Does Corticospinal Tract Connectivity Influence the Response to Intensive Bimanual Therapy in Children With Unilateral Cerebral Palsy?

The study had a small sample, which makes it difficult to draw firm conclusions. There was no follow-up after therapy, so it cannot show whether gains were retained. Corticospinal tract testing was done before therapy for some children and up to 3 years after therapy for others. Children were recruited from two sites with slightly different therapy, and the Brussels group also received lower extremity training. The study was a before-and-after therapy study grouped by corticospinal tract pattern, so it cannot show that the therapy caused the improvements. The study did not compare bimanual therapy with constraint-induced movement therapy, so it cannot say which therapy is optimal. Children with bilateral corticospinal tract patterns were analysed separately and were too few for correlations with Laterality Index. The population was heterogeneous, and lesion size, lesion location, and timing of injury could not be fully controlled.

Funded by NIH grants R03HD073515, R01HD076436, and K01NS062116. The Brussels study was also funded by the Fondation van Goethem-Brichant Prize for Rehabilitation 2012 and a Fonds de la recherche clinique fellowship.

Do not conclude that corticospinal tract pattern should guide therapy choice. The ipsilateral and contralateral groups improved similarly, and the Brussels group also received lower extremity training, so the separate contribution of bimanual therapy cannot be isolated. The study was a before-and-after therapy study, so it cannot show that the therapy caused the improvements.