Piloting individualised probabilistic tractography to measure motor system integrity and rehabilitation potential in cerebral palsy

Motivation: A biomarker of motor system function is needed to assist with treatment selection for children with cerebral palsy (CP). Goal(s): We aimed to pilot an automated tractography tool in a clinical trial cohort of adolescents with CP, and determine if corticospinal tract (CST) integrity could be used as a biomarker for baseline function and treatment response. Approach: A customised probabilistic tractography pipeline was used to quantify CST integrity. Hand function was assessed at baseline and after a motor training intervention. Results: We demonstrated feasibility, and found that CST integrity was positively correlated with baseline hand function, and negatively correlated with improvement after training. Impact: Automated individualised native-space tractography is feasible in a clinical population of adolescents with cerebral palsy. Tractography-derived corticospinal tract integrity predicts baseline hand function impairment and may be useful as a predictive biomarker for rehabilitation response.