Exploring Clinical and Neurophysiological Factors Associated with Response to Constraint Therapy and Brain Stimulation in Children with Hemiparetic Cerebral Palsy

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.

KEYWORDS:

• Perinatal stroke
• hemiparetic cerebral palsy
• transcranial magnetic stimulation
• constraint-induced movement therapy
• personalized rehabilitation

Acknowledgments

We thank children and families participating in this study.

PLASTIC CHAMPS was funded by Heart and Stroke Foundation of Canada and Alberta Children’s Hospital Foundation. AK was funded by Canadian Institutes of Health Research; H-CK was funded by postdoc salary awards of Canadian Partnership for Stroke Recovery and Alberta Children’s Hospital Research Institute.

Disclosure Statement

The authors report no conflicts of interest.

Additional information

Funding

This work was supported by the Heart and Stroke Foundation of Canada; Alberta Children’s Hospital Foundation; Canadian Institutes of Health Research (CIHR); Canadian Partnership for Stroke Recovery; Alberta Children’s Hospital Research Institute.