Can Children With Perinatal Stroke Use a Simple Brain Computer Interface?

Background and Purpose: Perinatal stroke is the leading cause of hemiparetic cerebral palsy resulting in lifelong disability for millions of people worldwide. Options for motor rehabilitation are limited, especially for the most severely affected children. Brain computer interfaces (BCIs) sample brain activity to allow users to control external devices. Functional electrical stimulation enhances motor recovery after stroke, and BCI-activated functional electrical stimulation was recently shown to improve upper extremity function in adult stroke. We aimed to determine the ability of children with perinatal stroke to operate a simple BCI. Methods: Twenty-one children with magnetic resonance imaging­confirmed perinatal stroke (57% male, mean [SD] 13.5 [2.6] years, range 9­18) were compared with 24 typically developing controls (71% male, mean age [SD] 13.7 [3.7] years, range 6­18). Participants trained on a simple EEG-based BCI over 2 sessions (10 trials each) utilizing 2 different mental imagery strategies: (1) motor imagery (imagine opening and closing of hands) and (2) goal oriented (imagine effector object moving toward target) to complete 2 tasks: (1) drive a remote controlled car to a target and (2) move a computer cursor to a target. Primary outcome was Cohen Kappa with a score >0.40 suggesting BCI competence. Results: BCI performance was comparable between stroke and control participants. Mean scores were 0.39 (0.18) for stroke versus 0.42 (0.18) for controls (t[42]=0.478, P=0.94). No difference in performance between venous (M=0.45, SD=0.29) and arterial (M=0.34, SD=0.22) stroke (t[82]=1.89, P=0.090) was observed. No effect of task or strategy was observed in the stroke participants. Over 90% of stroke participants demonstrated competency on at least one of the 4 task-strategy combinations. Conclusions: Children with perinatal stroke can achieve proficiency in basic tasks using simple BCI systems. Future directions include exploration of BCI-functional electrical stimulation systems for rehabilitation for children with hemiparesis and other forms of cerebral palsy.

Effects of three kinds of head acupuncture therapies on regulation of brain microenvironment and rehabilitation of nerve function in rats with cerebral palsy.

OBJECTIVE: To compare and observe the effects of three kinds of cephalic acupuncture therapies commonly used in the clinic on promoting nerve function rehabilitation in the brain microenvironment of rats with cerebral palsy. METHODS: A negative control group, positive control group, and three cephalic acupuncture groups based on the administration of three cephalic acupuncture therapies were established. Ten experimental rats were selected from each group at 1, 2, and 3 weeks after modeling. Neuromotor function after treatment was rated according to the Basso, Beattie, and Bresnahan method. White matter fiber bundles were evaluated by head diffusion tensor imaging. The expression levels of neuron-specific enolase, microtubule-associated protein 2, and myelin basic protein in the brain tissue extract were detected by Western blot analysis and the activities of ATPases were determined using a fixed phosphorus method. RESULTS: The pathological changes in brain tissue were restored and motor function scores were increased in the mice in each cephalic acupuncture group, and the expression of neuronal growth-related proteins in the brain tissue extract was significantly increased. Additionally, the activities of ATPases in the lesion area were significant enhanced (P < 0.05). Diffusion tensor imaging revealed that the white matter fiber bundles of mice in each cephalic acupuncture group gradually increased and recovered. The nervous system structure was significantly improved. CONCLUSIONS: All three acupuncture methods promoted the rehabilitation of nerve function damaged by cerebral palsy. These effects are likely related to the improved expression of nerve growth-related proteins, enhancement of ATPase activities, and regulation of the brain microenvironment.

Effect of "Tonifying Kidney and Invigorating Brain" acupuncture in children with spastic cerebral palsy analyzed by multi-modality MRI combined with dynamic electroencephalogram.

