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REGENTS OF THE UNIVERSITY OF MINNESOTA

This study will determine the effectiveness, mechanism, and safety of 5 treatments of 6-Hz primed low-frequency repetitive transcranial magnetic stimulation (rTMS) applied to the non-stroke hemisphere and combined with constraint induced therapy (CIT) to promote recovery of the paretic hand in children with brain injury. Fifteen children with pediatric hemiplegia, age 8 -16 years, at each of two pediatric medical facilities (total N = 30), will be randomly assigned to one of two treatment groups that will receive treatment for 2 weeks. The rTMSreal/CIT group will receive alternating days of the real rTMS and CIT for 5 treatments of each. The rTMSsham/CIT group will receive alternating days of sham rTMS with real CIT for 5 treatments of each. Subjects will be tested at pretest and posttest. The hypotheses are: 1) the rTMS treatment will show no serious side effects, 2) both groups will show improvement in hand function but the rTMSsham/CIT group will show significantly greater improvement, 3) the rTMSreal/CIT group will also show significantly greater improvements in brain reorganization measured by paired-pulse TMS testing, cortical silent period testing, and fMRI. The potential impact of this research is a radical change to pediatric rehabilitation that accomplishes a higher functional recovery through the synergism of behavioral training (CIT) combined with rTMS-induced changes in brain excitability.

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