Anatomical and Functional Imaging Correlates of Chronic Pain in Cerebral Palsy
Conditions: Cerebral Palsy, Chronic Pain
Sponsor: Hugo W. Moser Research Institute at Kennedy Krieger, Inc.

 
 
 
Kennedy Krieger 
 Anatomical and 
functional imaging 
correlates of chronic 
pain in cerebral palsy 
August 23rd, 2021 

Date: 8/23/2021 
Principal Investigator: Eric Chin 
Application Number: IRB00181801 
JHMIRB eFormA 01 
Version 3 Dated:  06/2007 
Page 1 of 10 
 
 
 
 
JHM IRB - eForm A – Protocol 
 
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Anatomical and functional imaging correlates of chronic pain in cerebral palsy 
 
1. 
Abstract 
a. Provide no more than a one page research abstract briefly stating the problem, the research 
hypothesis, and the importance of the research. 
 
Chronic pain is reported in 2/3 of adults with cerebral palsy (CP) 1. Physicians have historically attributed 
pain to orthopedic complications, tone abnormalities, and systemic complications 2, which would be 
expected to be nociceptive. However, over 40% of hemiplegic CP respondents with pain report 
neuropathic pain characteristics 3. Alterations in brain somatosensory pathways have been found both 
structurally and functionally. Sensory thalamocortical white matter tracts appear to be affected in children 
with CP born preterm 4. Cortical somatosensory representation also appears to be altered 5. Decreased 
mechanical pain sensitivity 6 and higher-level cortical sensory deficits 7 have been described in CP. 
Contributions of sensory deficits and alterations in cortical processing to chronic pain symptoms frequently 
reported in CP are not well-understood. We hypothesize that neuropathic pain amplification in CP as well 
as motor and other sensory deficits are symptoms of the same widespread sensorimotor network 
disruption extending beyond periventricular white matter. This hypothesis predicts that individuals with 
more severe motor deficits have more features of neuropathic pain as well as more abnormal anatomic 
connectivity in somatosensory networks. We anticipate data that will increase understanding of chronic 
pain in CP by identifying presence of a component of neuropathic pain. Better understanding could affect 
management of pain in patients with CP. 
 
2. 
Objectives (include all primary and secondary objectives) 
 
Primary: Identify and characterize sensorimotor network disruption patterns associated with chronic pain 
and motor deficits in CP 
 
Secondary: 
● Improve understanding of anatomical brain network changes in CP associated with sensory 
deficits and pain 
● Identify non-invasive imaging-based neurobiomarkers applicable to sensory loss and pain in CP 
 
 
3. 
Background (briefly describe pre-clinical and clinical data, current experience with procedures, 
drug or device, and any other relevant information to justify the research) 
 
A diagnosis of CP implies an early, non-progressive brain injury 8. Motor learning studies have shown that 
white matter networks can selectively change diffusion parameters in an experience-dependent fashion 
over as few as 6 weeks 9. Careful examination of structural changes in the pain network thus allows better 
understanding not only of the initial injury but also of network-wide remodeling. We posit (based on 

Date: 8/23/2021 
Principal Investigator: Eric Chin 
Application Number: IRB00181801 
JHMIRB eFormA 01 
Version 3 Dated:  06/2007 
Page 2 of 10 
 
 
 
 
selective spinal volume loss seen in our animal models) that remodeling extends into ascending 
spinothalamic tracts in the spine. 
PVWMI is the most common MRI finding in CP 10. Though attention was initially largely paid to 
motor fibers, our lab has identified that sensory fibers in the posterior thalamic radiations appear to be 
particularly affected and that apparent decreased integrity of these fibers predicts motor functioning 4. More 
recent studies suggest that posterior periventricular white matter represents a nexus with high          
densities of intertwined long-distance afferent, efferent, crossing, and associative fibers 11. The 
conventional DTI MRI model is mathematically unable to map white matter tracts near fiber crossings 12 -- 
including components of interest in somatosensation and CP (e.g. posterior thalamic radiations, 
corticocortical association fibers). Next-generation diffusion MRI models such as high angular resolution 
diffusion imaging (HARDI) 12 able to overcome this limitation have been demonstrated but are not yet 
commonplace. Use of higher-order diffusion models allow visualization of corticocortical connections and 
has identified previously undiscovered white matter tracts 13. Higher-order diffusion models have been 
used successfully in CP 14 but have not been used to evaluate somatosensory pain networks. 
 
