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  • Review Article
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Rehabilitation and neuroplasticity in children with unilateral cerebral palsy

Key Points

  • Activity-based therapy is the main clinical rehabilitation strategy for children with unilateral cerebral palsy (UCP)

  • Therapies can be considered to be effective if they bring about improvements that transfer to daily activities and help children to meet their individual needs and goals

  • Current research suggests that motor impairments in children with UCP result from damage to the corticospinal tract, as well as from impairments of sensorimotor pathways and motor planning

  • A variety of tools and imaging modalities will enable the measurement of neuroplasticity in future clinical trials

  • Future therapies for UCP are likely to be multimodal, and to be derived from research into the neurobiology of the condition

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.

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Figure 1: The influence of periventricular lesions on corticospinal laterality.
Figure 2: An example of functional-MRI-guided diffusion MRI tractography.

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Reid, L., Rose, S. & Boyd, R. Rehabilitation and neuroplasticity in children with unilateral cerebral palsy. Nat Rev Neurol 11, 390–400 (2015). https://doi.org/10.1038/nrneurol.2015.97

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