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The Impact of an Interactive Rehabilitation Protocol ‎on Reorganization of Brain Networks in Children ‎with Cerebral Palsy: A Pilot Study

Authors :

Shahed Salehzehi¹ Mahdi Mollaei² Parisa Hosseini³ Ali Koohian Mohammad abadi⁴ Mohammad Ebrahim Hashemi⁵ Hamid Reza Kobravi⁶ Narges Hashemi⁷ Mehran Beiraghi Toosi⁸ Javad Akhondian⁹

1- دانشگاه آزاد مشهد 2- دانشگاه صنعتی خواجه نصیرالدین طوسی 3- دانشگاه آزاد مشهد 4- دانشگاه آزاد مشهد 5- دانشگاه آزاد مشهد 6- دانشگاه آزاد مشهد 7- دانشگاه علوم پزشکی مشهد 8- دانشگاه علوم پزشکی مشهد 9- دانشگاه علوم پزشکی مشهد

Keywords :

neurorehabilitation،neuroplasticity،hemiparetic cerebral palsy ‎‎(HCP)،phase-amplitude coupling (PAC)،phase-phase coupling ‎‎(PPC)‎

Abstract :

Abstract—Hemiparetic cerebral palsy (HCP) is a condition ‎caused by brain damage that affects one side of the body, ‎making it difficult for children to control the muscles on the ‎affected side and affecting their ability to perform daily tasks. ‎Traditional motor rehabilitation methods often lack patient ‎interaction and fail to produce sufficient neuroplastic changes. ‎Therefore, this study presents a new interactive, game-based ‎program enhanced with functional sensory stimulation for ‎upper extremity rehabilitation. Five children with hemiparetic ‎cerebral palsy participated in this rehabilitation intervention, ‎which consisted of 15 sessions of 20 minutes each. The Fugl-‎Meyer Assessment (FMA) and electroencephalography (EEG) ‎were used to quantify motor improvement and analyze the ‎underlying neural mechanisms, respectively, before and after ‎the intervention. Advanced signal processing techniques, ‎including phase-amplitude coupling (PAC) and phase-phase ‎coupling (PPC), were used to provide a deeper understanding ‎of brain network dynamics and neuroplasticity after the ‎intervention. The results of the FMA scores showed significant ‎improvement in hand motor abilities. These findings were fully ‎correlated with positive neurophysiological changes. PAC ‎analysis showed increased neural efficiency and coordination, ‎while PPC confirmed improved functional connectivity between ‎key cortical regions. This study provides compelling evidence ‎that our innovative therapeutic approach not only improves ‎physical function but also induces lasting and positive changes ‎in the brain's neural networks. It validates the use of engaging, ‎technology-based interventions, such as computer games and ‎mechanical stimulation, in pediatric neurorehabilitation.‎