal tract in children with UCP.

Article Free Access