ABSTRACT

Background

Perinatal stroke causes hemiparetic cerebral palsy (HCP) and lifelong disability. Constraint-induced movement therapy (CIMT) and neurostimulation may enhance motor function, but the individual factors associated with responsiveness are undetermined.

Objective

We explored the clinical and neurophysiological factors associated with responsiveness to CIMT and/or brain stimulation within a clinical trial.

Methods

PLASTIC CHAMPS was a randomized, blinded, sham-controlled trial (n = 45) of CIMT and neurostimulation paired with intensive, goal-directed therapy. Primary outcome was the Assisting Hand Assessment (AHA). Classification trees created through recursive partitioning suggested clinical and neurophysiological profiles associated with improvement at 6-months.

Results

Both clinical (stroke side (left) and age >14 years) and neurophysiological (intracortical inhibition/facilitation and motor threshold) were associated with responsiveness across treatment groups with positive predictive values (PPV) approaching 80%.

Conclusion

This preliminary analysis suggested sets of variables that may be associated with response to intensive therapies in HCP. Further modeling in larger trials is required.

中文翻译：

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探索与偏瘫脑瘫患儿对约束治疗和脑刺激反应相关的临床和神经生理学因素

摘要

背景

围产期中风会导致偏瘫性脑瘫 (HCP) 和终身残疾。约束诱导运动疗法 (CIMT) 和神经刺激可以增强运动功能，但与反应性相关的个体因素尚未确定。

客观的

我们在临床试验中探索了与对 CIMT 和/或脑刺激的反应相关的临床和神经生理学因素。

方法

PLASTIC CHAMPS 是一项随机、盲法、假对照试验 (n = 45)，将 CIMT 和神经刺激与强化的目标导向治疗相结合。主要结果是辅助手评估（AHA）。通过递归分区创建的分类树建议与 6 个月时改善相关的临床和神经生理学特征。

结果

临床（中风侧（左）和年龄 > 14 岁）和神经生理学（皮质内抑制/促进和运动阈值）都与治疗组的反应性相关，阳性预测值 (PPV) 接近 80%。

结论

这一初步分析提出了一组变量，这些变量可能与 HCP 对强化治疗的反应有关。需要在更大的试验中进一步建模。