I have a broad background in neurophysiology and biomechanics and have extensive clinical and research expertise involving motor learning and development in typically developing children and children with cerebral palsy. Our team has been studying hand motor control in healthy individuals and individuals with cerebral palsy (CP) for over 25 years. In a line of basic research funded by the National Science Foundation, we have been elucidating the nature of internal models underlying object manipulation by studying fingertip forces and positions during object manipulation.
In 1996 I founded the Center for Cerebral Palsy Research (http://www.tc.columbia.edu/cit/). The Center consists of a unique team of scientists and clinicians, and is committed to improving the lives of children with CP through research and education, with an emphasis on understanding the mechanisms underlying motor disorders associated with CP, and developing evidence-based treatment approaches targeting these disorders. Our initial studies on grip force planning and modulation during object manipulation showed that children with CP 1) show improvements in grasping during development, and 2) benefit from extensive practice. Thus, hand function is not static, and is amenable to improvement.
Our first approach to providing extensive practice was modifying constraint-induced movement therapy (CIMT) for children with CP. In 2001 we published the first study on modified CIMT in children with unilateral CP. Subsequently in a line of work supported by the National Institute of Health, we more broadly studied the efficacy of CIMT. We used CIMT as the basis for creating a highly structured and intensive form of bimanual therapy, Hand-Arm Bimanual Intensive Therapy (HABIT), and have conducted several trials indicating efficacy in improving upper extremity function. Since 2002 more than 300 children with CP have participated in our hand treatment day camps. We subsequently collaborated with a team in Belgium to modify HABIT to target both the upper and lower extremity of children with unilateral and bilateral CP. We have been using transcranial magnetic stimulation (TMS) to study the neuroplasticity associated with such intensive training and discovered that skill progression was a key ingredient to drive cortical plasticity, improve goal performance and movement coordination. Recent work has been using TMS and diffusor tensor imaging to study whether specific patterns of brain connectivity predict response to CIMT and HABIT, and the role of sensory systems in hand function and recovery in children with CP.
