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Neural Plasticity
Volume 2015, Article ID 798481, 13 pages
Research Article

Brain Plasticity following Intensive Bimanual Therapy in Children with Hemiparesis: Preliminary Evidence

1Functional Brain Center, The Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, 6423906 Tel Aviv, Israel
2Department of Psychology, Gonda Multidisciplinary Brain Research Center, Bar-Ilan University, 5290002 Ramat Gan, Israel
3Sackler Faculty of Medicine, Tel Aviv Sourasky Medical Center, 6997801 Tel Aviv, Israel
4Health and Life Sciences, Oxford Brookes University, Oxford OX3 3FL, UK
5Child Development & Pediatric Neurology Service, Meuhedet, 3350127 Haifa, Israel
6Department of Radiology, Tel Aviv Sourasky Medical Center, 6423906 Tel Aviv, Israel
7Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY 10027, USA
8Paediatric Neurology Unit, Tel Aviv Sourasky Medical Center, 6423906 Tel Aviv, Israel
9Sagol School of Neuroscience, Tel Aviv University, 6997801 Tel Aviv, Israel

Received 30 January 2015; Revised 10 June 2015; Accepted 11 June 2015

Academic Editor: Lin Xu

Copyright © 2015 Maya Weinstein et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Neuroplasticity studies examining children with hemiparesis (CH) have focused predominantly on unilateral interventions. CH also have bimanual coordination impairments with bimanual interventions showing benefits. We explored neuroplasticity following hand-arm bimanual intensive therapy (HABIT) of 60 hours in twelve CH (6 females, mean age 11 ± 3.6 y). Serial behavioral evaluations and MR imaging including diffusion tensor (DTI) and functional (fMRI) imaging were performed before, immediately after, and at 6-week follow-up. Manual skills were assessed repeatedly with the Assisting Hand Assessment, Children’s Hand Experience Questionnaire, and Jebsen-Taylor Test of Hand Function. Beta values, indicating the level of activation, and lateralization index (LI), indicating the pattern of brain activation, were computed from fMRI. White matter integrity of major fibers was assessed using DTI. 11/12 children showed improvement after intervention in at least one measure, with 8/12 improving on two or more tests. Changes were retained in 6/8 children at follow-up. Beta activation in the affected hemisphere increased at follow-up, and LI increased both after intervention and at follow-up. Correlations between LI and motor function emerged after intervention. Increased white matter integrity was detected in the corpus callosum and corticospinal tract after intervention in about half of the participants. Results provide first evidence for neuroplasticity changes following bimanual intervention in CH.