Rehabilitation and neuroplasticity in children with unilateral cerebral palsy

Abstract

Cerebral palsy is a childhood-onset, lifelong neurological disorder that primarily impairs motor function. Unilateral cerebral palsy (UCP), which impairs use of one hand and perturbs bimanual co-ordination, is the most common form of the condition. The main contemporary upper limb rehabilitation strategies for UCP are constraint-induced movement therapy and bimanual intensive therapy. In this Review, we outline the factors that are crucial to the success of motor rehabilitation in children with UCP, including the dose of training, the relevance of training to daily life, the suitability of training to the age and goals of the child, and the ability of the child to maintain close attention to the tasks. Emerging evidence suggests that the first 2 years of life are a critical period during which interventions for UCP could be more effective than in later life. Abnormal brain organization in UCP, and the effects of development on rehabilitation, must also be understood to develop new effective interventions. Therefore, we also consider neuroimaging methods that can provide insight into the neurobiology of UCP and how the condition responds to existing therapies. We discuss how these methods could shape future rehabilitative strategies based on the neurobiology of UCP and the therapy-induced changes seen in the brain.BMC Pediatr. 2014 Jun 05;14:141. (PMID: 24903062); Dev Med Child Neurol. 2015 Jun;57(6):530-8. (PMID: 25955443); Neurology. 2001 Nov 13;57(9):1543-54. (PMID: 11706088); Lancet Neurol. 2003 Mar;2(3):145-56. (PMID: 12849236); Early Hum Dev. 1993 Sep;34(1-2):89-100. (PMID: 8275886); Neuroimage. 2007 Jul 15;36(4):1225-35. (PMID: 17532230); BMC Neurol. 2013 Jun 11;13:57. (PMID: 23758951); Neurorehabil Neural Repair. 2013 Jan;27(1):72-8. (PMID: 22677505); BMJ Open. 2013 Apr 10;3(4):null. 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