Browsing by Author "Cole, Lauran"

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    Bilateral actigraphic quantification of upper extremity movement in hemiparetic children with perinatal stroke: a case control study
    (2021-12-16) Hollis, Asha; Cole, Lauran; Zewdie, Ephrem; Metzler, Megan J.; Kirton, Adam
    Abstract Background Hemiparetic cerebral palsy impacts millions of people worldwide. Assessment of bilateral motor function in real life remains a major challenge. We evaluated quantification of upper extremity movement in hemiparetic children using bilateral actigraphy. We hypothesized that movement asymmetry correlates with standard motor outcome measures. Methods Hemiparetic and control participants wore bilateral wrist Actiwatch2 (Philips) for 48 h with movement counts recorded in 15-s intervals. The primary outcome was a novel statistic of movement asymmetry, the Actigraphic Movement Asymmetry Index (AMAI). Relationships between AMAI and standard motor outcomes (Assisting Hand Assessment, Melbourne Assessment, and Box and Block Test [BB]) were explored with Pearson or Spearman correlation. Results 30 stroke (mean 11 years 2 months (3 years 10 months); 13 female, 17 male) and 23 control (mean 11 years 1 month (4 years 5 months); 8 female, 15 male) were enrolled. Stroke participants demonstrated higher asymmetry. Correlations between AMAI and standard tests were moderate and strongest during sleep (BB: r = 0.68, p < 0.01). Conclusions Standard tests may not reflect the extent of movement asymmetry during daily life in hemiparetic children. Bilateral actigraphy may be a valuable complementary tool for measuring arm movement, potentially enabling improved evaluation of therapies with a focus on child participation.
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    Effects of Transcranial Direct Current Stimulation on GABA and Glx in Children: A pilot study
    (Public Library of Science (PLoS), 2020-01-07) Nwaroh, Chidera; Giuffre, Adrianna; Cole, Lauran; Bell, Tiffany; Carlson, Helen L.; MacMaster, Frank P.; Kirton, Adam; Harris, Ashley D.
    Transcranial direct current stimulation (tDCS) is a form of non-invasive brain stimulation that safely modulates brain excitability and has therapeutic potential for many conditions. Several studies have shown that anodal tDCS of the primary motor cortex (M1) facilitates motor learning and plasticity, but there is little information about the underlying mechanisms. Using magnetic resonance spectroscopy (MRS), it has been shown that tDCS can affect local levels of gamma-aminobutyric acid (GABA) and Glx (a measure of glutamate and glutamine combined) in adults, both of which are known to be associated with skill acquisition and plasticity; however this has yet to be studied in children and adolescents. This study examined GABA and Glx in response to conventional anodal tDCS (a-tDCS) and high definition tDCS (HD-tDCS) targeting the M1 in a pediatric population. Twenty-four typically developing, right-handed children ages 12-18 years participated in five consecutive days of tDCS intervention (sham, a-tDCS or HD-tDCS) targeting the right M1 while training in a fine motor task (Purdue Pegboard Task) with their left hand. Glx and GABA were measured before and after the protocol (at day 5 and 6 weeks) using a PRESS and GABA-edited MEGA-PRESS MRS sequence in the sensorimotor cortices. Glx measured in the left sensorimotor cortex was higher in the HD-tDCS group compared to a-tDCS and sham at 6 weeks (p = 0.001). No changes in GABA were observed in either sensorimotor cortex at any time. These results suggest that neither a-tDCS or HD-tDCS locally affect GABA and Glx in the developing brain and therefore it may demonstrate different responses in adults.
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    Sensorimotor robotic changes of tDCS and HD-tDCS enhanced motor learning in children
    (2018-07-06) Cole, Lauran; Kirton, Adam; Dukelow, Sean P.; Emery, Carolyn A.
    Non-invasive brain stimulation, such as transcranial direct-current stimulation (tDCS), can alter cortical excitability and human behavior but investigations to date have been limited in pediatrics. Emerging neurostimulation technologies such as high-definition tDCS (HD-tDCS) are unstudied in the developing brain. Application of tDCS can safely enhance motor skill acquisition in children but mechanisms are poorly understood. Robotics can objectively quantify sensorimotor function and may examine functional changes associated with motor learning and neurostimulation. We aimed to characterize the effects of tDCS and HD-tDCS on motor learning in healthy children. Our randomized, blinded, sham-controlled five day interventional trial demonstrated that both tDCS and HD-tDCS can enhance motor learning with medium to large effect sizes, lasting effects, and favorable safety and tolerability. To explore changes in sensorimotor function accompanying enhanced motor learning, a validated robotic protocol was performed before and after the trial. Motor training was associated with changes in sensory and motor function with less evident effects of stimulation. Both tDCS and HD-tDCS enhance motor learning in children while robotics can explore associated behavioural mechanisms, both of which promise to advance neurorehabilitation strategies in disabled children.
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    Sensorimotor Robotic Measures of tDCS- and HD-tDCS-Enhanced Motor Learning in Children
    (2018-12-18) Cole, Lauran; Dukelow, Sean P.; Giuffre, Adrianna; Nettel-Aguirre, Alberto; Metzler, Megan J.; Kirton, Adam
    Transcranial direct-current stimulation (tDCS) enhances motor learning in adults. We have demonstrated that anodal tDCS and high-definition (HD) tDCS of the motor cortex can enhance motor skill acquisition in children, but behavioral mechanisms remain unknown. Robotics can objectively quantify complex sensorimotor functions to better understand mechanisms of motor learning. We aimed to characterize changes in sensorimotor function induced by tDCS and HD-tDCS paired motor learning in children within an interventional trial. Healthy, right-handed children (12–18 y) were randomized to anodal tDCS, HD-tDCS, or sham targeting the right primary motor cortex during left-hand Purdue pegboard test (PPT) training over five consecutive days. A KINARM robotic protocol quantifying proprioception, kinesthesia, visually guided reaching, and an object hit task was completed at baseline, posttraining, and six weeks later. Effects of the treatment group and training on changes in sensorimotor parameters were explored. Twenty-four children (median 15.5 years, 52% female) completed all measures. Compared to sham, both tDCS and HD-tDCS demonstrated enhanced motor learning with medium effect sizes. At baseline, multiple KINARM measures correlated with PPT performance. Following training, visually guided reaching in all groups was faster and required less corrective movements in the trained arm ((2) = 9.250, ). Aspects of kinesthesia including initial direction error improved across groups with sustained effects at follow-up ((2) = 9.000, ). No changes with training or stimulation were observed for position sense. For the object hit task, the HD-tDCS group moved more quickly with the right hand compared to sham at posttraining ((2) = 6.255, ). Robotics can quantify complex sensorimotor function within neuromodulator motor learning trials in children. Correlations with PPT performance suggest that KINARM metrics can assess motor learning effects. Understanding how tDCS and HD-tDCS enhance motor learning may be improved with robotic outcomes though specific mechanisms remain to be defined. Exploring mechanisms of neuromodulation may advance therapeutic approaches in children with cerebral palsy and other disabilities.