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Understanding Brain Reorganization in Infants With Perinatal Stroke Through Neuroexcitability and Neuroimaging

Chen, Chao-Ying PT, PhD, MS; Georgieff, Michael MD; Elison, Jed PhD; Chen, Mo PhD; Stinear, James PhD; Mueller, Bryon PhD; Rao, Raghavendra MD; Rudser, Kyle PhD; Gillick, Bernadette PT, MSPT, PhD

doi: 10.1097/PEP.0000000000000365
Study Protocol

Purpose: The primary aim of this proposed study is to evaluate brain reorganization patterns in infants with perinatal stroke between 3 and 5 months of age using transcranial magnetic stimulation and magnetic resonance imaging, with the addition of the General Movements Assessment. A secondary aim is to demonstrate feasibility and safety of infant-appropriate brain assessment protocols.

Methods: Ten infants with perinatal stroke will be enrolled. In this exploratory study, infants will first receive magnetic resonance imaging scanning during natural sleep to examine their corticospinal tract integrity. Infants will then receive transcranial magnetic stimulation to assess their corticomotor excitability. A General Movements Assessment video of at least 5 minutes will also be recorded.

Discussion: Study results will enhance our understanding of brain reorganization in infants with perinatal stroke. We expect these results will also guide the development of early interventions designed to mitigate maladaptive neuroplastic changes and improve long-term motor outcomes.

This presents a safe and feasible protocol for measuring brain reorganization patterns in infants with stroke using transcranial magnetic stimulation (TMS) and magnetic resonance imaging (MRI).

Department of Physical Medicine and Rehabilitation (Drs C-Y Chen and Gillick), Department of Pediatrics (Drs Georgieff and Rao), Institute of Child Development (Dr Elison), Institute for Engineering in Medicine (Dr M Chen), and Department of Psychiatry (Dr Mueller), University of Minnesota, Minneapolis; Department of Exercise Sciences (Dr Stinear), University of Auckland, New Zealand; and Clinical and Translational Science Institute (Dr Rudser), University of Minneapolis, Minnesota.

Correspondence: Bernadette Gillick, PT, MSPT, PhD, 273 Children's Rehabilitation Center, 388 MMC, 426 Church St SE, Minneapolis, MN 55455 (

Grant Support: This study was supported by grants from and Academic Health Center Seed Grant (2015) from the University of Minnesota and American Academy for Cerebral Palsy and Developmental Medicine (AACPDM) and the Cerebral Palsy Alliance, MnDRIVE Brain Conditions Fellowship.

The authors declare no conflicts of interest.

Copyright © 2017 Wolters Kluwer Health, Inc. and Section on Pediatrics of the American Physical Therapy Association. All rights reserved.