Electroencephalography (EEG) and Diffusion Tensor Magnetic Resonance Imaging (DT-MRI) correlates of motor behaviour in children and adolescents with unilateral Cerebral Palsy (uCP): effects of intervention

Children with unilateral Cerebral Palsy (uCP) use their affected side less than
their non-affected side. Several intervention programs have been developed to
increase hand/arm capacity of the affected side. It has been proposed that a
lasting increase in hand/arm capacity of the affected side due to these
interventions can be largely ascribed to cortical reorganization.
Magnetic Resonance Imaging (MRI) research in hemiparetic patients recovering
from a Cerebral Vascular Accident (CVA) indeed showed anatomical changes in the
neural substrate after intervention. However, to our knowledge, the effects of
intervention on the neural substrate of children with unilateral CP have not
yet been systematically studied. Such a study would be especially valuable
because these children have acquired their motor deficit very early in life and
therefore are fundamentally different compared to the adult hemiparetic
patients. Thus, with respect to rehabilitation, these children have to learn
and develop new skills unlike older CVA patients whose aim it is to regain
skills.
Recent brain imaging techniques provide an excellent way to study the involved
anatomical structures underlying the clinical syndrome of CP with a high
spatial resolution. Therefore, in our research, we first of all aim to obtain
Diffusion Tensor Imaging (DTI) during MRI scanning to determine the white
matter anatomy of the cortico-spinal tracts of both ipsi- and contra-lateral
hemispheres in relation to the affected side before and after an intervention.
The (remaining) integrity of these tracts has been associated with outcome of
intervention.
In addition, we would like to determine the effects of intervention on
functional cortical processes involved in motor behavior (i.e. response
selection, response initiation and response inhibition). A suitable method to
map functionality of cortical areas is to measure the EEG and Event Related
Potentials in the ongoing EEG related to i.e. sensory stimulation and motor
behavior.
Combined DT-MRI and EEG/ERP research can provide good insight in both
anatomical and functional aspects of the neural substrate involved in motor
behavior before and after different intervention programs.
We expect that our currently proposed research will lead to clinically relevant
information with respect to tailored treatment programs for individual
children. Because we propose to study unilaterally affected children, comparing
affected and non-affected side before and after intervention, there is no need
to include a group of typically developing children.

Main group:
EEG/ERP study (children and adolescents 4-17 years old)
To quantify the effects of different intervention programs (mCIMT; BiT;
combined mCIMT-BiT) on functional cortical processes involved in different
aspects of motor behavior (i.e. response selection, response initiation, and
response inhibition).

Sub group:
DT-MRI study (adolescents 12-17 years old)
To determine parameters by means of Diffusion Tensor MRImaging (DT-MRI) and
subsequent tractography. Main aim is to quantify the anatomy of the
cortico-spinal tracts from both the ipsi- and contra-lateral hemispheres in
relation to both the affected and non-affected hand/arm. The remaining
integrity of these tracts has been previously related to intervention outcome.

The study is designed as an quasi experiment, in which the affected and
non-afected side before and after intervention all serve as within subject
variables.

Regular care

Main group:
The amount of discomfort which the participants will experience is minimal and
exists of the placement of a 32-channel EEG-cap and the participation in
different, playful computer-game-like tasks each of about 5 till 10 minutes. In
our previous pilot, it appeared that children enjoyed to participate in these
computer-game-like tasks.
There are no risks involved with EEG research. The duration will be maximally
30 minutes for EEG preparation (approximately 20-30 minutes). During the
adjustment of the EEG electrode cap, the participant has the opportunity to
watch a cartoon DVD on a laptop. After preparation, the computer tasks will
last maximally 45 minutes (including breaks).
The measurements will be performed twice (once before intervention and once
after intervention) at the location of the child*s Rehabilitation Centre and is
therefore a familiar environment. Parents may be present during the
measurements. Children will receive a small present after participation (value
ca 5 euro).

Sub group:
The DT-MRI measurement will last about 30 minutes and is not invasive. The
adolescents must be able to lie down motionless during brief periods of
scanning. There are no health-risks involved in MRI. Travel expenses will be
refunded and participants will receive a gift voucher of 20 euro.