INTRODUCTION: Cerebral palsy is the most common motor disability of childhood. Spastic cerebral palsy accounts for 60% to 70% of cases. Research has shown that acupuncture can improve the quality of life of children with cerebral palsy, but the mechanism of action remains unclear. This study aims to determine the effectiveness of acupuncture for treatment of children with spastic cerebral palsy and to assess the value of multimodal magnetic resonance imaging (MRI) and ambulatory electroencephalogram (EEG) for evaluation of treatment effect. METHODS AND ANALYSIS: This randomized controlled trial will enroll a total of 72 children with CP from 2 hospitals-Jiangsu Province Hospital of Chinese Medicine and Nanjing State Hospital of Pediatric-with 36 participants from each hospital. Patients will be randomly assigned (1:1 ratio) to receive "Tonifying Kidney and Invigorating Brain" acupuncture treatment plus standardized physical rehabilitation treatment (treatment group) or only standardized physical rehabilitation (control group). All participants will receive 3 treatment sessions per week for 3 consecutive months; they will then be followed up for another 3 months. The primary outcome measures will include multimodal magnetic resonance imaging (MRI), ambulatory electroencephalogram (EEG), and Gesell Developmental Diagnostic Schedules. The secondary outcome measures will include Gross Motor Function Classification System (GMFCS), Gross Motor Function Measure (GMFM), Functional Independence Measure (WeeFIM), and Modified Ashworth Scale score. Outcome measures (including primary and secondary outcome measures) were collected at the baseline, 3 months and 6 months prior to the intervention.Ethics and dissemination PATIENTS CONSENT:: Obtained. ETHICS APPROVAL: The central independent ethics committee of Jiangsu Province Hospital of Traditional Chinese Medicine approved the protocol (2017NL-115-02). SAFETY CONSIDERATIONS: Routine blood tests and liver and kidney function tests will be conducted to exclude patients with severe heart, liver, or kidney diseases. The same examinations will be performed again at the end of the study to detect any possible side effects. Possible acupuncture-related adverse events (e.g., fainting, needle stick injury, local infection, subcutaneous hematoma, and low-grade fever) will be documented. Serious adverse events will be reported to the principal investigator immediately. All unexpected and unintended responses, even those not necessarily related to the acupuncture intervention, will be documented as adverse events. CASE DROPOUT MANAGEMENT: Participants have a right to withdraw from the study at any time if they feel uncomfortable upon receiving the treatments or being diagnosed with serious complications or diseases. They will then be referred to the preferred department for further treatment and management. If cases of dropout, the researcher need to contact the participant to reason the problem out, collect and record all the necessary assessments on the last visit as well as the date of last visit. All data available until the date of withdrawal will be stored for further statistical analysis. DISCUSSION: This research is being conducted to assess the value of acupuncture as an intervention for rehabilitation of children with spastic cerebral palsy and also to evaluate the usefulness of multimodal MRI and ambulatory EEG for identifying changes in brain function. TRIAL REGISTRATION: This trial is registered with Chinese Clinical Trials Register, ChiCTR 1900024546 (registered 15 July 2019; retrospective registration, http://www.chictr.org.cn/showproj.aspx?proj=35763).

Understanding the impact of bilateral brain injury in children with unilateral cerebral palsy.

The presence of bilateral brain injury in patients with unilateral cerebral palsy (CP) may impact neuroplasticity in the ipsilateral hemisphere; however, this pattern of injury is typically under-analyzed due to the lack of methods robust to severe injury. In this study, injury-robust methods have been applied to structural brain magnetic resonance imaging (MRI) data of a cohort of 91 children with unilateral CP (37 with unilateral and 54 with bilateral brain injury, 4-17 years) and 44 typically developing controls (5-17 years), to determine how brain structure is associated with concurrent motor function, and if these associations differ between patients with unilateral or bilateral injury. Regression models were used to associate these measures with two clinical scores of hand function, with patient age, gender, brain injury laterality, and interaction effects included. Significant associations with brain structure and motor function were observed (Pearson's r = .494-.716), implicating several regions of the motor pathway, and demonstrating an accurate prediction of hand function from MRI, regardless of the extent of brain injury. Reduced brain volumes were observed in patients with bilateral injury, including volumes of the thalamus and corpus callosum splenium, compared to those with unilateral injury, and the healthy controls. Increases in cortical thickness in several cortical regions were observed in cohorts with unilateral and bilateral injury compared to controls, potentially suggesting neuroplasticity might be occurring in the inferior frontal gyrus and the precuneus. These findings identify prospective useful target regions for transcranial magnetic stimulation intervention.

The relationship between neuroimaging and motor outcome in children with cerebral palsy: A systematic review-Part B diffusion imaging and tractography.

