Cortical reorganisation after Constraint Induced Movement Therapy in children with unilateral Cerebral Palsy - an EEG approach

Plasticity is an important characteristic of the brain. Although different
cortical areas execute different functions, changes occur. Such changes have
been observed after loss of certain functions, for example due to the
amputation of a limb, but also as a result of gaining new skills. Such a shift
in the localization of a brain function is known as Cortical Reorganization.

Children with unilateral Cerebral Palsy (CP) use the affected side of the body
less than the non-affected side. A common therapy of these children consists of
modified Constraint Induced Movement Therapy (mCIMT) in which the children are
stimulated to perform activities with the affected arm/hand, by immobilizing
the not-affected arm/hand for several hours per day during several weeks during
active game-therapy. It is generally assumed that mCIMT leads to cortical
reorganization as a result of which the functionality of the affected arm/hand
will permanently increase.

Functional MRI research has indicated that adult patients with a hemiparesis
due to CVA indeed show cortical reorganization after CIMT (Cramer, et al.
1997). The effect of such a therapy has never been systematically researched in
children with unilateral CP. This is important because these children are often
born with their functional impairments by early damage of the brain. Aspects of
cortical reorganization might be even more extensive in this group than in
adult patients after a CVA. Because fMRI research is considered to be too
invasive for (young) children, the current research proposal is based on
non-invasive EEG measurements. With the use of the advanced method of
source-localization (Van der lubbe, et al. in press) it is possible to study
cortical reorganization following mCIMT in this patient group. Comparable
research has been done in the past in children with Dyslexia (Spironelli, et
al. 2010).The expectation is that the proposed research will give new important
information with relation to the treatment of children with unilateral Cerebral
Palsy.

To study if, how, and to what extent, cortical reorganization occurs in
children with unilateral Cerebral Palsy after mCIMT.

The study is designed as an open randomised study, in which the participants
serve their own controls (comparing affected side with non-affected side).

The amount of discomfort which the participants will experience is minimal and
exists of the placement of a 32-channel EEG-cap and the execution of a simple,
playful computer task of about 10 minutes. In earlier comparable research with
this task it appears that children like to perform this task very much. The
measurement will be performed twice on the location of the therapy and will
take, including the attachment of the EEG equipment, maximally 1 hour at a
time. There are no risks involved with the EEG research. This study is focused
on studying cortical reorganization which will be expected to occur in children
with unilateral cerebral palsy after participation of mCIMT.