Jeong-Yi Kwon1, Won Hyuk Chang2, Hyun Jung Chang3, Sook-Hee Yi4, Min-Young Kim1, Eun-Hye Kim5, Yun-Hee Kim6. 1. Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Republic of Korea. 2. Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Republic of Korea; Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Republic of Korea. 3. Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Republic of Korea; Department of Physical and Rehabilitation Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Republic of Korea. 4. Department of Pediatric Rehabilitation, Seoul, Republic of Korea. 5. Department of Physical and Rehabilitation Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Republic of Korea. 6. Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Republic of Korea; Center for Prevention and Rehabilitation, Heart Vascular and Stroke Institute, Samsung Medical Center, Republic of Korea. Electronic address: yun1225.kim@samsung.com.
Abstract
OBJECTIVE: The objective of the study was to determine whether constraint-induced movement therapy (CIMT) could lead to changes in diffusion tensor tractography (DTT) associated with clinical improvement in young children with unilateral cerebral palsy (CP). METHODS: A standardized pediatric CIMT protocol (4weeks, 120h of constraint) was used on 10 children with unilateral CP who were younger than 5years. DTT was performed in five participants before and after the intervention. Clinical outcome was measured by using the Pediatric Motor Activity Log (PMAL), Quality of Upper Extremity Skills Test (QUEST), and self-care domain of the Pediatric Evaluation of Disability Inventory. RESULTS: In two patients, the affected corticospinal tract (CST) visible on pretreatment DTT became more prominent on posttreatment DTT. In one patient, the affected CST was not visible on pretreatment DTT, but was visible on posttreatment DTT. All the clinical outcomes significantly improved in the CIMT group compared with the control group. Changes in the PMAL how often scale (PMAL-HO) score significantly differed between the CIMT and control groups. CONCLUSIONS: Changes in the properties of the affected CST on DTT were accompanied with improved arm function after CIMT in the children with CP. SIGNIFICANCE: CIMT might lead to CST reorganization in young children with CP.
OBJECTIVE: The objective of the study was to determine whether constraint-induced movement therapy (CIMT) could lead to changes in diffusion tensor tractography (DTT) associated with clinical improvement in young children with unilateral cerebral palsy (CP). METHODS: A standardized pediatric CIMT protocol (4weeks, 120h of constraint) was used on 10 children with unilateral CP who were younger than 5years. DTT was performed in five participants before and after the intervention. Clinical outcome was measured by using the Pediatric Motor Activity Log (PMAL), Quality of Upper Extremity Skills Test (QUEST), and self-care domain of the Pediatric Evaluation of Disability Inventory. RESULTS: In two patients, the affected corticospinal tract (CST) visible on pretreatment DTT became more prominent on posttreatment DTT. In one patient, the affected CST was not visible on pretreatment DTT, but was visible on posttreatment DTT. All the clinical outcomes significantly improved in the CIMT group compared with the control group. Changes in the PMAL how often scale (PMAL-HO) score significantly differed between the CIMT and control groups. CONCLUSIONS: Changes in the properties of the affected CST on DTT were accompanied with improved arm function after CIMT in the children with CP. SIGNIFICANCE: CIMT might lead to CST reorganization in young children with CP.
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