Title: Multi-modal longitudinal assessment of infant brain organization in perinatal stroke
Legend: This slide shows our study design – we are conducting a longitudinal, multi-modal study across the first two years of life for infants with perinatal brain injury, including perinatal stroke and brain bleed. The aim is to identify possible bioindicators of recovery and repair of motor corticospinal pathways which may be targeted by future interventions in infants with early brain injury. We will recruit 50 infants for this study and will perform observational assessments at 5 time points between term birth and 2 years of age.
Infants will undergo non-sedated MRI to assess at brain structure and connectivity, single-pulse non-invasive brain stimulation using transcranial magnetic stimulation to assess corticospinal circuitry and excitability, and age-appropriate motor assessments: the General Movements Assessment, the Hammersmith Infant Neurological Examination, and the Bayley Scales of Infant and Toddler Development- 4th edition.
Citation: Catarina Saiote PhD, Ellen Sutter DPT, PT Annette Xenopoulos-Oddsson MSc, Raghavendra Rao MD, Michael Georgieff MD, Kyle Rudser PhD, Douglas Dean PhD, Ryan M. McAdams MD, Bernadette Gillick PhD, MSPT, PT, ‘R01 Study Protocol: Multimodal Longitudinal Assessment of Infant Brain Organization and Recovery in Perinatal Brain Injury’, Pediatric Physical Therapy, (in press)
Abstract: Perinatal brain injury is a primary cause of cerebral palsy, a condition resulting in life-long motor impairment. Infancy is an important period of motor system development, including development of the corticospinal tract (CST), the primary pathway for cortical movement control. The interaction between perinatal stroke recovery, CST organization, and resultant motor outcome in infants is not well understood. Here, we present a protocol for multimodal longitudinal assessment of brain development and motor function following perinatal brain injury using transcranial magnetic stimulation and magnetic resonance imaging to non-invasively measure CST functional and structural integrity across multiple timepoints in infants 3 to 24 months of age. We will further assess the association between cortical excitability, integrity, and motor function. This protocol will identify bioindicators of motor outcome and neuroplasticity, and subsequently inform early detection, diagnosis, and intervention strategies for infants with perinatal stroke, brain bleeds and related diagnoses.
About the Lab: Bernadette Gillick’s Pediatric Neuromodulation Laboratory at the Waisman Center investigates how the brain simultaneously develops and recovers after perinatal stroke in early infancy. Further, Gillick’s team investigates interventions using combined non-invasive brain stimulation with neurorehabilitation to optimize functional outcomes in children with cerebral palsy due to perinatal stroke. By understanding the patterns of brain recovery and the optimal timing of intervention, Gillick aims to improve functional outcomes early in life, for improved lifelong activity and participation.