4. 
Study Procedures 
a. Study design, including the sequence and timing of study procedures 
(distinguish research procedures from those that are part of routine care). 
 
 
Recruitment: 
Clinic Screening 
-screen 
up 
to 
500 
individuals in total 
ICTR Screening 
-screen 
up 
to 
5000 
individuals in total 
Survey 
participation 
(under 
waiver 
of 
documentation 
of 
informed consent) 
Remote consent 
On-site visit 2 
-up to 60 participants (50 
individuals with CP, 10 
control 
participants) 
meeting criteria 
Kirby Center 
2020-onwards: 
Resuming 
- Use ICTR/Epic filters 
containing basic 
eligibility criteria (e.g. 
diagnosis, age) to 
distribute flyer/link 
-Interested  individuals 
fill out a REDcap form 
containing 
remaining 
eligibility criteria 
-Individuals 
meeting 
eligibility criteria sent 
survey 
-Individuals 
 
who 
completed 
survey, 
if 
interest 
indicated, 
contacted         regarding 
further 
participation 
(allowing 
review 
of 
medical records/imaging 
results, interest in later 
in-person visits) 
-Secure REDcap survey 
link to online consent 
document sent; consent 
reviewed synchronously 
via telephone or secure 
Enterprise Zoom 
- MRI/fMRI scan (90m) 
 
Paper documents indicating consent will be kept in a locked compartment in a locked room, and only 
investigators will have access. Following consent, subjects will be assigned a pseudorandom numeric 
identifier (see separate identifier number table); the table of research identifier/personally-identifying 
subject correspondences will be kept in a single file on the secure KKI server system. 

Date: 8/23/2021 
Principal Investigator: Eric Chin 
Application Number: IRB00181801 
JHMIRB eFormA 01 
Version 3 Dated:  06/2007 
Page 3 of 10 
 
 
 
 
ICTR-based screening: We will consult with ICTR CCDA to identify individuals 1) with a diagnosis of 
CP (ICD-9 343.* OR   ICD-9 333.71 OR ICD-10 G80.*), 2) age 8 or older, and 3) had not previously 
completed this study, and 4) had not previously been contacted about this study and explicitly declined to 
participate. 
 
Group 1: Individuals with active Epic MyChart access: Individuals meeting criteria 1-4 who 
have active Epic MyChart will be contacted via the JH ICTR MyChart recruitment service. They will 
receive an IRB-approved recruitment flyer providing interested individuals with a link to complete 
screening. Follow-up messages may be sent to individuals who do not respond. 
 
Group 2: Individuals without active Epic MyChart access: A list of email addresses for 
individuals meeting criteria 1-4 who do not have active Epic MyChart will be provided by JH ICTR 
CCDA. The same IRB-approved recruitment flyer will be sent once via JH REDcap providing interested 
individuals with a link to complete screening. 
 
Survey participation: Individuals who complete screening as above and qualify will receive email survey 
invitations. These invitations will contain the following text: 
“Your completion of the survey or questionnaire will serve as your consent to be in this research study.” 
 
Survey (via JH REDcap) will also query willingness to 1) permit access to medical records and 2) to 
participate in in-person research. Indication of interest in either will prompt contact to obtain informed 
consent. 
 
Example questionnaire protocol: 
 
CFCS 
Level 
Description 
Self 
questionnaire 
Caregiver 
questionnaire usage 
I 
A person independently and effectively 
alternates between being a sender and 
receiver of information with most people in 
most environments. 
Long form 
(~100 items) 
Validation only 
II 
A person independently alternates between 
being a sender and receiver with most people 
in most environments but the conversation 
may be slower. 
Short form (~65 
items) 
Validation only 
III 
A person usually communicates effectively 
with familiar communication partners, but not 
unfamiliar partners, in most environments. 
Short form (~65 
items) 
Validate pain report, 
supplement objective 
information 
IV 
The person is not always consistent at 
communicating with familiar communication 
partners. 
Primary information 
source 

Date: 8/23/2021 
Principal Investigator: Eric Chin 
Application Number: IRB00181801 
JHMIRB eFormA 01 
Version 3 Dated:  06/2007 
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V 
A person is seldom able to communicate 
effectively even with familiar people. 
Primary information 
source 
 
 
Example adult vs. pediatric battery: 
 
