The Childhood Hemiplegic Cerebral Palsy (CP) Integrated Neuroscience Discovery System “Hemi-NET” (2011 - 2013) was designed to bring together children with hemiplegic CP, their families, and clinical and basic scientists to foster neuroscience discoveries through integrated translation. Hemi-NET focused on preventing hemiplegia, aiding in early identification and innovating neurorehabilitation treatments to improve the child’s neurological function and quality of life.
Hemi-NET focused on hemiplegic CP, the most common type of CP in which one side of the body is affected (namely an arm, leg, or both) and is most often caused by a stroke, similar to what happens with older adults. Hemi-NET brought together world-renowned researchers from across Ontario–and across scientific disciplines to better understand the causes of the disease and to improve treatments for children who have CP.
The Hemi-NET research program was divided into four research themes:
The largest component of Hemi-NET was the Clinical Database. Nine clinical sites from across Ontario recruited children with CP and acquired a large database of information about clinical risk factors, neuroimaging, genetics, neurodevelopmental factors as well as the psychosocial and participation dimensions of children’s lives.
This data was collected by conducting a detailed review of the child’s neonatal, medical and rehabilitation charts, along with maternal medical and obstetrical records. Other variables include socio-demographic information, family history as well as diagnostic data. Clinically acquired imaging data from fMRIs were obtained and read, classified, and coded to create a neuroimaging database.
These efforts have supported current and future CP-NET research questions and themes.
The objective of the study was to assess the role of novel genetic mutations in individuals with hemiplegic CP to refine the understanding of the genetic risk factors. Ninety seven children between 2-18 years (59 male, 38 female) were recruited from nine clinical centers across Ontario. The results suggested that hemiplegic CP can be associated with novel and rare inherited genetic mutations. The presence of these mutations and those involving well-defined genomic disorders among the sample suggest the benefits of testing for diagnostic purposes in hemiplegic CP.
Zarrei M, Fehlings DL, Mawjee K, Switzer L, Thiruvahindrapuram B, Walker S, Merico D, Casallo G, Uddin M, MacDonald JR, Gazzellone MJ, Higginbotham EJ, Campbell C, deVeber G, Frid P, Gorter JW, Hunt C, Kawamura A, Kim M, McCormick A, Mesterman R, Samdup D, Marshall CR, Stavropoulos DJ, Wintle RF, Scherer SW. De novo and rare inherited copy-number variations in the hemiplegic form of cerebral palsy. Genet Med. 2017 Feb;20(2):172-180 doi.org/10.1038/gim.2017.83
Constraint Induced Movement Therapy (CIMT)
Constraint Induced Movement Therapy (CIMT) is a proven treatment for children with hemiplegic CP to help gain more functioning in their affected arm and hand. In CIMT, the dominant arm is constrained (put in a cast or splint) to force the child to use the hemiplegic arm. We know this works with both children and adults who have one-sided weakness because it forces the brain to re-wire to improve the arm’s function. The brain’s ability to re-wire is called “plasticity” and we do not fully understand how the brain accomplishes this rewiring months or years after the initial brain injury or who responds best to CIMT intervention.
Related Research Summary
Technology Innovation for Neuro-rehabilitation
The Technology Innovation theme encompassed technological innovations for improving the lives of children and youth with CP. The first arm combined CIMT with active video gaming to make the therapy more enticing to chidren while being able to target specific behaviours and repetitive movements. The second arm employed robotic gait trainers and fMRI to investigate the relation between training-induced neuroplastic changes in the brain and clinical gross motor or gait outcomes. This project also used robotic technology, in the form of the Kinarm Exoskeleton Robot, to measure upper limb movement and control in children with hemiplegic CP, when compared with typically developing children function. The final arm replaced conventional CIMT with repetitive transcranial magnetic stimulation (rTMS) in children with hemiplegic CP greater than 5 years of age to further explore the importance of interhemispheric inhibition and the impact this has on the child’s hand function.