Brain Reorganization following Intervention in Children with Congenital Hemiplegia: A Systematic Review

E Inguaggiato,A Guzzetta,G Sgandurra,G Cioni,S Perazza

doi:10.1155/2013/356275

Abstract

Noninvasive rehabilitation strategies for children with unilateral cerebral palsy are routinely used to improve hand motor function, activity, and participation. Nevertheless, the studies exploring their effects on brain structure and function are very scarce. Recently, structural neuroplasticity was demonstrated in adult poststroke patients, in response to neurorehabilitation. Our purpose is to review current evidence on the effects of noninvasive intervention strategies on brain structure or function, in children with unilateral cerebral palsy. The main literature databases were searched up to October 2013. We included studies where the effects of upper limb training were evaluated at neurofunctional and/or neurostructural levels. Only seven studies met our selection criteria; selected studies were case series, six using the intervention of the constraint-induced movement therapy (CIMT) and one used virtual reality therapy (VR). CIMT and VR seem to produce measurable neuroplastic changes in sensorimotor cortex associated with enhancement of motor skills in the affected limb. However, the level of evidence is limited, due to methodological weaknesses and small sample sizes of available studies. Well-designed and larger experimental studies, in particular RCTs, are needed to strengthen the generalizability of the findings and to better understand the mechanism of intervention-related brain plasticity in children with brain injury.

Highlights

Unilateral cerebral palsy (U-CP) is the most common type of cerebral palsy (CP), with an incidence of 1 in 1000 livebirths [1]
U-CP often leads to delays in motor development or deconditioning of the affected limb, as individuals are inclined to functional compensation with the intact limb rather than attempting to use the involved limb [4]; this may result in suppression of development of cortical representation of the affected limb, and it may further inhibit its functional use [5, 6]
Despite the high number of studies exploring the functional effects of neurorehabilitation in children with unilateral cerebral palsy, relatively little is known on the neurobiological underpinnings of such effects

Summary

Introduction

Unilateral cerebral palsy (U-CP) is the most common type of cerebral palsy (CP), with an incidence of 1 in 1000 livebirths [1]. The upper limb (UL) is more involved than the lower, with impairments of spasticity, sensation, and reduced strength. U-CP often leads to delays in motor development or deconditioning of the affected limb, as individuals are inclined to functional compensation with the intact limb rather than attempting to use the involved limb [4]; this may result in suppression of development of cortical representation of the affected limb, and it may further inhibit its functional use [5, 6]. Primary motor control of the hemiplegic upper limb can be eventually maintained within the spared tissue of the affected hemisphere (ipsilesional reorganization), or it can be reorganized within the unaffected hemisphere, as a result of the complete withdraw of the crossing fibers from the affected

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