Current adult instruments 
(self-report and self/caregiver 
questionnaire) 
Pediatric Self-report 
Pediatric Parent Questionnaire 
PROMIS Pain Intensity 3a 
PROMIS Ped Pain Intensity SF 1a 
PROMIS Ped Proxy Pain Intensity SF 1a 
PROMIS Pain Interference 4a 
PROMIS Ped Pain Interference SF 8a 
PROMIS Ped Proxy Pain Interference SF 8a 
PROMIS Pain Behavior 7a 
PROMIS Ped Pain Behavior SF 8a 
PROMIS Ped Proxy Pain Behavior SF 8a 
PROMIS Pain Quality 
PROMIS Ped Pain Quality SF 8a 
- 
CPUP Pain location 
CPUP Pain location (Westbom 2017) 
CPUP Pain location 
PainDETECT 
- 
- 
AQoL-4D 
KIDSCREEN-10 (Dickenson 2007) 
KIDSCREEN-10 Parent form 
PHQ-4 
PHQ-4 
- 
PCS 
PCS-C 
- 
PSS 
PSS-C (White 2014) 
- 
ISI 
- 
PISI (Byars 2016) 
SOAPP-R 
NIDA-modified ASSIST – Substance use 
NIDA-modified ASSIST – all 
CPCI 
KCS 
- 
Vineland-3 (caregiver report) 
Vineland-3 (caregiver report) 
BRIEF-A (self-report or 
caregiver report) 
BRIEF-2 Self-report 
BRIEF-2 Parent report 
 
Review of medical records: Following consent, medical records will be reviewed and extracted by 
provider-level research associates (for subjects with CP only). Data extracted from the medical record, the 
structured interview, and the structured physical exam will be entered by provider-level research associates 
into a database indexed by the research identifier number via a secure data entry system (REDCap, 
Nashville, TN) recording data directly into secure JH servers. Extant brain and spine imaging will be stored 
as de-identified DICOM files on secure KKI servers. Items for the REDCap form (see separate sample 
data sheet for information extracted from the medical record, from the structured interview, and 
from the structured physical examination) are primarily based on the CP Research Network (CPRN) 
database entries but are expanded using validated instruments to NIH-NINDS recommended common data 
elements (CDE) for CP. Instruments include quality of life scales (AQoL-8D) and the NIH-developed 
PROMIS pain scales. The collected information is designed to be cross-compliant with both NIH and 
CPRN standards while adequately addressing the question at hand and minimizing burden to subjects. 
 
Structured Interview and Physical Examination (discontinued post-COVID restrictions): Information 
not attainable from the medical record (e.g. subjective measures regarding pain, quality of life, and 
sociopsychological functioning) will be obtained via a structured interview between a provider-level 
research associate and the subject +/- caretaker. The subject +/- caretaker will communicate responses, 
which will be recorded into RedCAP in real-time by the research associate. The degree of reliance on 
individual interview responses vs. pre-filled questionnaire will be determined by degree of communicative 
ability (example breakdown in table below). A non-invasive physical examination will then document and 
quantify motor abnormalities (e.g. grading of spasticity and dystonia) as well as other contributing 

Date: 8/23/2021 
Principal Investigator: Eric Chin 
Application Number: IRB00181801 
JHMIRB eFormA 01 
Version 3 Dated:  06/2007 
Page 5 of 10 
 
 
 
 
abnormalities (e.g. balance abnormalities or orthopedic deformities), which will similarly be recorded into 
REDCap in real-time by the research associate. In the process of optimizing the structured interview, we 
may reformat items and add or remove interview instruments but will maintain overall interview/exam 
length less than 2 hours. If a subject desires, the study visit can be halted at any time and either continued 
at a later date or not. 
 
Analysis of existing neuroimaging: Previously-acquired traditional MRI obtained for clinical purposes 
will be requested and reviewed to detect correlation between routine neuroimaging markers of perinatal 
brain injury and CP and pain. If of suitable quality, quantitative analysis methods (e.g. analysis of brain 
lobe and ventricular volumes for volumetric anatomical sequences, analysis of white matter volumes from 
DTI sequences) may be applied to prior images. 
 
MR Scanning Methods: Research unsedated MRI scans (outside of usual care) will be performed using a 
3T Philips scanner at the F.M. Kirby Research Center. An MRI scanning protocol will be at the F.M. Kirby 
Research Center; the protocol will not last more than 1.5 hours. Acquisitions will include a triplanar survey, 
functional and anatomical multi-slice imaging of the brain as well as MRI of selected spinal levels. 
Protocols will be used that do not involve use of contrast agents and limit power/tissue absorption as well  
as otherwise remain within FDA and Kirby Center safety regulations. When possible, MRI will be 
performed within 3 months of initial survey/interview administration. If MRI is scheduled >3 months after 
initial survey/interview administration, a brief survey will be re-administered to screen for changes in 
pain/clinical status. 
 
b. Study duration and number of study visits required of research participants. 
 
