Read Full Text: Rehabilitation and neuroplasticity in children with unilateral cerebral palsy (This is a paid article, but we thought it was imporant to cover.)
Journal: Nature Reviews Neurology
Year Published: 2015
Ranked 89th on our 2015-2020 list of the 100 most influential OT-related articles
Wow! This week’s article sums up the future of therapy better than any others I’ve found!
The article focuses on cerebral palsy (CP) rehab—but you’ll notice some similarities to articles we’ve covered on stroke rehab. Specifically, you’ll see that the primary goal of therapy in this article is inducing neuroplasticity.
The big takeaway is this:
Therapy is currently single-mode (meaning the sole therapy delivered is traditional rehabilitation). But, the future will be multimodal, where your traditional therapy will be paired with some kind of brain imaging/stimulation.
This article is a great read for any therapist who is interested in the future of therapy. Plus, it provides valuable practice insights specific to pediatric therapy.
Let’s dive in.
What type of article was this, and what was its intent?
This article was a review of research available on children with unilateral cerebral palsy (UCP)—specifically, children under 2 with this condition. The authors examined 2 ideas:
- Current best practices for children with UCP, as well as the factors that can impact those practices.
- Neuroimaging technologies that are being used to better understand neurological diagnoses—specifically in this case, UCP.
The authors were able to look at what we know—and, perhaps more importantly, what we still don’t know—about UCP, including how this knowledge impacts service delivery.
Current best practices in existing rehab strategies for CP
This article reinforced some concepts that many OTs already view as best practice for children with UCP-driven sensorimotor impairments.
First, therapy should be activity-based. Secondly, the benefits of those activities should be generalized to the child’s daily activities. Lastly, the family’s abilities to participate, engage their child in these activity-based therapies, and find the “just right” level of challenge were all crucial to success. This is absolutely where we OTs shine.
The authors focused on two main types of intervention in the article.
- Modified Constraint-Induced Movement Therapy (mCIMT)
- Bimanual Intensive Therapy
Almost all of the research articles the authors discussed used these therapies as their interventions. The authors also briefly mentioned some of the newer technologies that are being researched, such as robot-assisted therapy—but they pointed out that evidence hasn’t supported these technologies quite yet.
Lastly, the majority of research examining the effectiveness of interventions for children with UCP looks at school-aged children. However, there were multiple pilot studies looking at young children, all under two, that supported the immense positive impact of early intervention.
What is neuroplasticity-informed rehabilitation?
Neuroplasticity is the brain’s ability to grow and change in response to whatever is thrown at it, whether it’s an environmental change or an injury. The authors argue that by better understanding how the brain responds to change, we will have more opportunity to harness such changes and inform the clinical process accordingly.
First, we need to better understand what is happening in the brains of children with UCP in order to fully process why practitioners see what we see.
Secondly, we need to better understand how the therapies we are using with children are impacting their brains. This will help us determine which interventions are effective, and which are not.
What technologies did the authors assert might impact the future of CP?
The authors went into very specific detail about a variety of technologies being used to better understand UCP. While understanding the minute detail of these technologies might not be in our wheelhouse right now, it’s important for OTs to remain aware of what’s happening and coming in the future.
- Transcranial Magnetic Stimulation (TMS)
- Diffusion Magnetic Resonance Imaging (dMRI)
- Electroencephalogram (EEG)
- Magnetoencephalography (MEG)
- Structural Magnetic Resonance Imaging (sMRI)
- Blood-oxygen-level-dependent (BOLD) functional MRI (fMRI)
Some interesting preliminary findings that could impact rehab in the future
In children with UCP, motor control could be ipsilateral rather than contralateral.
This finding jumped out as an example of how a better understanding of the neurological workings of our clients can (and should) influence our interventions. It also supports how the sensory feedback loop impacts motor output, and provides an area for OTs to explore in the future.
Motor planning is more closely linked to challenges in motor output than we previously thought.
The authors reviewed a study that suggested motor planning might be a limiting factor in the execution of motor movements. The authors also linked this finding to success with activating the mirror neuron system, which is a system we see referenced frequently in discussions about autism spectrum disorder (ASD).
Assessments that are relevant to OT
- Assisting Hand Assessment (AHA)
- Canadian Occupational Performance Measure (COPM)
- Jebsen Taylor Test of Hand Function (JTTHF)
What did the authors conclude/discuss?
While there was a lot of information in this article, the authors’ conclusion was pretty succinct: the better we understand how the brain is working, the more likely we are to provide highly effective interventions.
Takeaways for OT practitioners
1. Intensive therapy should start sooner than we might have previously thought.
This article made it clear that while more research is needed, the brains of children under two are highly plastic. Capitalizing on all of those potential changes in early life could lead to significantly improved long-term outcomes.
However, these intensive interventions often have high demands in terms of time, financial resources, and access to advanced training for practitioners. As a profession, we need to consider how to reconcile all of these factors to best serve all of our clients.
2. Once again, family engagement is a key factor to success.
It seems to come up again and again when looking at this younger age group: the more engaged and supported the family is, the more successful outcomes we see in their children. This was even a takeaway in last week’s article review!
3. Incorporating new technologies with tried-and-true interventions will keep us at the forefront of the rehabilitation arena.
One interesting takeaway from this article was that each new advanced imaging study seemed to support the interventions we are already using. What we do works.
Since its inception, our profession has been ever-evolving and adapting—but OT has always been rooted in a humanistic, holistic groundwork. By continuing to blend our humanistic roots with the technological future, we can continue to reinforce our value.
(Possibly) Earn CEUs/PDUs for reading this article.
Many of you can receive continuing education credits for reading this article. Here’s a form to help you do it, along with information to help you understand who qualifies.
And, here’s the full APA citation you many need:
Reid, L. B., Rose, S. E., & Boyd, R. N. (2015). Rehabilitation and neuroplasticity in children with unilateral cerebral palsy. Nature Reviews Neurology, 11(7), 390-400. doi:10.1038/nrneurol.2015.97