BACKGROUND: Diffusion magnetic resonance imaging (dMRI) is able to detect, localize and quantify subtle brain white matter abnormalities that may not be visible on conventional structural MRI. Over the past years, a growing number of studies have applied dMRI to investigate structure-function relationships in children with cerebral palsy (CP). AIMS: To provide an overview of the recent literature on dMRI and motor function in children with CP. METHODS: A systematic literature search was conducted in PubMed, Embase, Cochrane Central Register of Controlled trials, Cinahl and Web of Science from 2012 onwards. RESULTS: In total, 577 children with CP in 19 studies were included. Sixteen studies only included unilateral CP, while none included dyskinetic CP. Most studies focused on specific regions/tracts of interest (n = 17) versus two studies that investigated the whole brain. In unilateral and bilateral CP, white matter abnormalities were widespread including non-motor areas. In unilateral CP, consistent relationships were found between white matter integrity of the corticospinal tract and somatosensory pathways (e.g. thalamocortical projections, medial lemniscus) with upper limb sensorimotor function. The role of commissural and associative tracts remains poorly investigated. Also results describing structure-function relationships in bilateral CP are scarce (n = 3). CONCLUSIONS: This review underlines the importance of both the motor and somatosensory tracts for upper limb sensorimotor function in unilateral CP. However, the exact contribution of each tract requires further exploration. In addition, research on the relevance of non-motor pathways is warranted, as well as studies including other types of CP.

Efficacy of photobiomodulation therapy on masseter thickness and oral health-related quality of life in children with spastic cerebral palsy.

The study aimed to evaluate the efficacy of photobiomodulation therapy (PBMT) on bilateral masseter muscle thickness and amplitude of mouth opening in children with spastic cerebral palsy (CP), and the impact on their oral health-related quality of life (OHRQOL). Three groups were included: experimental CP group (EG: n = 26 with oral complaints), positive control CP group (PCG: n = 26 without complaints), and negative control group (NCG: n = 26 without CP). In the EG, the masseter muscles on both sides were irradiated with an infrared low-level Ga-Al-As laser (λ = 808 ± 3 nm, 120 mW) using a 3 J/cm2 energy dose per site, with a 20 s exposure time per site (spot area: 4 mm2; irradiance: 3 W/cm2; energy delivery per point: 2.4 J) six times over six consecutive weeks. Masseter thickness, assessed through ultrasonography, and the amplitude of mouth opening were measured in the EG before and after six applications of PBMT and once in the PCG and NCG. The Parental-Caregiver Perception Questionnaire (P-CPQ) was used to evaluate OHRQOL. ANOVA, chi-square, t tests, and multilevel linear regression were used for statistical analysis. In the EG, the study results revealed average increments of 0.77 (0.08) millimeter in masseter thickness (P < 0.05) and 7.39 (0.58) millimeter for mouth opening (P < 0.05) and reduction in all P-CPQ domains (P < 0.001), except for social well-being. The six applications of PBMT increased masseter thickness and mouth opening amplitude and reduced the impact of spastic CP on OHRQOL.

Optic nerve morphology as marker for disease severity in cerebral palsy of perinatal origin.

BACKGROUND: It is difficult to predict the neurologic outcome and ambulatory status in children with perinatal neurologic insult until 2-5years age. This study aims to correlate clinical optic nerve head (ONH) findings-cupping, pallor and hypoplasia, with gestational period and neurologic (motor) outcomes in patients with cerebral palsy (CP) from perinatal insults. METHODS: 54 consecutive patients with CP from perinatal insults were enrolled. Patients with intraocular disease, retinopathy of prematurity and hydrocephalus were excluded. ONH was labeled as pale, hypoplastic or large cup (cup/disc ratio≥0.5) if 2 ophthalmologists independently agreed after an ophthalmoscopic examination. Inter-rater reliability was excellent. RESULTS: Mean age at examination was 10.98±6.49years; mean gestational period was 33.26±4.78weeks. Abnormal ONH (pallor, cupping or hypoplasia) was seen in 38/54 (70%) patients. Of patients with pallor (n=17), 88% were quadriplegic and 82% non-ambulatory. Mean cup/disc ratio was 0.45±0.22; 50% patients had large cup. Multivariate logistic regression models showed that disc pallor was associated with non-ambulatory status (OR: 21.7; p=0.003) and quadriplegia (OR: 12.8; p=0.03). Large cup was associated with age at examination (OR 1.15; p=0.03). Cup/disc ratio showed positive correlation with age at examination (Pearson's r=0.39; p=0.003). There was no significant association of ONH parameters with gestational age. CONCLUSION: Clinically observed ONH changes (pallor, cupping and hypoplasia) are common in CP. Presence of ONH pallor serves as an indicator for poor motor outcome in patients who develop CP from perinatal causes and should prompt early referral for rehabilitation.

