For some children with cerebral palsy, constraint therapy is an extremely effective way to regain movement in a spastic limb. For some children, however, the therapy which involves physically restraining their dominant limb, can be a particularly frustrating experience with little or no clinical outcome.
Researchers at Western University have now shown that Functional Magnetic Resonance Imaging (fMRI) may be an effective tool to predict which patients will benefit from the therapy and which are likely not to. The study was published in the Journal of Child Neurology.
“Right now we don’t really have a good tool to decide whether these kids are going to respond well to constraint therapy,” said Ravi Menon, PhD, a professor at Western’s Schulich School of Medicine & Dentistry and director of Western’s Centre for Functional and Metabolic Mapping. “We need a biomarker that will tell us who might be a good candidate for constraint therapy and who might be better off doing something else.”
The study, which involved seven children with hemiplegic cerebral palsy, showed that children with more compromised networks and tracts in their brains improved the most following constraint therapy. The researchers were also able to show reliable robust changes in the neuropathways in the brain following the therapy and are now working on identifying the neurological basis for the improvement in the limb function.
“Looking at these networks we were able to see what it looked like at baseline and again after the therapy,” said Kathryn Manning, a PhD candidate at Schulich Medicine & Dentistry and first author on the paper. “We began to see the neurological basis of the clinical improvement. It was a strong change.”
The researchers hope that this initial study will lead to a larger multi-centered trial that will prove their findings on a larger scale.
“If it turns out to be a viable experiment on a larger scale, then this is something that could be done clinically to predict outcomes of constraint therapy relatively easily,” said Menon.
The study was funded by the Ontario Brain Institute. Video of the researchers discussing their work can be found here: https://youtu.be/TihwR8fXeRw
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