Background

The corpus callosum (CC) plays an important role in upper extremity (UE) function. The impact on UE function in children with unilateral spastic cerebral palsy (USCP) and improvements following intensive interventions remain unknown.

Objectives

To examine the (1) relationship between UE function and CC integrity and (2) relationship between CC integrity and changes in UE function following intensive interventions.

Methods

We retrospectively analyzed clinical and neuroimaging data from a sample of convenience of 44 participants (age 9.40 ± 3.10 years) from 2 larger trials. Participants received 90 hours of Hand-Arm Bimanual Intensive Therapy (HABIT) or Constraint-Induced Movement Therapy (CIMT). Unimanual dexterity (Jebsen-Taylor Test of Hand Function [JTTHF]) and bimanual performance (Assisting Hand Assessment [AHA]) were assessed preintervention and postintervention. CC tractography was reconstructed with diffusion tensor imaging (DTI) and segmented into 3 regions (genu, midbody, splenium). Pearson correlations and regression were used to assess the relationship between outcomes and DTI parameters (ie, fractional anisotropy [FA], number of streamlines, and mean, radial, and axial diffusivity).

Results

Both groups improved in bimanual performance (P < .01). The CIMT group improved in unimanual dexterity (P < .01). Baseline unimanual dexterity and bimanual performance correlated with FA and number of streamlines for most CC regions (P < .05). Following CIMT, pre-post changes in JTTHF were negatively correlated with axial and radial diffusivity of the CC, and AHA with splenium and number of streamlines for the CC, midbody, and splenium (all P < .05). Following HABIT, midbody FA was positively correlated with pre-post AHA changes (r = 0.417; P = .042).

Conclusions

CC integrity is important for UE function in children with USCP.

中文翻译：

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胼胝体完整性与单侧痉挛性脑瘫儿童强化康复后上肢功能的改善有关

 背景

胼胝体（CC）在上肢（UE）功能中发挥着重要作用。单侧痉挛性脑瘫 (USCP) 儿童 UE 功能的影响以及强化干预后的改善仍不清楚。

 目标

检查 (1) UE 功能与 CC 完整性之间的关系以及 (2) CC 完整性与密集干预后 UE 功能变化之间的关系。

 方法

我们回顾性分析了来自 2 项大型试验的 44 名参与者（年龄 9.40 ± 3.10 岁）样本的临床和神经影像数据。参与者接受了 90 小时的手臂双手强化治疗 (HABIT) 或约束诱导运动治疗 (CIMT)。在干预前和干预后评估单手灵活性（捷森泰勒手功能测试[JTTHF]）和双手性能（辅助手评估[AHA]）。 CC 纤维束成像采用弥散张量成像 (DTI) 进行重建，并分为 3 个区域（膝部、中体、压部）。 Pearson 相关性和回归用于评估结果与 DTI 参数（即分数各向异性 [FA]、流线数以及平均、径向和轴向扩散率）之间的关系。

 结果

两组的双手操作能力均有所改善 ( P < .01)。 CIMT 组的单手灵活性有所提高 ( P < .01)。大多数 CC 区域的基线单手灵巧性和双手性能与 FA 和流线数量相关 ( P < .05)。 CIMT 后，JTTHF 的前后变化与 CC 的轴向和径向扩散率、AHA 与压部以及 CC、中体和压部的流线数量呈负相关（所有P < .05）。习惯后，中体 FA 与 AHA 前后的变化呈正相关（ r = 0.417； P = .042）。

 结论

CC 完整性对于 USCP 儿童的 UE 功能非常重要。