Article

Intensive bimanual therapy can improve hand function in children with
unilateral spastic cerebral palsy (USCP). We compared the effects of structured
bimanual skill training versus unstructured bimanual practice on motor outcomes
and motor map plasticity in children with USCP.
Objective : We hypothesized that
structured skill training would produce greater motor map plasticity than
unstructured practice. Methods Twenty children with USCP (average age 9.5; 12
males) received therapy in a day camp setting, 6 h/day, 5 days/week, for 3 weeks.
In structured skill training (n = 10), children performed progressively more
difficult movements and practiced functional goals. In unstructured practice (n =
10), children engaged in bimanual activities but did not practice skillful
movements or functional goals. We used the Assisting Hand Assessment (AHA),
Jebsen-Taylor Test of Hand Function (JTTHF), and Canadian Occupational
Performance Measure (COPM) to measure hand function. We used single-pulse
transcranial magnetic stimulation to map the representation of first dorsal
interosseous and flexor carpi radialis muscles bilaterally. Results Both groups
showed significant improvements in bimanual hand use (AHA; P < .05) and hand
dexterity (JTTHF; P < .001). However, only the structured skill group showed
increases in the size of the affected hand motor map and amplitudes of motor
evoked potentials (P < .01). Most children who showed the most functional
improvements (COPM) had the largest changes in map size. Conclusions These
findings uncover a dichotomy of plasticity: the unstructured practice group
improved hand function but did not show changes in motor maps. Skill training is
important for driving motor cortex plasticity in children with USCP.
CI - (c) The Author(s) 2016.

Langue : ANGLAIS