Measuring intellectual ability in cerebral palsy: The comparison of three tests and their neuroimaging correlates.

Standard intelligence scales require both verbal and manipulative responses, making it difficult to use in cerebral palsy and leading to underestimate their actual performance. This study aims to compare three intelligence tests suitable for the heterogeneity of cerebral palsy in order to identify which one(s) could be more appropriate to use. Forty-four subjects with bilateral dyskinetic cerebral palsy (26 male, mean age 23 years) conducted the Raven's Coloured Progressive Matrices (RCPM), the Peabody Picture Vocabulary Test-3rd (PPVT-III) and the Wechsler Nonverbal Scale of Ability (WNV). Furthermore, a comprehensive neuropsychological battery and magnetic resonance imaging were assessed. The results show that PPVT-III gives limited information on cognitive performance and brain correlates, getting lower intelligence quotient scores. The WNV provides similar outcomes as RCPM, but cases with severe motor impairment were unable to perform it. Finally, the RCPM gives more comprehensive information on cognitive performance, comprising not only visual but also verbal functions. It is also sensitive to the structural state of the brain, being related to basal ganglia, thalamus and white matter areas such as superior longitudinal fasciculus. So, the RCPM may be considered a standardized easy-to-administer tool with great potential in both clinical and research fields of bilateral cerebral palsy.

Extent of altered white matter in unilateral and bilateral periventricular white matter lesions in children with unilateral cerebral palsy.

AIMS: To investigate the extent of white matter damage in children with unilateral cerebral palsy (UCP) caused by periventricular white matter lesions comparing between unilateral and bilateral lesions; and to investigate a relationship between white matter microstructure and hand function. METHODS AND PROCEDURES: Diffusion MRI images from 46 children with UCP and 18 children with typical development (CTD) were included. Subjects were grouped by side of hemiparesis and unilateral or bilateral lesions. A voxel-wise white matter analysis was performed to identify regions where fractional anisotropy (FA) was significantly different between UCP groups and CTD; and where FA correlated with either dominant or impaired hand function (using Jebsen Taylor Hand Function Test). OUTCOMES AND RESULTS: Children with unilateral lesions had reduced FA in the corticospinal tract of the affected hemisphere. Children with bilateral lesions had widespread reduced FA extending into all lobes. In children with left hemiparesis, impaired hand function correlated with FA in the contralateral corticospinal tract. Dominant hand function correlated with FA in the posterior thalamic radiations as well as multiple other regions in both left and right hemiparesis groups. CONCLUSIONS AND IMPLICATIONS: Periventricular white matter lesions consist of focal and diffuse components. Focal lesions may cause direct motor fibre insult resulting in motor impairment. Diffuse white matter injury is heterogeneous, and may contribute to more global dysfunction.

Neuromuscular electrical stimulation-assisted gait increases muscle strength and volume in children with unilateral spastic cerebral palsy.

AIM: To determine if neuromuscular electrical stimulation (NMES) applied to the ankle dorsiflexors during gait improves muscle volume and strength in children with unilateral spastic cerebral palsy (CP). METHOD: Thirty-two children (15 females, 17 males; mean age 10y 8mo, age range 5y 5mo-18y 1mo) with unilateral spastic CP and a Gross Motor Function Classification System of level I or level II were randomly assigned to either the 8-week daily NMES treatment group or control group (usual or conventional treatments). Outcomes at week 8 (post-NMES) and week 14 (carryover) included magnetic resonance imaging for muscle volumes (tibialis anterior, anterior compartment, and gastrocnemius), strength (hand-held dynamometry for isometric dorsiflexion strength and heel raises for functional strength), and clinical measures for lower limb selective motor control. RESULTS: At week 8, the treatment group demonstrated significantly (p<0.05) increased muscle volumes for tibialis anterior, anterior compartment, medial and lateral gastrocnemius, and dorsiflexion strength not only when compared to their baseline values but also when compared to the control group at week 8. At week 14, both tibialis anterior and lateral gastrocnemius volumes in the treatment group remained significantly increased when compared to their baseline values. However, only lateral gastrocnemius volumes had significantly greater values when compared to the control group at week 14. There were no between group differences in the clinical measures for lower limb selective motor control at week 8 and 14. INTERPRETATION: Eight weeks of daily NMES-assisted gait increases muscle volume and strength of the stimulated ankle dorsiflexors in children with unilateral spastic CP. These changes are use-dependent and do not carry over after the 8-week treatment period. Gastrocnemius volume also increased post-treatment with carryover at week 14.

