How motor learning and neuroplasticity may inform development of rehabilitation technology for children with cerebral palsy

Andrew Gordon | Professor of Movement Sciences, Teachers College, Columbia University

Abstract

Cerebral palsy (CP) is the most common pediatric physical and neurological disorder, and describes a group of permanent disorders of the development of movement and posture, causing activity limitation. The manifestation of CP is attributed to non-progressive disturbances that occurred in the developing fetal or infant brain. Although the brain disturbances are non-progressive, the expression of the impairments and resulting disabilities change throughout the life cycle as the child grows, develops, and compensates for the underlying abnormalities. Historically treatment was focused primarily and remediating impairments (e.g., increased muscle tone), with little expectation that motor function could improve. However, we later showed that upper extremity function, albeit impaired, develops at the same rate in children with CP as their typically developed peers. Furthermore, although children with CP demonstrated impaired motor learning, our studies of prehension showed that motor function can indeed improve, but only with much more intensive practice than required of their typically developing peers. Recent systematic analyses of treatment studies demonstrate that rehabilitation approaches that capitalize on these findings, and involve active movement of the participant using “motor learning approaches” and neuroplasticity are effective in improving movement coordination and function. Here we review how motor learning and neuroplasticity research has informed pediatric rehabilitation, the current state-of-the-science behind effective rehabilitation approaches, the neural predictors (especially the integrity and connectivity pattern of the corticospinal tract) and neural plasticity associated with improved motor outcomes.  The implications for rehabilitation technology and a recent implementation for robotic seated postural control training will be discussed.

Bio

Dr. Andrew Gordon has a broad background in neurophysiology and biomechanics and has extensive clinical and research expertise involving children with cerebral palsy. He has been studying hand motor control in healthy individuals and individuals with CP for over 25 years. In 1996 he founded the Center for Cerebral Palsy Research at Teachers College, Columbia University. The Center places emphasis on understanding the mechanisms underlying motor disorders associated with CP, and developing evidence-based treatment approaches targeting these disorders using motor learning approaches taking advantage of neuroplasticity. More than 300 children with CP have participated in constraint-induced movement therapy, bimanual training (HABIT), and recently combined upper and lower extremity training day camps. Recently he has been capitalizing on his neuroplasticity findings associated with these approaches to pair non-invasive brain stimulation with motor training, and he and his colleagues have developed a robotic trunk training device for training seated postural control. He is a fellow in the National Academy of Kinesiology, and has more than 150 peer-reviewed papers.

https://www.tc.columbia.edu/faculty/ag275/
https://www.tc.columbia.edu/cit/