Imaging Predictors of Improvement from a Motor Learning-Based Intervention for Children with Unilateral Cerebral Palsy

Mitchell Schertz*, Shelly I. Shiran, Vicki Myers, Maya Weinstein, Aviva Fattal-Valevski, Moran Artzi, Dafna Ben Bashat, Andrew M. Gordon, Dido Green

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background. Motor-learning interventions may improve hand function in children with unilateral cerebral palsy (UCP) but with inconsistent outcomes across participants. Objective. To examine if pre-intervention brain imaging predicts benefit from bimanual intervention. Method. Twenty children with UCP with Manual Ability Classification System levels I to III, aged 7-16 years, participated in an intensive bimanual intervention. Assessments included the Assisting Hand Assessment (AHA), Jebsen Taylor Test of Hand Function (JTTHF) and Children's Hand Experience Questionnaire (CHEQ) at baseline (T1), completion (T2) and 8-10 weeks post-intervention (T3). Imaging at baseline included conventional structural (radiological score), functional (fMRI) and diffusion tensor imaging (DTI). Results. Improvements were seen across assessments; AHA (P = 0.04), JTTHF (P <.001) and CHEQ (P < 0.001). Radiological score significantly correlated with improvement at T2; AHA (r =.475) and CHEQ (r =.632), but negatively with improvement on unimanual measures at T3 (JTTFH r = -.514). fMRI showed negative correlations between contralesional brain activation when moving the affected hand and AHA improvements (T2: r = -.562, T3: r = -0.479). Fractional Anisotropy in the affected posterior limb of the internal capsule correlated negatively with increased bimanual use on CHEQ at T2 (r = -547) and AHA at T3 (r = -.656). Conclusions. Children with greater structural, functional and connective brain damage showed enhanced responses to bimanual intervention. Baseline imaging may identify parameters predicting response to intervention in children with UCP.

Original languageEnglish
Pages (from-to)647-660
Number of pages14
JournalNeurorehabilitation and Neural Repair
Issue number7
StatePublished - 1 Aug 2016
Externally publishedYes


  • DTI
  • fMRI
  • prediction
  • treatment
  • unilateral cerebral palsy


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