Alicia J Hilderley, F Virginia Wright, Margot J Taylor, Joyce L Chen, Darcy Fehlings
{"title":"双瘫性脑瘫儿童大运动干预后的功能神经可塑性和运动技能改变。","authors":"Alicia J Hilderley, F Virginia Wright, Margot J Taylor, Joyce L Chen, Darcy Fehlings","doi":"10.1177/15459683221143503","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Gross motor intervention designs for children with diplegic cerebral palsy (DCP) require an improved understanding of the children's potential for neuroplasticity.</p><p><strong>Objective: </strong>To identify relations between functional neuroplasticity and motor skill changes following gross motor interventions for children with DCP.</p><p><strong>Methods: </strong>There were 17 participants with DCP (ages 8-16 years; 6 females; Gross Motor Function Classification System Level I [n = 9] and II [n = 8]). Each completed a 6-week gross motor intervention program that was directed toward achievement of individualized motor/physical activity goals. Outcomes were assessed pre/post and 4 to 6 months post-intervention (follow-up). An active ankle dorsiflexion task was completed during functional magnetic resonance imaging. The ratio of motor cortical activation volume in each hemisphere was calculated using a laterality index. The <i>Challenge</i> was the primary gross motor skill measure. Change over time and relations among outcomes were evaluated.</p><p><strong>Results: </strong>Challenge scores improved post-intervention (4.57% points [SD 4.45], <i>P</i> = .004) and were maintained at follow-up (0.75% [SD 6.57], <i>P</i> = 1.000). The laterality index for dominant ankle dorsiflexion increased (<i>P</i> = .033), while non-dominant change was variable (<i>P</i> = .534). Contralateral activation (laterality index ≥+0.75) was most common for both ankles. <i>Challenge</i> improvements correlated with increased ipsilateral activity (negative laterality index) during non-dominant dorsiflexion (<i>r</i> = -.56, <i>P</i> = .045). Smaller activation volume during non-dominant dorsiflexion predicted continued gross motor gains at follow-up (<i>R</i><sup>2</sup> = .30, <i>P</i> = .040).</p><p><strong>Conclusions: </strong>Motor cortical activation during non-dominant ankle dorsiflexion is a modest indicator of the potential for gross motor skill change. Further investigation of patterns of neuroplastic change will improve our understanding of effects.</p><p><strong>Clinicaltrials.gov registry: </strong>NCT02584491 and NCT02754128.</p>","PeriodicalId":56104,"journal":{"name":"Neurorehabilitation and Neural Repair","volume":"37 1","pages":"16-26"},"PeriodicalIF":3.7000,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/95/74/10.1177_15459683221143503.PMC9896542.pdf","citationCount":"1","resultStr":"{\"title\":\"Functional Neuroplasticity and Motor Skill Change Following Gross Motor Interventions for Children With Diplegic Cerebral Palsy.\",\"authors\":\"Alicia J Hilderley, F Virginia Wright, Margot J Taylor, Joyce L Chen, Darcy Fehlings\",\"doi\":\"10.1177/15459683221143503\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Gross motor intervention designs for children with diplegic cerebral palsy (DCP) require an improved understanding of the children's potential for neuroplasticity.</p><p><strong>Objective: </strong>To identify relations between functional neuroplasticity and motor skill changes following gross motor interventions for children with DCP.</p><p><strong>Methods: </strong>There were 17 participants with DCP (ages 8-16 years; 6 females; Gross Motor Function Classification System Level I [n = 9] and II [n = 8]). Each completed a 6-week gross motor intervention program that was directed toward achievement of individualized motor/physical activity goals. Outcomes were assessed pre/post and 4 to 6 months post-intervention (follow-up). An active ankle dorsiflexion task was completed during functional magnetic resonance imaging. The ratio of motor cortical activation volume in each hemisphere was calculated using a laterality index. The <i>Challenge</i> was the primary gross motor skill measure. Change over time and relations among outcomes were evaluated.