Functional and Structural Brain Connectivity in Children With Bilateral Cerebral Palsy Compared to Age-Related Controls and in Response to Intensive Rapid-Reciprocal Leg Training.

The sample size was very small, particularly for the resting-state fMRI analysis (9 children pre- and post-training), which limits statistical power. Head motion was a significant problem, leading to the exclusion of some data and requiring a lenient motion threshold that could bias results. The training dose (up to 20 hours) may have been too low to induce detectable brain changes, as other studies showing plasticity used much higher doses. The study only included children with bilateral cerebral palsy and diffuse white matter injury, so findings may not apply to other subtypes. Different sample sizes were used for different imaging modalities, making comparisons between modalities less direct.

The study was funded by the Intramural Research Program of the National Institutes of Health Clinical Center, the Cerebral Palsy Alliance Research Foundation, and the Johns Hopkins Neurosurgery Pain Research Institute. The authors declared no commercial or financial conflicts of interest.

Do not conclude that brain training is ineffective for cerebral palsy. This study used a relatively low training dose and had a very small sample size with significant motion artifacts. The null findings on brain structure and connectivity may reflect these limitations rather than a true lack of effect.