Our imaging protocol will require no more than 1.5 hours of scan time per participant; participants will be 
selected who can complete scanning in one session. 
 
 
N/A 
N/A 
c. Blinding, including justification for blinding or not blinding the trial, if applicable. 
 
d. Justification of why participants will not receive routine care or will have current therapy 
stopped. 
 
e. Justification for inclusion of a placebo or non-treatment group. 
A control group of typical subjects without CP with groupwise similar ages and genders will be included to 
demonstrate typical norms. 
 
 
N/A 
 
 
N/A 
f. Definition of treatment failure or participant removal criteria. 
 
g. Description of what happens to participants receiving therapy when study ends or if a 
participant’s participation in the study ends prematurely. 
 
5. 
Inclusion/Exclusion Criteria 
 
Subjects with CP: Caregiver questionnaire only 
Inclusion criteria (must be YES to all): 
1) Individual 8+ years of age 
2) Diagnosis of cerebral palsy 

Date: 8/23/2021 
Principal Investigator: Eric Chin 
Application Number: IRB00181801 
JHMIRB eFormA 01 
Version 3 Dated:  06/2007 
Page 6 of 10 
 
 
 
 
 
Subjects with CP: Core Study (Survey) 
Inclusion criteria (must be YES to all): 
1) Individual 8+ years of age 
2) Adult subject able to indicate understanding and affirmative consent 
OR 
Adult/child subject unable to indicate understanding and affirmative consent AND subject assents AND 
LAR consents 
3) Diagnosis of cerebral palsy 
4) CFCS I-III and able to respond unambiguously to at least 65 multiple-choice items 
 
Control subjects: Core Study (Survey) 
Inclusion criteria (must be YES to all): 
1) Individual 8+ years of age 
2) Adult subject able to indicate understanding and affirmative consent 
OR 
Adult/child subject unable to indicate understanding and affirmative consent AND subject assents AND 
LAR consents 
 
Exclusions (must be NO to all): 
1) Clinically-significant neurologic or developmental diagnosis 
 
Subjects with CP undergoing MRI 
Inclusion criteria (must be YES to all): 
1) Individual 8+ years of age 
2) Adult subject able to indicate understanding and affirmative consent 
OR 
Adult subject unable to indicate understanding and affirmative consent AND subject assents AND LAR 
consents 
3) Diagnosis of cerebral palsy 
4) Clinical imaging demonstrating isolated periventricular white matter injury 
5) Clinical judgment that all neurologic symptoms are attributable to non-progressive periventricular white 
matter injury 
6) Able to lie still in scanner for 1.5 hours in at most 2 sessions and be able to have MRI 
 
Control subjects undergoing MRI: 
Inclusion criteria (must be YES to all): 
1) Individual 8+ years of age 
2) Adult subject able to indicate understanding and affirmative consent 
3) Able to lie still in scanner for 1.5 hours and be able to have MRI 
 
Exclusions (must be NO to all): 
1) Clinically-significant neurologic or developmental diagnosis 
 
 
6. 
Drugs/ Substances/ Devices 
a. The rationale for choosing the drug and dose or for choosing the device to be used. 
N/A 
 
 
 
N/A 
 
b. Justification and safety information if FDA approved drugs will be administered for non-FDA 
approved indications or if doses or routes of administration or participant populations are 
changed. 

Date: 8/23/2021 
Principal Investigator: Eric Chin 
Application Number: IRB00181801 
JHMIRB eFormA 01 
Version 3 Dated:  06/2007 
Page 7 of 10 
 
 
 
 
 
 
N/A 
c. Justification and safety information if non-FDA approved drugs without an IND will be 
administered. 
 
7. 
Study Statistics 
a. Primary outcome variable. 
 
Primary outcome variables include brain and spine volumes and diffusion scalars for tracts of interest 
including the posterior thalamic radiations as well as somatosensory association fibers and the spinal 
spinothalamic tract. 
 
b. Secondary outcome variables. 
 
None 
 
c. Statistical plan including sample size justification and interim data analysis. 
 
