Neuroplasticity in a randomised clinical trial of multi-modal training of children with unilateral cerebral palsy?

Abstract

Background and Objective(s): To determine whether multimodal training (Mitii: Move it to improve it) leads to use dependent neuroplasticity and concurrent changes in motor and processing skills compared to wait-list control in children with unilateral cerebral palsy (CP). Study Design: Randomised controlled trial. Study Participants & Setting: In an RCT of Mitti intervention (n=102, 51 in each group) a subset of 27 children (mean age 12.3y [SD 2.8y]; 10 males) with unilateral CP (GMFCS I=16; II=11; MACs I=12; II=20) completed MRI studies pre-post intervention. Materials/Methods: Children were randomly allocated to immediate Mitii training for 30 minutes per day for a total dose of 60 hours over 12 weeks or wait-list control group. Children undertook an MRI at 3T (sMRI, fMRI motor task and 64 direction HARDI dMRI) at both baseline (T1) and after 12 weeks (T2). Children undertook concurrent clinical functional assessments on the Assessment of Motor Processing skills (AMPs Motor and Process) by an OT accredited in AMPs assessment. Diffusion measures were taken of the more-affected corticospinal tract using functional-MRI driven tractography. Results: Sixty-six children underwent the fMRI-DTI protocol but only 27 had follow-up data suitable for analysis (Mitii n=14; Control n=13). There were no significant differences on baseline measures. The Mitii group demonstrated significant gains in motor processing (AMPs) from baseline to 12 weeks (EMD=0.50, 95%CI 0.28, 0.71, p=0.0001). Neither FA nor MD changed significantly more in the Mitii group than in the control group (p>0.05). Conclusions/Significance: Intensive multi-modal training lead to clinically significant improvements in motor and processing skills but these were not accompanied by changes in microstructure of the more-affected corticospinal tract. This may have been because brain changes underlying AMPs motor processing improvements are explained by other forms of brain changes which may be at odds with recent a motor learning study in healthy participants. More likely this was due to a lack of statistical power. This highlights a need for sample size calculations to detect changes in neuroplasticity; it is possible that numbers required for imaging may need to be larger than those to detect changes in clinical motor performance in children with unilateral CP. (Figure Presented).L6184697122017-09-29 <br />