Brain Control of Movements in Cerebral Palsy

Completed

Conditions studied: Cerebral Palsy

In brief

This study will examine how the brain controls movements in patients with certain types of cerebral palsy. In healthy people, one side of the body usually controls movements on the other side of the body. In patients with cerebral palsy, this pattern may be altered, and one side of the brain may control movements on the same side of the body. Information obtained from this study may lead to improved rehabilitation therapy strategies for patients with cerebral palsy. Healthy volunteers and patients with cerebral palsy between 6 and 18 years of age may be eligible for this study. All candidates will be screened with a medical history, physical examination, and psychological testing. In addition, patients with cerebral palsy will have hearing and vision tests, a review of their medical records, and a magnetic resonance imaging (MRI) scan if one has not been done within the past year. For this test, the patient lies on a table that slides into a narrow metal cylinder with a strong magnetic field (the scanner). The scanning time usually lasts between 45 and 90 minutes. Patients enrolled in the study also will be evaluated by a physiatrist and physical and occupational therapists. They will be examined for muscle stiffness and reflexes. Their gait and movements (e.g., how they pick up a glass of water) will be evaluated. They will be asked about their ability to perform activities around the house and at school and whether a wheelchair or walker is needed to get around. Patients may also be asked about how they are dealing with their movement problems and how it affects their caregivers. All participants will undergo three tests, described below, to evaluate movement control. The first two tests use electrodes (small metal discs) taped to the skin over the muscles in both hands to measure muscle activity. A small disc placed on the fingers detects and measures the hand movements. The third test uses magnetic pulses that stimulate the brain to study how the brain controls movements. 1. Quantitative test of fine motor function: For this test, the subject taps buttons at different speeds on a box attached to a computer. The test is similar to playing simple computer games. 2. Long latency reflexes: For this test, the subject's hand is lightly strapped into a holder that holds the hand still while a motor moves the index finger with sudden small movements. These reflexes may also be tested using a gentle shock to the finger delivered through a ring electrode. 3. Transcranial magnetic stimulation: For this test, the subject sits in a comfortable chair. An insulated coil is held on the scalp. A magnetic pulse from the coil stimulates the brain. The subject may hear a click and feel a snap or pulling sensation on the scalp under the coil. The stimulation may also cause twitching in the muscles of the arm or leg. During the stimulation, the subject may be asked to move certain muscles or perform other simple actions.

Key facts

Study ID: NCT00076596
Run by: National Institute of Neurological Disorders and Stroke (NINDS)
People needed: 130
Starts: 2004-01-23
Expected to finish: 2007-12-10
Last updated by the study team: 2017-07-02

Who can join

Age: 6 and older, up to 30. Sex: any. Healthy volunteers: accepted.

You may not qualify if…

Any child who is pregnant. Adult women and girls between 12 and 17 years of age who have started their menstrual periods will be required to take a pregnancy test at the initial interview. If this is positive, they will not be allowed to take part in the study. At the initial phone screening we will inform both the parent/ guardian and the child that we will require this pregnancy test at the initial interview to determine eligibility and that we will inform both the child and her parents with the results of the test.
CEREBRAL PALSY PATIENTS:
Patients with subtypes of cerebral palsy that are not hemiplegia or diplegia. These include spastic quadriplegia (no difference in level of severity of motor deficit between arms and legs); spastic triplegia; mixed forms of cerebral palsy; athetoid or dystonic forms of cerebral palsy; unclassifiable forms of cerebral palsy.
Hemiplegic cerebral palsy with greater than minimal motor deficits on the good hand.
Spastic diplegia patients who have asymmetry of the motor deficit greater than 1 severity point between the two sides (e.g. left side mild, right side severe).
Patients with DQ or IQ below 50 as assessed by Gesell or with standardized tests (pre-school age), or through school testing (school age).
Uneducable patients by reason of severely impaired attention.
Patients with seizures within the last 6 months.
Patients with an underlying known genetic or chromosomal disorder.
Patients with clearly identified familial or non-familial syndromes (without known chromosomal or genetic defect).
Cerebral lesions acquired after 1 year of age.
Patients with progressive or neurodegenerative disorders.
Patient with spinal disorders in the absence of cerebral lesions.
Patients with cerebral lesions caused by sickle cell disease or by emboli associated with congenital cardiac lesions.
Patients with severe cognitive deficits who cannot follow simple verbal commands.
Patients incapable of voluntary movement of either upper or lower limbs due to contractures.
Patients who have had rhizotomy for upper extremity plasticity, who have had botulinum toxin within the last 3 months or have an intrathecal baclofen pump.
Patients with severe postural abnormalities who cannot maintain supported sitting.
HEALTHY SUBJECTS:
Children or adults with any neurological and/or psychiatric disorder including attention deficit hyperactivity disorder or learning disorder.
Subjects with any chronic medical disorders.
Subjects taking regular medications, including medications for allergies, hormonal oral contraceptives, or over-the-counter medications.
Healthy subjects born before 36 weeks gestation as estimated by dates, ultrasound or other methods (if a discrepancy exists, then the ultrasound estimation will be taken as definitive).
Subjects with siblings who have developmental delay or abnormalities of the corpus callosum (these subjects have an increased chance of having asymptomatic abnormalities of the central nervous system).
Subjects with albinism or a personal or family history of sensorineural hearing loss (these subjects have an increased incidence of incidental callosal abnormalities).

Where it is running

Childrens National Medical Center — Washington D.C., District of Columbia, United States
Georgetown University Medical Center — Washington D.C., District of Columbia, United States

Full record on ClinicalTrials.gov

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