Imaging Predictors of Improvement From a Motor Learning-Based Intervention for Children With Unilateral Cerebral Palsy.

Background Motor-learning interventions may improve hand function in children with unilateral cerebral palsy (UCP) but with inconsistent outcomes across participants. Objective To examine if pre-intervention brain imaging predicts benefit from bimanual intervention. Method Twenty children with UCP with Manual Ability Classification System levels I to III, aged 7-16 years, participated in an intensive bimanual intervention. Assessments included the Assisting Hand Assessment (AHA), Jebsen Taylor Test of Hand Function (JTTHF) and Children's Hand Experience Questionnaire (CHEQ) at baseline (T1), completion (T2) and 8-10 weeks post-intervention (T3). Imaging at baseline included conventional structural (radiological score), functional (fMRI) and diffusion tensor imaging (DTI). Results Improvements were seen across assessments; AHA (P = 0.04), JTTHF (P < .001) and CHEQ (P < 0.001). Radiological score significantly correlated with improvement at T2; AHA (r = .475) and CHEQ (r = .632), but negatively with improvement on unimanual measures at T3 (JTTFH r = -.514). fMRI showed negative correlations between contralesional brain activation when moving the affected hand and AHA improvements (T2: r = -.562, T3: r = -0.479). Fractional Anisotropy in the affected posterior limb of the internal capsule correlated negatively with increased bimanual use on CHEQ at T2 (r = -547) and AHA at T3 (r = -.656). Conclusions Children with greater structural, functional and connective brain damage showed enhanced responses to bimanual intervention. Baseline imaging may identify parameters predicting response to intervention in children with UCP.

Short-Term effects of neuromuscular electrical stimulation on muscle architecture of the tibialis anterior and gastrocnemius in children with cerebral palsy: preliminary results of a prospective controlled study.

OBJECTIVE: The aim of this study was to explore the short-term effects of neuromuscular electrical stimulation application on tibialis anterior (stimulated muscle) and gastrocnemius (antagonist) muscles' size and architecture in children with cerebral palsy by using ultrasound. DESIGN: This prospective, controlled study included 28 children diagnosed with spastic diplegic cerebral palsy. Participants were treated either with neuromuscular electrical stimulation application and conventional physiotherapy (group A) or with conventional physiotherapy alone (group B). Outcome was evaluated by clinical (gross motor function, selective motor control, range of motion, spasticity) and ultrasonographic (cross-sectional area, pennation angle, fascicle length of tibialis anterior and gastrocnemius muscles) measurements before and after treatment in both groups. RESULTS: Cross-sectional area values of tibialis anterior (238.7 ± 61.5 vs. 282.0 ± 67.1 mm) and gastrocnemius (207.9 ± 48.0 vs. 229.5 ± 52.4 mm) (P < 0.001 and P = 0.008, respectively) muscles were increased after treatment in group A. Cross-sectional area values of tibialis anterior muscle were decreased (257.3 ± 64.7 vs. 239.7 ± 60.0 mm) after treatment in group B (P < 0.001), and the rest of the measurements were found not to have changed significantly in either group. CONCLUSIONS: These results have shown that cross-sectional area of both the agonist and antagonist muscles increased after 20 sessions of neuromuscular electrical stimulation treatment. Future studies with larger samples and longer follow-up are definitely awaited for better evaluation of neuromuscular electrical stimulation application on muscle architecture and its possible correlates in clinical/functional outcome.

Clinical observation on treatment of clearing the Governor Vessel and refreshing the mind needling in neural development and remediation of children with cerebral palsy.

