Changes in diffusion tensor tractographic findings associated with constraint-induced movement therapy in young children with cerebral palsy

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.

Keywords: Cerebral palsy; Constraint-induced movement therapy; Corticospinal tract; Diffusion tensor tractography.