Perinatal stroke can result in motor impairments, and is one of the major causes of cerebral palsy (CP) diagnosis later in childhood. Because of the rapid development and heightened neuroplasticity in the first years of life, intervention provided earlier rather than later is thought to offer the best chance of recovery following perinatal stroke. However, the evidence for early interventions is lacking, mainly due to the paucity of data regarding brain organization, connectivity and resulting motor development after perinatal stroke in humans. Therefore, in this proposed study, our objective is to perform a multimodal, non-invasive assessment of infant brain and behavioral development over the first two years of life to identify possible bioindicators of recovery and repair which may be targeted by future interventions. Our study design incorporates longitudinal assessment over the first two years of life after perinatal stroke of brain excitability and organization using non- invasive brain stimulation, in addition to neuroimaging and age-appropriate behavioral assessments. We will recruit 50 infants with perinatal stroke from local and regional neonatal intensive care units for assessment at 4 time points up to 24 months of age. Measures of brain excitability and connectivity will be correlated with motor development and possible CP diagnosis to study the trajectory and patterns of recovery over time. If the child has been diagnosed with CP, a trained investigator will also assign a Gross Motor Functional Classification Scale level and a mini-Manual Ability Classification Scale level to predict motor function and plan for care. Ultimately, identifying structure/function relationships discovered in this study will allow development of tailored early interventions, based on individual patterns of brain development, designed to improve life-long motor function in infants with CP due to perinatal stroke, as well as development of early interventions for other related neurologic diagnoses.
Perinatal stroke may lead to the secondary diagnosis of cerebral palsy and life-long movement impairment. By studying processes of early brain recovery and how recovery is related to brain development and movement in the first two years of life, we can develop effective, early treatments for infants with perinatal stroke. Minimizing future disability through early interventions would greatly improve quality of life and reduce burden on children and families.