An ANOVA will be used to compare MRI-based parameters (e.g. volumes and diffusion MRI scalars) 
between the three groups. Tracts of interest and specific diffusion MRI scalars will be selected a priori to 
minimize multiple comparisons confounds. Based on effect size seen in the PLIC tract in our prior study 
using DTI including 24 subjects with CP16, a power analysis suggests that a sample size of 7 per group 
allows a power of 0.8 while maintaining α of 0.05. As higher-order diffusion sequences gather strictly 
more information than DTI techniques, we expect them to be even more sensitive. 
 
d. Early stopping rules. 
 
Subjects may withdraw from the study at any time and for any reason. 
 
8. 
Risks 
a. Medical risks, listing all procedures, their major and minor risks and expected frequency. 
 
The proposed research presents no more than minimal physical, psychological, legal, or financial risk to 
participants. Magnetic resonance imaging is a minimal risk procedure when able to be done without 
sedation, as planned based on the age range for this study. Subjects that are susceptible to injury from 
high-power magnetic fields (e.g. presence of metallic objects (such as pacemakers) implanted in his/her 
body) will be identified using the Johns Hopkins Radiographic Sciences Department screening form prior 
to imaging. Study team members who will be in the control room or scanning room of the MRI suite are 
required to undergo MRI safety training provided by the Radiographic Sciences Department. Risks during 
the scan may include anxiety from loud noises or the enclosed space of the scanner. Breach of 
confidentiality and incidental findings on MRI is also a potential risk. We do not anticipate any risks to 
study personnel, as only subjects who are trained in MRI safety will be allowed access to the MRI scanner. 
 
b. Steps taken to minimize the risks. 
 
The magnet in the scanner can cause electronic devices like pacemakers, beepers, and watches to 
malfunction, and some metal objects can be pulled into the magnet. If a subject has an electronic device 
(like a pacemaker) implanted in his/her body there is a risk that the metal may move or be dislodged. To 
minimize this risk, we will ask subjects/parents a series of questions before the scan to make sure the subject 
does not have any metal on or in his/her body, and we will ask him/her to take off any metal objects he/she 

Date: 8/23/2021 
Principal Investigator: Eric Chin 
Application Number: IRB00181801 
JHMIRB eFormA 01 
Version 3 Dated:  06/2007 
Page 8 of 10 
 
 
 
 
may be wearing (such as a watch or jewelry). No sedation is used. Scanning sessions will be terminated 
immediately upon the request of the participant, or if the participant becomes upset by the noise, 
claustrophobia, anxiety or poor performance during testing. Participants with implanted electrical devices 
or ferromagnetic foreign bodies in critical soft tissues will be excluded from this study. 
Also, we may discover an abnormality on the MR exam that we are not expecting. Some findings may 
require additional tests to find out what they are. Any unexpected results will be shared with the participant. 
The participant will also be told any new facts that could affect whether s/he wants to stay in the study. 
All assessment information will be considered confidential. No participant will be identified by name in any 
presentation of the results. Identification numbers will code data entered for computer analysis, and the data 
coordinator will keep all names and code numbers. Findings will be made available to legitimate agents of 
the participants (physicians) only with the express, written consent of the subject. 
 
c. Plan for reporting unanticipated problems or study deviations. 
Unanticipated problems or study deviations will be reported to the Johns Hopkins IRB within 48 hours of 
occurrence. 
 
d. Legal risks such as the risks that would be associated with breach of confidentiality. 
 
Strict maintenance of confidentiality of subject data and identifying information will be utilized to minimize 
legal risks. Any physical data will be kept in a locked office in a locked cabinet to which only key study 
members have the key. Electronic data will be kept on a secure, password-protected server with access 
limited to key research team members; image processing will occur on a dedicated, password-protected 
computer in a locked office with access limited to key research team members. Study documents and files 
outside of the linking document will be deidentified and marked with a study identifier only. 
 
e. Financial risks to the participants. 
 
None. 
 
9. 
Benefits 
a. 
Description of the probable benefits for the participant and for society. 
 
The participant is unlikely to receive any direct benefits from being in the study. This research will be 
used to better improve prognosis and management of pain in cerebral palsy patients in the future. 
 
10. 
Payment and Remuneration 
a. 
Detail compensation for participants including possible total compensation, proposed bonus, 
and any proposed reductions or penalties for not completing the protocol. 
 
Individuals completing all survey components will receive an honorarium of $10 by mail. 
 
We will additionally provide an honorarium of $20 per in-person visit to cover time and travel expenses. 
Parking at KKI is free for research subjects. 
 
