Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium.
Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium.
Neurorehabil Neural Repair. 2020 Jun;34(6):533-546. doi: 10.1177/1545968320918841. Epub 2020 May 14.
. In children with unilateral cerebral palsy (UCP), the fibers of the corticospinal tract (CST) emerging from the lesioned hemisphere are damaged following the initial brain injury. The extent to which the integrity of these fibers is restorable with training is unknown. . To assess changes in CST integrity in children with UCP following Hand-and-Arm-Bimanual-Intensive-Therapy-Including-Lower-Extremity (HABIT-ILE) compared to a control group. . Forty-four children with UCP participated in this study. Integrity of the CSTs was measured using diffusion tensor imaging before and after 2 weeks of HABIT-ILE (treatment group, n = 23) or 2 weeks apart without intensive treatment (control group, n = 18). Fractional anisotropy (FA) and mean diffusivity (MD) were the endpoints for assessing the integrity of CST. . As highlighted in our whole tract analysis, the FA of the CST originating from the nonlesioned and lesioned hemispheres increased significantly after therapy in the treatment group compared to the control group (group * test session interaction: < .001 and = .049, respectively). A decrease in MD was also observed in the CST emerging from the nonlesioned and lesioned hemispheres (group * time interaction: both < .001). In addition, changes in manual ability correlated with changes in FA in both CSTs ( = 0.463, = .024; = 0.643, < .001) and changes in MD in CST emerging from nonlesioned hemisphere ( = -0.662, < .001). . HABIT-ILE improves FA/MD in the CST and hand function of children with UCP, suggesting that CST fibers retain a capacity for functional restoration. This finding supports the application of intensive motor skill training in clinical practice for the benefit of numerous patients.
在单侧脑瘫（UCP）患儿中，皮质脊髓束（CST）的纤维在初始脑损伤后从受损半球中出现受损。这些纤维的完整性在训练中可以恢复到何种程度尚不清楚。
评估与对照组相比，在手和手臂双手密集治疗（包括下肢）（HABIT-ILE）后，UCP 患儿的 CST 完整性发生变化。
44 名 UCP 患儿参加了这项研究。在 2 周的 HABIT-ILE（治疗组，n = 23）或 2 周无密集治疗（对照组，n = 18）前后，使用弥散张量成像测量 CST 的完整性。各向异性分数（FA）和平均弥散度（MD）是评估 CST 完整性的终点。
正如我们的整个束分析所强调的，与对照组相比，治疗组中 CST 的 FA 源自非损伤半球和损伤半球在治疗后显著增加（组测试会话交互作用：均<0.001 和=0.049）。还观察到 CST 中 MD 从非损伤半球和损伤半球出现下降（组时间交互作用：均<0.001）。此外，手功能的变化与 CST 中 FA 的变化（=0.463，=0.024；=0.643，<0.001）和源自非损伤半球的 CST 中 MD 的变化（=0.662，<0.001）相关。
HABIT-ILE 可改善 UCP 患儿 CST 的 FA/MD 和手功能，提示 CST 纤维保留功能恢复的能力。这一发现支持在临床实践中应用强化运动技能训练，使众多患者受益。
