Study may offer direction for cerebral palsy treatment

Paul Mayne // Western News

PhD candidate Kathryn Manning, left, under the supervision of Ravi Menon, director of Western’s Centre for Functional and Metabolic Mapping, explores functional magnetic resonance imaging (fMRI) as an effective tool to predict which children with cerebral palsy would benefit most from constraint therapy.

A new Western-led study may lead to more guided treatment for young cerebral palsy patients, potentially increasing effectiveness in treatment and reducing frustration for thousands of sufferers.

For some children with cerebral palsy, constraint therapy is seen as an effective way to regain movement in a spastic limb. However, the therapy, which involves physically restraining their dominant limb in order to improve the weak limb, can be a particularly frustrating experience with little or positive outcome.

Western researchers have now shown functional magnetic resonance imaging (fMRI) could be an effective tool to predict which patients will benefit from the therapy, and which are likely not to. The study was recently 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, a professor at Western’s Schulich School of Medicine & Dentistry and director of Western’s Centre for Functional and Metabolic Mapping. “Fifty per cent seem to respond very well, 50 per cent don’t – and 100 per cent get frustrated with it. You’d like to understand what goes on in the brain when you do this.

“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.”

Cerebral palsy affects muscle tone, movement and motor skills, and is caused by brain damage that occurs before or during a child’s birth, or during the first 3-5 years of life.

There currently isn’t a good marker for determining who would benefit from constraint-induced movement therapy – it can’t be based on the child’s age or the lesion size in the brain. In response to that need, PhD candidate Kathryn Manning, the study’s lead author, aimed to identify any neuroimaging predictors that showed identifiable improvements following the therapy.

She gathered data on seven children with hemiplegic cerebral palsy, an injury affecting one side of the body. While it was a small group of subjects, Manning said it offered some intriguing results.

“It was a little surprising. The subjects who had the most compromised networks actually tended to improve the most. It didn’t seem to be correlated with the size of the lesion, which was interesting,” she said, adding the children showed strong changes in the neuropathways of the brain. “Looking at these networks, we were able to see what it looked like at baseline, and again after the therapy.

“We began to see the neurological basis of the clinical improvement. It was a strong change.”

Menon added, should this initial study lead to a larger multi-centered trial, fMRI could become a useful clinical tool when determining if constraint therapy is an appropriate treatment option for individuals with hemiplegic cerebral palsy.

“If it turns out to be viable on a larger scale, it’s a very simple, very benign type of experiment to do, to both understand how things change and, ultimately, predict who would benefit from the therapy,” Menon said.