OBJECTIVE: To investigate the effects of clearing the Governor Vessel and refreshing the mind needling in neural development and remediation of children with cerebral palsy. METHODS: A total of 200 cases of children with cerebral palsy were randomly assigned to the treatment group (100 patients) and the control group (100 patients). The treatment group was given the combined therapy of acupuncture and rehabilitation training, and the chosen acupoints were 13 points of the Governor Vessel, Shenshu (BL 23), Taixi (KI 3), Yanglingquan (GB 34), Zusanli (ST 36) and Sanyinjiao (SP 6), and points of refreshing the mind were also selected, which included puncturing Shenting (GV 24) toward Qianding (GV 21), puncturing Qianding (GV 21) toward Baihui (GV 20), puncturing Baihui (GV 20) toward Naohu (GV 17) and Sishencong (Ex-HN 1). The control group was only treated with rehabilitation training. A contrastive analysis of the therapeutic effect between acupuncture combined with rehabilitation training and rehabilitation training alone was made after a treatment course of 3 months. The Gross Motor Function Measure (GMFM) and Beijing Gesell Developmental Scale were adopted to assess the neural development and rehabilitation outcomes of the two groups. In addition, skull CT/MRI was adopted to evaluate the plerosis of injured cerebral nerve after treatment. RESULTS: The total effective rate in treatment group was 87% (87/100), significantly higher than the 55% (55/100) in the control group. The children's development quotient (DQ) tested by Gesell Developmental Scale and scores tested by GMFM in the treatment group were obviously higher than those in the control group (P<0.01). The improving and curing rates presented by skull CT/MRI in the treatment group were higher than those in the control group (P<0.01). CONCLUSIONS: Clearing the Governor Vessel and refreshing the mind needling could accelerate the recovery of injured brain nerve and the reconstruction of brain function. The acupuncture therapy could ameliorate both the motor development and cognitive development. On the other hand, the forward curative effect of acupuncture combined with rehabilitation training was significantly better than the rehabilitation training alone.

Muscle plasticity and ankle control after repetitive use of a functional electrical stimulation device for foot drop in cerebral palsy.

BACKGROUND/OBJECTIVES: The primary goal was to determine whether repetitive functional electrical stimulation (FES) for unilateral foot drop increases tibialis anterior (TA) muscle size compared with an untreated baseline and the contralateral side in cerebral palsy (CP). Secondary goals were to determine whether positive changes in muscle size and gait, if found, accumulated during the 3 intervals during which participants used the device. FES devices differ from traditional orthoses that often restrict muscle activation and may exacerbate weakness, promote continued dependence on orthoses, or precipitate functional decline. METHODS: Participants were 14 independent ambulators with inadequate dorsiflexion in swing, with a mean age of 13.1 years, evaluated before and after the 3-month baseline, 1-month device accommodation, 3-month primary intervention, and 3-month follow-up phases. The FES device (WalkAide) stimulated the common fibular nerve to dorsiflex the ankle and evert the foot while monitoring use. TA muscle ultrasound, gait velocity, and ankle kinematic data for barefoot and device conditions are reported. RESULTS: Ultrasound measures of TA anatomic cross-sectional area and muscle thickness increased in the intervention compared with baseline and with the contralateral side and were maintained at follow-up. Maximum ankle dorsiflexion decreased at baseline but improved or was maintained during the intervention phase with and without the device, respectively. Muscle size gains were preserved at follow-up, but barefoot ankle motion returned to baseline values. CONCLUSIONS: This FES device produced evidence of use-dependent muscle plasticity in CP. Permanent improvements in voluntary ankle control after repetitive stimulation were not demonstrated.

[The role of therapeutic physical training and massage in the restoration of static and dynamic functions in the children presenting with the atonic-astatic form of infantile cerebral paralysis].

Fifteen patients out of 25 involved in this study were given eight 20-day courses of toning massage and a series of special physical exercises designed to strengthen the occlusor muscles of the hip, knee and ankle joints. A massage technique and special physical exercises have been developed that made it possible to significantly improve the static and dynamic functions in the children presenting with the atonic-astatic form of infantile cerebral paralysis. No appreciable changes in the locomotor function was documented in the control group consisting of 10 patients.

Effects of intermittent normobaric hypoxia on the state of the CNS and cerebral circulation in children with cerebral palsy.

