Background. In children with unilateral cerebral palsy (UCP), the fibers of the corticospinal tract (CST) emerging from the lesioned hemisphere are damaged following the initial brain injury. The extent to which the integrity of these fibers is restorable with training is unknown. Objective. To assess changes in CST integrity in children with UCP following Hand-and-Arm-Bimanual-Intensive-Therapy-Including-Lower-Extremity (HABIT-ILE) compared to a control group. Methods. Forty-four children with UCP participated in this study. Integrity of the CSTs was measured using diffusion tensor imaging before and after 2 weeks of HABIT-ILE (treatment group, n = 23) or 2 weeks apart without intensive treatment (control group, n = 18). Fractional anisotropy (FA) and mean diffusivity (MD) were the endpoints for assessing the integrity of CST. Results. As highlighted in our whole tract analysis, the FA of the CST originating from the nonlesioned and lesioned hemispheres increased significantly after therapy in the treatment group compared to the control group (group * test session interaction: P < .001 and P = .049, respectively). A decrease in MD was also observed in the CST emerging from the nonlesioned and lesioned hemispheres (group * time interaction: both P < .001). In addition, changes in manual ability correlated with changes in FA in both CSTs (r = 0.463, P = .024; r = 0.643, P < .001) and changes in MD in CST emerging from nonlesioned hemisphere (r = −0.662, P < .001). Conclusions. HABIT-ILE improves FA/MD in the CST and hand function of children with UCP, suggesting that CST fibers retain a capacity for functional restoration. This finding supports the application of intensive motor skill training in clinical practice for the benefit of numerous patients.

中文翻译：

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运动技能训练可以恢复脑瘫儿童受损的皮质脊髓束纤维

背景。在患有单侧脑瘫 (UCP) 的儿童中，从受损半球出现的皮质脊髓束 (CST) 纤维在最初的脑损伤后受损。这些纤维的完整性在多大程度上可以通过训练恢复尚不清楚。目标。与对照组相比，评估手和手臂双手密集治疗包括下肢 (HABIT-ILE) 后 UCP 儿童 CST 完整性的变化。方法。44 名患有 UCP 的儿童参加了这项研究。在 HABIT-ILE 治疗 2 周（治疗组，n = 23）之前和之后使用扩散张量成像测量 CST 的完整性，或者在没有强化治疗的情况下相隔 2 周（对照组，n = 18）。分数各向异性 (FA) 和平均扩散率 (MD) 是评估 CST 完整性的终点。结果。正如我们的全道分析所强调的那样，与对照组相比，治疗组治疗后源自未损伤和损伤半球的 CST 的 FA 显着增加（组 * 测试会话交互：P < .001 和 P = .049，分别）。在从非损伤和损伤半球出现的 CST 中也观察到 MD 减少（组 * 时间交互作用：两者 P < .001）。此外，手动能力的变化与两个 CST 中 FA 的变化相关（r = 0.463，P = .024；r = 0.643，P < .001）和来自未损伤半球的 CST 的 MD 变化（r = -0.662， P < .001)。结论。HABIT-ILE 改善了 UCP 儿童的 CST 和手部功能的 FA/MD，表明 CST 纤维保留了功能恢复的能力。