The LINE (Laboratory for Investigative Neurophysiology), Radiology Department and Neuropsychology Service, University Hospital Center and University of Lausanne, 1011 Lausanne, Switzerland.
Information Systems Institute at the University of Applied Sciences Western Switzerland (HES-SO Valais), 3960 Sierre, Switzerland.
Neural Plast. 2018 Nov 8;2018:1891978. doi: 10.1155/2018/1891978. eCollection 2018.
Cerebral palsy (CP) is predominantly a disorder of movement, with evidence of sensory-motor dysfunction. CIMT is a widely used treatment for hemiplegic CP. However, effects of CIMT on somatosensory processing remain unclear. To examine potential CIMT-induced changes in cortical tactile processing, we designed a prospective study, during which 10 children with hemiplegic CP (5 to 8 years old) underwent an intensive one-week-long nonremovable hard-constraint CIMT. Before and directly after the treatment, we recorded their cortical event-related potential (ERP) responses to calibrated light touch (versus a control stimulus) at the more and less affected hand. To provide insights into the core neurophysiological deficits in light touch processing in CP as well as into the plasticity of this function following CIMT, we analyzed the ERPs within an electrical neuroimaging framework. After CIMT, brain areas governing the more affected hand responded to touch in configurations similar to those activated by the hemisphere controlling the less affected hand before CIMT. This was in contrast to the affected hand where configurations resembled those of the more affected hand before CIMT. Furthermore, dysfunctional patterns of brain activity, identified using hierarchical ERP cluster analyses, appeared reduced after CIMT in proportion with changes in sensory-motor measures (grip or pinch movements). These novel results suggest recovery of functional sensory activation as one possible mechanism underlying the effectiveness of intensive constraint-based therapy on motor functions in the more affected upper extremity in CP. However, maladaptive effects on the less affected constrained extremity may also have occurred. Our findings also highlight the use of electrical neuroimaging as feasible methodology to measure changes in tactile function after treatment even in young children, as it does not require active participation.
脑瘫（CP）主要是一种运动障碍疾病，伴有感觉运动功能障碍的证据。强制性运动疗法（CIMT）是治疗偏瘫 CP 的常用方法。然而，CIMT 对体感处理的影响仍不清楚。为了研究皮质触觉处理中潜在的 CIMT 诱导变化，我们设计了一项前瞻性研究，在此期间，10 名偏瘫 CP 儿童（5 至 8 岁）接受了为期一周的非可移除硬约束 CIMT 强化治疗。在治疗之前和之后，我们记录了他们的皮质事件相关电位（ERP）对校准轻触（与对照刺激相比）在更受影响和较少受影响的手上的反应。为了深入了解 CP 中轻触处理的核心神经生理缺陷以及 CIMT 后该功能的可塑性，我们在电神经影像学框架内分析了 ERP。在 CIMT 之后，控制更受影响的手的大脑区域对触摸的反应类似于在 CIMT 之前控制较少受影响的手的半球激活的反应。这与受影响的手形成对比，受影响的手的反应类似于 CIMT 之前的更受影响的手的反应。此外，使用分层 ERP 聚类分析确定的功能失调的脑活动模式在 CIMT 后似乎减少了，与感觉运动测量（抓握或捏合运动）的变化成比例。这些新的结果表明，作为强化基于约束的治疗对 CP 中更受影响的上肢运动功能有效性的一种可能机制，功能性感觉激活的恢复。然而，对受约束的较少受影响的四肢也可能发生了适应性不良的影响。我们的研究结果还强调了使用电神经影像学作为可行的方法来测量治疗后触觉功能的变化，即使在幼儿中也是如此，因为它不需要主动参与。
