Moradi Birgani Parmida, Ashtiyani Meghdad, Jameie Seyed Behnamedin, Shahrokhi Amin, Rahimian Elham, Deevband Mohammad Reza, Mirbagheri M Mehdi
Department of Medical Physics and Biomedical Engineering, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Department of Biomedical Engineering and Medical Physics, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Basic Clin Neurosci. 2025;16(Spec Issue):309-322. doi: 10.32598/bcn.2023.4679.1. Epub 2025 Mar 18.
Gait impairment is one of the consequences of cerebral palsy (CP) as a permanent neurological disorder. The therapy-induced neuroplasticity should be accompanied by functional improvement to have a persistent treatment effect. In this regard, we aimed to determine the correlation between brain functional activity changes and walking capacity improvement following treatments in children with hemiplegic CP (HCP).
Twenty-one spastic HCP children (7-12 years old) were randomly divided into 3 groups. Occupational therapy (OT) was performed for the first group. The second group received repetitive transcranial magnetic stimulation (rTMS) treatment, and the third group underwent anti-gravity treadmill (AlterG system) training. AlterG training and OT were provided for 45 minutes, and rTMS was applied for 20 minutes per session, 3 times per week for 8 weeks. Brain functional activity while executing passive tasks involving knee flexion/extension and ankle plantarflexion/dorsiflexion over the range of motion was quantified using functional magnetic resonance imaging (fMRI). Walking capacity was indexed by clinical measures. Clinical and fMRI evaluations were performed pre- and post-training.
Our results indicate that intensive OT, rTMS, and AlterG training enhance brain functional activity and walking capacity in pediatrics with CP. Also, our results reveal a robust correlation between the corpus callosum (CC) functional activity changes and walking capacity improvement.
Regardless of the type of treatment, the improvement in gait function in children with CP may reflect an increase in brain functional activity in callosal neurons, which may reveal an increase in interhemispheric coupling.
步态障碍是脑瘫（CP）这种永久性神经疾病的后果之一。治疗诱导的神经可塑性应伴随着功能改善，以产生持久的治疗效果。在这方面，我们旨在确定偏瘫型脑瘫（HCP）患儿治疗后大脑功能活动变化与步行能力改善之间的相关性。
21名痉挛型HCP患儿（7 - 12岁）被随机分为3组。第一组进行作业治疗（OT）。第二组接受重复经颅磁刺激（rTMS）治疗，第三组进行反重力跑步机（AlterG系统）训练。AlterG训练和OT每次进行45分钟，rTMS每次应用20分钟，每周3次，共8周。使用功能磁共振成像（fMRI）对在运动范围内执行涉及膝关节屈伸和踝关节跖屈/背屈的被动任务时的大脑功能活动进行量化。步行能力通过临床测量指标来衡量。在训练前后进行临床和fMRI评估。
我们的结果表明，强化OT、rTMS和AlterG训练可增强CP患儿的大脑功能活动和步行能力。此外，我们的结果揭示了胼胝体（CC）功能活动变化与步行能力改善之间存在显著相关性。
无论治疗类型如何，CP患儿步态功能的改善可能反映了胼胝体神经元大脑功能活动的增加，这可能揭示了半球间耦合的增加。