We studied the effects of intermittent normobaric hypoxia (INH) on the processes of CNS functions and cerebral circulation recovery in children with cerebral palsy (CP). Altogether, 87 patients (from 8.5 months to 12 years) with CP were examined and received the course of treatment. Clinico-neurophysiological examination was performed before the treatment and immediately after termination of the therapeutic course. Patients were divided into two groups; age and sex distributions and clinical manifestations of CP were randomized. The comparison group was formed from 34 children who received the course of the generally accepted complex therapy (medicamental treatment, massage, Bobat-therapy, Vojta-therapy at al).. The main group included 53 patients who, in addition to the same therapy, were exposed to INH using an individual apparatus for artificial mountain air, Borey-M, made in the Scientific Medico-Engineering Center NORT (Ukrainian National Academy of Sciences, Kyiv). Children of the main group were exposed to the dosed normobaric sanogenetic level hypoxia intermittently once per day. For this purpose, we used a normobaric gas hypoxic mixture (12% O2 + 88% N2). Each cycle included a 15-min-long episode of breathing with the gas mixture alternated by a 5-min-long episode of breathing an ambient atmospheric air. The number of hypoxic cycles was gradually increased (from one to three). The entire course of treatment included, on average, 10 sessions. After complex therapy the stable positive effects on the motor status were observed in 94% of patients of the main group (exposed to INH) and in 74% of patients of the comparison group (unexposed to INH). EEG examination showed that positive dynamics of spectral EEG components were in 70% of patients of the main group and in 56% of children of the comparison group. Doppler examination showed that brain hemodynamics was normalized in 85% of patients of the main group and in 59% of children of the comparison group. In the course of ophthalmoscopic examination, we found that the dynamics of indices of the state of the eye fundus were expressed more clearly in children of the main group than in patients of the comparison group (in 32 and 12% of patients, respectively).

Transient hypermetabolism of the basal ganglia following perinatal hypoxia.

Positron emission tomography can be used to evaluate brain function following perinatal hypoxia. This case report demonstrates transient hypermetabolism in the basal ganglia detected by glucose metabolism positron emission tomography study in a newborn who suffered hypoxic-ischemic encephalopathy and developed dystonic cerebral palsy later. A scan repeated at 4 years of age showed severe hypometabolism in the lentiform nuclei and thalami. Transient hypermetabolism in the basal ganglia following perinatal hypoxia may be related to excitotoxic damage causing permanent neurological symptoms in the form of dystonic cerebral palsy. Thus, positron emission tomography can help predict this form of cerebral palsy in neonates.

[Effects of acupuncture on quality of life in children with spastic cerebral palsy].

OBJECTIVE: To investigate the effect of acupuncture in children with spastic cerebral palsy (SCP). METHODS: One hundred SCP children, 2 to 7 years old, were randomly assigned to two groups equally. The control group was treated with rehabilitation training using Bobath and Vojta physical training methods and the acupuncture group treated also with the same training but with acupuncture conducted additionally. The therapeutic course was 3-12 months arranged according to the state of illness. RESULTS: The total effective rate, development quotient (DQ), improvement rate of brain hypogenesis and atrophy showed by skull CT, and recovery rate of cerebral emission computed tomography (ECT) were all higher in the acupuncture group than those in the control group (all P < 0.01). CONCLUSION: Acupuncture obviously promotes the compensation of cerebral function and shows a favorable effect in improving quality of life of the children with SCP.

Pilot study of positron emission tomography (PET) brain glucose metabolism to assess the efficacy of tongue and body acupuncture in cerebral palsy.

We aimed to assess the efficacy of tongue and body acupuncture with clinical function and brain glucose metabolism in children with a severe type of cerebral palsy. Four children were recruited. The motor function belonged to grade 5 of the Gross Motor Function Measure (i.e., completely nonambulatory). Daily tongue and body acupuncture was applied for 5 days a week for 8 weeks. The Functional Independence Scale for Children (WeeFIM), Clinical Global Impression Scale (CGIS), and positron emission tomography of the brain with [18F]fluorodeoxyglucose (FDG) were performed at baseline and after acupuncture. None of the children had any significant change in the Functional Independence Scale for Children score, despite the fact that all mothers scored 3 on the Clinical Global Impression Scale (i.e., 25% in improvement) in overall function. The brain glucose metabolism, however, showed a >10% increase in the frontal, parietal, temporal, and occipital cortices and cerebellum. Thus, a short course of tongue and body acupuncture was shown to increase brain glucose metabolism, despite lacking any clinical functional improvement seen during the eight-week course, possibly owing to the severity of the motor dysfunction and the short duration of treatment. The objective increase in brain glucose metabolism might serve as a surrogate marker for assessing the subclinical efficacy of an alternative treatment before any objective clinical improvement is evident. A larger-scale study for different degrees of severity of cerebral palsy and an impairment model should be undertaken to correlate clinical with neurometabolic change.