Translational Initiative to Minimize Childhood Hemiparesis After Asymmetrical Perinatal Brain Injury

The purpose of this perspective paper is to present a translational approach aimed at identifying the critical periods in brain development during which to provide neuroprotective and neurorestorative strategies, followed by prehensile training, to minimize hemiparesis and foster skill acquisition after asymmetrical perinatal brain injury (APBI). We contend that hemiparesis could be minimized after APBI through a multimodal sequential approach based on timely implementation of evidence-based intervention strategies. If APBI is identified early, neuroprotective techniques can be used in the first 10 days of life to minimize cell death. This can be followed in the next 3 months by the provision of timely neurorestorative strategies to enhance neuron survival and promote brain growth. Ideally these strategies will prime the system for targeted prehensile training from 3 months and beyond. Building on animal work, scientifically sound pilot work in human infants is needed to determine the best timing and therapy dose verified with sensitive outcome measures available before widespread implementation. Strategic planning among a multidisciplinary group working in basic science, medicine, and rehabilitation will inform efforts to bring this translational approach to clinical fruition.