运动控制干预改善痉挛性双侧脑瘫儿童的髓鞘形成：弥散张量 MRI 研究。
Improved Myelination following Camp Leg Power, a Selective Motor Control Intervention for Children with Spastic Bilateral Cerebral Palsy: A Diffusion Tensor MRI Study.
机构信息
From the Departments of Bioengineering (A.V., S.H.J.)
Orthopaedic Surgery (A.V., L.A.S., E.G.F.).
出版信息
AJNR Am J Neuroradiol. 2023 Jun;44(6):700-706. doi: 10.3174/ajnr.A7860. Epub 2023 May 4.
BACKGROUND AND PURPOSE
Children with spastic cerebral palsy have motor deficits associated with periventricular leukomalacia indicating WM damage to the corticospinal tracts. We investigated whether practice of skilled lower extremity selective motor control movements would elicit neuroplasticity.
MATERIALS AND METHODS
Twelve children with spastic bilateral cerebral palsy and periventricular leukomalacia born preterm (mean age, 11.5 years; age range, 7.3-16.6 years) participated in a lower extremity selective motor control intervention, Camp Leg Power. Activities promoted isolated joint movement including isokinetic knee exercises, ankle-controlled gaming, gait training, and sensorimotor activities (3 hours/day, 15 sessions, 1 month). DWI scans were collected pre- and postintervention. Tract-Based Spatial Statistics was used to analyze changes in fractional anisotropy, radial diffusivity, axial diffusivity, and mean diffusivity.
RESULTS
Significantly reduced radial diffusivity ( < . 05) was found within corticospinal tract ROIs, including 28.4% of the left and 3.6% of the right posterior limb of the internal capsule and 14.1% of the left superior corona radiata. Reduced mean diffusivity was found within the same ROIs (13.3%, 11.6%, and 6.6%, respectively). Additionally, decreased radial diffusivity was observed in the left primary motor cortex. Additional WM tracts had decreased radial diffusivity and mean diffusivity, including the anterior limb of the internal capsule, external capsule, anterior corona radiata, and corpus callosum body and genu.
CONCLUSIONS
Myelination of the corticospinal tracts improved following Camp Leg Power. Neighboring WM changes suggest recruitment of additional tracts involved in regulating neuroplasticity of the motor regions. Intensive practice of skilled lower extremity selective motor control movements promotes neuroplasticity in children with spastic bilateral cerebral palsy.
背景与目的
患有痉挛性脑瘫的儿童存在与脑室周围白质软化相关的运动缺陷，这表明皮质脊髓束的白质损伤。我们研究了熟练的下肢选择性运动控制运动的练习是否会引起神经可塑性。
材料与方法
12 名患有痉挛性双侧脑瘫和脑室周围白质软化的早产儿（平均年龄 11.5 岁；年龄范围 7.3-16.6 岁）参与了下肢选择性运动控制干预，即 Camp Leg Power。活动促进了孤立关节运动，包括等速膝关节运动、踝关节控制游戏、步态训练和感觉运动活动（每天 3 小时，15 次，1 个月）。在干预前后采集弥散张量成像扫描。使用基于束的空间统计学分析各向异性分数、径向弥散度、轴向弥散度和平均弥散度的变化。
结果
发现皮质脊髓束 ROI 内的径向弥散度显著降低（<0.05），包括左侧内囊后肢的 28.4%和右侧的 3.6%以及左侧上辐射冠的 14.1%。在同一 ROI 内发现平均弥散度降低（分别为 13.3%、11.6%和 6.6%）。此外，左侧初级运动皮层的径向弥散度也降低。其他白质束的径向弥散度和平均弥散度也降低，包括内囊前肢、外囊、前辐射冠、胼胝体体部和膝部。
结论
Camp Leg Power 后皮质脊髓束的髓鞘化得到改善。邻近白质的变化表明，参与调节运动区神经可塑性的其他束被募集。熟练的下肢选择性运动控制运动的强化练习促进了痉挛性双侧脑瘫儿童的神经可塑性。
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