11. 
Costs 
a. 
Detail costs of study procedure(s) or drug (s) or substance(s) to participants and identify 
who will pay for them. 

Date: 8/23/2021 
Principal Investigator: Eric Chin 
Application Number: IRB00181801 
JHMIRB eFormA 01 
Version 3 Dated:  06/2007 
Page 9 of 10 
 
 
 
 
There are no costs to the subjects for any of the procedures in this study. Participants will be responsible for 
paying for food and transportation. Free valet parking will be offered at the Institute. 
 
References: 
 
1. 
Vogtle LK. Pain in adults with cerebral palsy: impact and solutions. Dev Med Child Neurol. 2009;51 Suppl 4:113- 
121. 
 
2. 
Penner M, Xie WY, Binepal N, Switzer L, Fehlings D. Characteristics of pain in children and youth with cerebral 
palsy. Pediatrics. 2013;132(2):e407-e413. 
 
3. 
Russo RN, Miller MD, Haan E, Cameron ID, Crotty M. Pain characteristics and their association with quality of 
life and self-concept in children with hemiplegic cerebral palsy identified from a population register. Clin J 
Pain. 2008;24(4):335-342. 
 
4. 
Hoon AH Jr, Stashinko EE, Nagae LM, et al. Sensory and motor deficits in children with cerebral palsy born 
preterm correlate with diffusion tensor imaging abnormalities in thalamocortical pathways. Dev Med Child 
Neurol. 2009;51(9):697-704. 
 
5. 
Cheyne D, Bakhtazad L, Gaetz W. Spatiotemporal mapping of cortical activity accompanying voluntary 
movements using an event-related beamforming approach. Hum Brain Mapp. 2006;27(3):213-229. 
 
6. 
Blankenburg M, Junker J, Hirschfeld G, et al. Quantitative sensory testing profiles in children, adolescents and 
young adults (6-20 years) with cerebral palsy: Hints for a neuropathic genesis of pain syndromes. Eur J 
Paediatr Neurol. 2018;22(3):470-481. 
 
7. 
Kurz MJ, Wiesman AI, Coolidge NM, Wilson TW. Children with Cerebral Palsy Hyper-Gate Somatosensory 
Stimulations of the Foot. Cereb Cortex. June 2017:1-8. 
 
8. 
Rosenbaum P, Paneth N, Leviton A, et al. A report: the definition and classification of cerebral palsy April 2006. 
Dev Med Child Neurol Suppl. 2007;109:8-14. 
 
9. 
Zatorre RJ, Douglas Fields R, Johansen-Berg H. Plasticity in gray and white: neuroimaging changes in brain 
structure during learning. Nat Neurosci. 2012;15(4):528-536. 
 
10. Krägeloh-Mann I, Horber V. The role of magnetic resonance imaging in elucidating the pathogenesis of 
cerebral palsy: a systematic review. Dev Med Child Neurol. 2007;49(2):144-151. 
 
11. Owen JP, Wang MB, Mukherjee P. Periventricular White Matter Is a Nexus for Network Connectivity in the 
Human Brain. Brain Connect. 2016;6(7):548-557. 
 
12. Tuch DS, Reese TG, Wiegell MR, Makris N, Belliveau JW, Wedeen VJ. High angular resolution diffusion imaging 
reveals intravoxel white matter fiber heterogeneity. Magn Reson Med. 2002;48(4):577-582. 
 
13. Ghaziri J, Tucholka A, Girard G, et al. The Corticocortical Structural Connectivity of the Human Insula. Cereb 
Cortex. 2017;27(2):1216-1228. 
 
14. Papadelis C, Ahtam B, Nazarova M, et al. Cortical somatosensory reorganization in children with spastic 
cerebral palsy: a multimodal neuroimaging study. Front Hum Neurosci. 2014;8:725. 
 
15. Palisano R, Rosenbaum P, Walter S, Russell D, Wood E, Galuppi B. Development and reliability of a system to 
classify gross motor function in children with cerebral palsy. Developmental Medicine & Child Neurology. 
2008;39(4):214-223. 

Date: 8/23/2021 
Principal Investigator: Eric Chin 
Application Number: IRB00181801 
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Version 3 Dated:  06/2007 
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16. Nagae LM, Hoon AH Jr, Stashinko E, et al. Diffusion tensor imaging in children with periventricular 
leukomalacia: variability of injuries to white matter tracts. AJNR Am J Neuroradiol. 2007;28(7):1213-1222.