</p><p><strong>Results: </strong>Challenge scores improved post-intervention (4.57% points [SD 4.45], <i>P</i> = .004) and were maintained at follow-up (0.75% [SD 6.57], <i>P</i> = 1.000). The laterality index for dominant ankle dorsiflexion increased (<i>P</i> = .033), while non-dominant change was variable (<i>P</i> = .534). Contralateral activation (laterality index ≥+0.75) was most common for both ankles. <i>Challenge</i> improvements correlated with increased ipsilateral activity (negative laterality index) during non-dominant dorsiflexion (<i>r</i> = -.56, <i>P</i> = .045). Smaller activation volume during non-dominant dorsiflexion predicted continued gross motor gains at follow-up (<i>R</i><sup>2</sup> = .30, <i>P</i> = .040).</p><p><strong>Conclusions: </strong>Motor cortical activation during non-dominant ankle dorsiflexion is a modest indicator of the potential for gross motor skill change. 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引用次数: 1
摘要
背景:对儿童双瘫性脑瘫(DCP)的大运动干预设计需要对儿童神经可塑性的潜力有更好的了解。目的:探讨DCP患儿大肌肉运动干预后功能神经可塑性与运动技能变化的关系。方法:17例DCP患者(年龄8 ~ 16岁;6雌性;大肌肉运动功能分类系统I级[n = 9]和II级[n = 8])。每个人都完成了为期6周的大肌肉运动干预计划，旨在实现个性化的运动/身体活动目标。评估干预前后和干预后4至6个月(随访)的结果。在功能性磁共振成像期间完成了主动踝关节背屈任务。使用侧性指数计算每个半球运动皮质激活体积的比例。挑战是主要的粗大运动技能测试。随时间的变化和结果之间的关系被评估。结果:挑战得分在干预后得到改善(4.57%分[SD 4.45]， P = 0.004)，随访时保持不变(0.75% [SD 6.57]， P = 1.000)。优势型踝关节背屈侧侧指数增高(P = 0.033)，非优势型踝关节背屈侧侧指数变化不大(P = 0.534)。双踝对侧激活(侧度指数≥+0.75)最为常见。挑战改善与非显性背屈时同侧活动(负侧性指数)增加相关(r = -)。56, p = .045)。非显性背屈时较小的激活量预示着随访时持续的大肌肉运动增益(R2 =)。30, p = .040)。结论:非显性踝关节背屈时的运动皮质激活是大运动技能改变的一个适度指标。对神经可塑性改变模式的进一步研究将提高我们对疗效的理解。临床试验。gov注册:NCT02584491和NCT02754128。
Functional Neuroplasticity and Motor Skill Change Following Gross Motor Interventions for Children With Diplegic Cerebral Palsy.
Background: Gross motor intervention designs for children with diplegic cerebral palsy (DCP) require an improved understanding of the children's potential for neuroplasticity.
Objective: To identify relations between functional neuroplasticity and motor skill changes following gross motor interventions for children with DCP.
Methods: There were 17 participants with DCP (ages 8-16 years; 6 females; Gross Motor Function Classification System Level I [n = 9] and II [n = 8]). Each completed a 6-week gross motor intervention program that was directed toward achievement of individualized motor/physical activity goals. Outcomes were assessed pre/post and 4 to 6 months post-intervention (follow-up). An active ankle dorsiflexion task was completed during functional magnetic resonance imaging. The ratio of motor cortical activation volume in each hemisphere was calculated using a laterality index. The Challenge was the primary gross motor skill measure. Change over time and relations among outcomes were evaluated.
Results: Challenge scores improved post-intervention (4.57% points [SD 4.45], P = .004) and were maintained at follow-up (0.75% [SD 6.57], P = 1.000). The laterality index for dominant ankle dorsiflexion increased (P = .033), while non-dominant change was variable (P = .534). Contralateral activation (laterality index ≥+0.75) was most common for both ankles. Challenge improvements correlated with increased ipsilateral activity (negative laterality index) during non-dominant dorsiflexion (r = -.56, P = .045). Smaller activation volume during non-dominant dorsiflexion predicted continued gross motor gains at follow-up (R2 = .30, P = .040).
Conclusions: Motor cortical activation during non-dominant ankle dorsiflexion is a modest indicator of the potential for gross motor skill change. Further investigation of patterns of neuroplastic change will improve our understanding of effects.
Clinicaltrials.gov registry: NCT02584491 and NCT02754128.
期刊介绍：
Neurorehabilitation & Neural Repair (NNR) offers innovative and reliable reports relevant to functional recovery from neural injury and long term neurologic care. The journal''s unique focus is evidence-based basic and clinical practice and research. NNR deals with the management and fundamental mechanisms of functional recovery from conditions such as stroke, multiple sclerosis, Alzheimer''s disease, brain and spinal cord injuries, and peripheral nerve injuries.
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