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Journal of the Korean Academy of Rehabilitation Medicine 2010;34(1):79-84.
Does Injured Corticospinal Tract Recover after Rehabilitation Therapy in Patients with Hemiplegic Cerebral Palsy?.
Son, Su Min , Kwak, So Young , Jang, Sung Ho , Ahn, Sang Ho , Cho, Yon Yoo , Kim, Han Seon , Cho, Hee Kyung , Moon, Han Ku
1Department of Physical Medicine & Rehabilitation, College of Medicine, Yeungnam University, Korea. july0025@hanmail.net
2Department of Pediatrics, College of Medicine, Yeungnam University, Korea.
편마비 뇌성 마비 환자에서 재활치료 이후 손상된 뇌피질 척수로의 회복
손수민, 곽소영, 장성호, 안상호, 조윤우, 김한선, 조희경, 문한구1
영남대학교 의과대학 재활의학교실, 1소아청소년과학교실
Abstract
Objective
To investigate whether injured corticospinal tract (CST) could recover after rehabilitative therapy in hemiplegic patients with cerebral palsy using diffusion tensor tractography (DTT) which is known to be useful in detecting microscopic white matter lesion in vivo.
Method
Sixteen hemiplegic patients (mean age, 13.6 months) were enrolled. Diffuse tensor image (DTI) and gross motor functional measurement (GMFM) evaluation were performed before rehabilitative therapy and at follow-up. We measured the fractional anisotropy (FA), and apparent diffusion coefficient (ADC) of CST in the affected and unaffected hemisphere. To evaluate asymmetry of affected and unaffected CST, asymmetry index of fractional anisotropy (AA) and asymmetry index of apparent diffusion coefficient (AD) were measured.
Results
The FA value of the affected CST was lower than that of the unaffected CST and the ADC value was higher than that of the unaffected CST in initial and follow up DTT (p<0.001). Compared with the result of initial DTT, the results of follow up DTT demonstrated that the FA value of both CST was increased (p=0.000). A significant increase in AA was showed in all patients (p=0.000) and the increase of AA had significant correlation with the increase of FA of affected CST, but not with the unaffected CST (r=0.537, p=0.032).
Conclusion
DTT would be a powerful modality not only for diagnosis and prognosis of cerebral palsy, but also assessment of microstructural change of CST after rehabilitative therapy. (J Korean Acad Rehab Med 2010; 34: 79-84)
Key Words: Diffusion tensor imaging, Corticospinal tract, Hemiplegia


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