Somatosensory Plasticity in Pediatric Cerebral Palsy following Constraint-Induced Movement Therapy

Figure 1

Flowchart of analytical steps performed in the present study. A multistep analysis framework was developed to identify the mechanisms within the somatosensory brain system contributing to impairments as well as (post-CIMT) to the recovery of motor function. In step 1, we compared ERPs to puff (and sham) stimuli to the more and less affected hand before and following CIMT. In step 2, we investigated whether CIMT modulated the strength of responses within statistically indistinguishable brain networks and/or through alternations in ERP topography. In step 3, we performed spatial correlations on ERPs to investigate whether CIMT influenced ERP topography by forcing the somatosensory system controlling the more affected hand to activate patterns of brain activity (“template maps”) more similar to those controlling the less affected hand. In step 4, to understand whether the observed associations were driven by relatively longer involvement of the more functional patterns of somatosensory brain activity, we, first, submitted group-averaged ERPs to a hierarchical cluster analysis and then fit the template maps detected in group-averaged ERPs to single-subject ERPs to test whether they were reliably present. Lastly, in step 5, we performed correlations between relative duration of the more functional template maps and relative changes in scores on the sensory and motor diagnostic CP tests, to test behavioral associations with observed patterns of somatosensory activity.