Lezingen en congressen 2013
Effects of mCIMT-BiT intervention in unilateral CP:
Hemispheric dominance of motor control
of the affected hand influences outcome of treatment.
MLA Jongsma PhD1, CM Baas MSc1, PBM Aarts PhD TO3, CM Rijn PhD MD2 & Prof. B. Steenbergen PhD1
1Behavioural Science Institute, Radboud University Nijmegen,
the Netherlands
2Donders Centre for Cognition, Radboud University Nijmegen,
the Netherlands
3Sint Maartens Kliniek, Nijmegen, the Netherlands
Introduction
It was demonstrated that both (modified) Constraint-Induced Movement Therapy (mCIMT) and Bimanual Training (BiT) lead to a marked improvement in upper limb function. Still, there is a wide variety in intervention outcome. A probable explanation is the ability of the brain to either strengthen contra-lateral or ipsi-lateral connections to recover function.
Objective
In this study we used EEG-recordings to determine hemispheric dominance for the control of the affected upper limb prior to intervention.
Patients
10 children (8-14) with unilateral Cerebral Palsy (CP) enlisted for a one week mCIMT-BiT intervention.
Methods
Hemispheric dominance was determined by comparing the LRP (Lateralised Readiness Potential) from the ongoing EEG measured over the contra-lateral hemisphere with the LRP measured over the ipsi-lateral hemisphere when generating button presses with the affected hand. Based on LRPs, five children were classified as having contra-lateral, and five as having ipsi-lateral dominance in controlling the affected hand.
Results
Groups did not differ with respect to hand capacity. However, occupational performance in bimanual tasks tended to be higher in the contra-lateral group. In addition, only the contra-lateral group showed intervention effects with respect to post-intervention EEG measures.
Discussion and conclusions
By extracting LRPs from the EEG we were able to distinguish two subtypes of unilateral CP. EEG thus offers a valid, affordable, and quick method for differential diagnosis.
Clinical message
Determining the hemispheric control of hand function before and after rehabilitation might add to a better understanding of intervention and involved mechanisms. We propose that this approach contributes to a more refined and individualised treatment protocol in the future.
