Research Report Abstracts - Gesundheit

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sided hemiplegia, GMFCS I = 8, II = 22; MACs I = 7, II = 22,
III = 1, all with predominant spasticity) were assessed.
Methods: Thirty children completed the structural MRI
T2-weighted anatomical, MR angiographic and 3D T1 volumes.
Function on the Melbourne Assessment of Unilateral
Upper Limb Function (MUUL), Assisting Hand Assessment
(AHA) and Jebsen Taylor Hand Function Test (JTHFT) were
assessed.
Analysis: SPSS v15.0 with p-values 2-tailed, p < 0.05.
Impairment data (2 pt discrimination, stereognosis, grip
strength) and activity data (JTHFT, MUUL, AHA) were
compared between limbs using Wilcoxon signed rank test.
Classification of MRI (3 groups), MRI severity by (i) lesion
laterality (unilateral/bilateral), (ii) brainstem involvement
(present/absent) and (iii) extent of the brain lesion (number
of anatomical lobes involved) were compared with impairment
and activity data using Mann–Whitney test and the
Kruskal–Wallis test respectively.
Results: Of the 30 children 25 had unilateral lesions (83%),
5 bilateral lesions. Pathogenesis was classified as brain malformation
(n = 2); periventricular white matter PWM lesions
(n = 16) and grey matter GM lesions (n = 11) with average
number of lobes involved for brain malformations (1),
PWM (2.3) and GM (2.6). Comparing pathogenesis, the
PWM group were superior to the GM group on 2pt discrimination
(z = −2.161, p = 0.03), stereognosis (z = −2.690,
p = 0.007), and bimanual co ordination AHA (z = −2.570;
p = 0.01), with a trend towards better performance on speed
testing (JTHFT, z = −1.875; p = 0.06); but there were no differences
in grip strength, and unimanual capacity. There were
no differences between groups for MRI severity, laterality,
brainstem involvement, lesion extent on JTHFT, MUUL and
AHA, though there was trend for the milder lesions to perform
better on the AHA (chi-sq = 5.541, p = 0.06).
Conclusions: In this study of pathogenesis of congenital
hemiplegia there is a clear relationship between type of lesion
and impairment measures and activity limitations. The results
imply that the underlying pathogenesis might carry important
prognostic information, with PWM lesions having fewer
functional impairments (sensory, speed and bimanual coordination)
than Grey Matter lesions. These findings could
help to predict functional performance based on MR characteristics
and would allow appropriate therapy to be instituted
to maximize potential at a young age.
Implications: Children with predominant Periventricular
white matter lesions will have superior upper limb bimanual
co-ordination than children with grey matter lesions so
that the GM lesion group will require early bimanual training.
Keywords: Congenital hemiplegia; Brain structure; Upper
limb function
Funding acknowledgements: National Health and Medical
Research Council of Australia Project Grant (468300),
Dora Lush post graduate scholarship (384488, LS) and Post
Doctoral Fellowship (RB).
Ethics approval: Ethics committees at the Royal Childrens
Hospital Brisbane and the University of Queensland.
Research Report Poster Discussion Session
Number: RR-PDS-2932 Wednesday 22 June 16:00
RAI: G102-103 (Topaz)
USE DEPENDENT NEUOROPLASTICITY IN A
RANDOMISED TRIAL OF CONSTRAINT INDUCED
MOVEMENT THERAPY VERSUS BIMANUAL
TRAINING FOR CHILDREN WITH CONGENITAL
HEMIPLEGIA
Boyd R. 1,2 , Sakzewski L. 1 , Ziviani J. 2
1The University of Queensland, Qld Cerebral Palsy and
Rehabilitation Research Centre, Brisbane, Australia, 2The University of Queensland, School of Rehabilitation Science,
Brisbane, Australia
Purpose: To understand the neural mechanisms underlying
response to Constraint Induced Movement Therapy (CIMT)
compared with Bimanual Training (BIM).
Relevance: Evidence for neuroplasticity in response to certain
methods of upper limb rehabilitation guides decision
making as to the content of intervention programs in children
with congenital hemiplegia. Design: Single blind matched
pairs randomised comparison trial.
Participants: Thirty children with congenital hemiplegia (15
pairs) matched for age (mean 10.2 yrs), gender (15 males) and
side of hemiplegia (13 right) were randomly allocated.
Methods: Each intervention was delivered in a “day camp”
for 6 hours/day over 10 days (60 hours). All groups received
the same intensity/duration but differing methods. 27 children
(15 CIMT, 12 BIM, MACs I = 5, II = 22) completed the structural
MRI (including 18 PVL, 11 cortical/deep gray matter, 1
malformation and 1 other). Whole-brain fMRI studies (3 T)
were conducted for a motor & sensory task (active/passive
wrist extension vs rest in a block design). On Transcranial
Magnetic Stimulation (TMS) bilateral motor threshold and
constructed recruitment curves at 100%, 110%, 120%, 130%
and 140% of MT were measured. Function on Melbourne
Unilateral Upper Limb Function (MUUL), Assisting Hand
Assessment (AHA) and Jebsen Taylor Hand Function Test
(JTHFT) were assessed.
Analysis: Data were compared between groups at baseline
and 3 weeks, 6 months using independent t-tests and within
groups over time using paired t-tests (STATA 10.0).
Results: After random allocation, there was no difference
between groups on any baseline measure. For BIM group
on TMS there were no changes in cortical excitability in
either side (impaired/unimpaired MD 0.14/0.7 at 3 weeks,
0.61/0.16 at 6 months, NS). In the CIMT group there were a
significant increase in excitability on the impaired motor cortex
at f/u compared to the baseline line at the 120%, 130%
and 140% intensities (impaired/unimpaired MD 0.06/0.29 at
3 weeks, 0.24/0.38 at 6 months). There were no differences
in the normal side. The CIMT group made greater gains on
unimanual capacity (MUUL) at 3 weeks and 6 months (MD