Wrist movement rehabilitation in hemiparetic Unilateral Cerebral Palsy children using mechanical stimulation of skin mechanoreceptors and computer game

Despite the considerable advancements in neuroscience and technology, neurorehabilitation for children with Unilateral Cerebral Palsy (UCP) remains a challenging issue in neuroscience. The concept of neuroplasticity-informed rehabilitation has already been presented in the literature in order to investigate how neural networks of the brain respond to a rehabilitation protocol. In this study, we proposed a novel protocol to evoke neural plasticity and motor learning in UCP children that involves applying mechanical fractal stimulus to the impaired hand mechanoreceptors while performing a designed computer-bimanual-motor-task. This method suggests a simpler, painless, less expensive, and side-effect-free therapy for the UCP children compared to other methodologies. Then in a case study, we trained two UCP children in 10 sessions (three sessions a week) using the designed protocol and recorded their EEG signals during the first and last sessions while they were performing the bimanual motor task and receiving stimuli simultaneously. EEG analysis revealed a relative decrease in effective connectivity between channels $\mathrm{Fz}, \mathrm{C} 3$, and C 4, by an average reduction of $\mathbf{8 2 . 4 6 \%}$ in Granger causality and $\mathbf{4 5 . 4 9 \%}$ in transfer entropy after the intervention. Additionally, some Recurrence Quantification Analysis (RQA) metrics—determinism (DET), diagonal line length (LMAX), and entropy (ENT)—increased by an average of $12.29 \%, 9.01 \%$, and $\mathbf{2 0 . 9 2 \%}$, respectively, across channels following the therapy. These findings suggest that our newly designed therapy protocol evoked neural plasticity and motor learning in the UCP children and therefore, it could set the foundation for developing an easier, more advanced, more suitable for children and cheaper therapy for the CP patients.