Constraint Induced Movement Therapy (CIMT)- Neuroimaging Predictors of Positive Response to Constraint
Condition: Hemiplegic Cerebral Palsy
MeSH terms: Cerebral Palsy
Study type: Interventional

Summary: 
      CIMT has shown great promise in helping children and adults regain lost function in a
      disabled limb by forcing its use through an intensive motor training program and constraining
      the unaffected arm with a cast. However, relatively little is known about the underlying
      mechanisms of CIMT in hemiplegic CP. This project will use an integrated translation model to
      explore neuroimaging predictors of a positive clinical response to CIMT.
    

Detailed description: 
      The primary research objective is to evaluate neuroimaging predictors of a positive response
      to CIMT in children with hemiplegic CP secondary to a middle cerebral artery territory stroke
      (MCA). A focus on the MCA territory is chosen as (1) it targets children with significant
      hand impairment who have the potential to benefit from CIMT, (2) is the most common
      neuropathological subtype, and (3) allows for enhanced homogeneity for the matching of case
      and comparison groups. The primary research question is: In children aged 7 to 16 years with
      hemiplegic CP secondary to an MCA stroke, are there neuroimaging predictors of a positive
      response to CIMT, a positive response being defined by an improvement in the Assisting Hands
      Assessment (AHA) one month after CIMT?

      Neuroimaging predictor variables include laterality index (LI) of the primary M1 and S1 areas
      on fMRI, IHI evaluated by resting state fMRI, dissociation of the M1 and S1 for the
      hemiplegic hand measured by fMRI, size and vascular distribution of the MCA lesion with T2
      weighted MRI, and white matter tract abnormality with Diffusion Tensor Imaging (DTI). We
      hypothesize that a negative LI, a non-dissociated M1 and S1, low IHI, small size of
      infarction, and large size of the contralateral corticospinal tract will predict a positive
      response to constraint. An evaluation of the neuroimaging predictor variables on the
      persistence of a positive response to CIMT at 6 months as measured by the AHA will also be
      explored. A secondary objective will evaluate change in the neuroimaging variables from
      baseline to one month post CIMT by comparing children in the case group who have received
      CIMT and a comparison group who are matched on baseline QUEST scores.
    

Intervention name(s): Casting & CIMT
Intervention type(s): Other
Intervention description(s): A standardized CIMT protocol will be administered over a three week period. The first week will consist of wearing a below elbow cast on the non-hemiplegic limb followed by a two week CIMT camp (5 hours per day, 5 days per week) where the child/youth wears a constraint splint on the non-hemiplegic hand. The two week camp will follow a standardized CIMT camp protocol ("Hand2Hand" developed at HBKRH) that includes activities that focus on unilateral hemiplegic hand activity in the first week and increasing incorporation of bilateral hand activities in the second week. The camp protocol for CIMT is based on camp protocols utilized successfully in other paediatric research studies.
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Cerebral Palsy; Hemiplegia; Constraint Induced Movement Therapy