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Trial registered on ANZCTR

Registration number

ACTRN12611000263998

Ethics application status

Approved

Date submitted

10/03/2011

Date registered

10/03/2011

Date last updated

14/03/2011

Type of registration

Retrospectively registered

Titles & IDs

Public title

Relationship between Executive Function and the Nature and Function of the Brain Injury in Children with Congenital Hemiplegia.

Scientific title

Executive function in children with congenital hemiplegia

Secondary ID [1]

Nil

Universal Trial Number (UTN)

U1111-1119-8014

Trial acronym

Linked study record

Health condition

Health condition(s) or problem(s) studied:

Congenital Hemiplegia (Cerebral Palsy)

Condition category

Condition code

Neurological

Other neurological disorders

Intervention/exposure

Study type

Observational

Patient registry

Target follow-up duration

Target follow-up type

Description of intervention(s) / exposure

This is not an intervention study. All participants will complete neuropsychological assessments and brain imaging assessments The neuropsychological assessments will take approximately 2 1/2 hours and the brain imaging, using diffusion tensor imaging and functional MRI will take approximately 1 1/2 hours. The neuropsychological and imaging assessments will be scheduled for two visits in order to prevent participant fatigue. The visits will be scheduled as closely as possible and will occur within 6 months of each other.

Intervention code [1]

Not applicable

Comparator / control treatment

Typically developing children and adolescents will be assessed as a comparison group.

Control group

Active

Outcomes

Primary outcome [1]

Executive functioning as measured by a neuropsychological battery (inculding tests from the D-KEFS, TEACH and WISC-IV)

Timepoint [1]

single time point only

Primary outcome [2]

Phase 2: neuroscience outcomes
The use of brain imaging techniques to examine the white matter connectivity/ damage (as measured with diffusion tensor imaging), and the brain structure - function relationship (as measured with functional MRI) while performing a specific executive function task (Flanker task).

Timepoint [2]

single time point only

Secondary outcome [1]

Behavioural manifestations of executive function in everyday life as measured by the Brief Rating Inventory of Executive Function (BRIEF)

Timepoint [1]

single time point only

Eligibility

Key inclusion criteria

Aged 8 – 16 years with a diagnosis of congenital hemiplegia.
Ability to understand/comprehend basic questions.
Ability to self-report answers.

Minimum age

8 Years

Maximum age

16 Years

Sex

Both males and females

Can healthy volunteers participate?

Key exclusion criteria

Children with uncontrolled seizure disorders, as research has indicated this can result in an overall deterioration in intellectual functions and thus confound results.
People whose primary language is other than English.
Children who have a postnatally acquired brain injury

Study design

Purpose

Natural history

Duration

Cross-sectional

Selection

Case control

Timing

Prospective

Statistical methods / analysis

Recruitment

Recruitment status

Recruiting

Date of first participant enrolment

Anticipated

1/08/2010

Actual

Date of last participant enrolment

Anticipated

Actual

Date of last data collection

Anticipated

Actual

Sample size

Target

Accrual to date

Final

Recruitment in Australia

Recruitment state(s)

Funding & Sponsors

Funding source category [1]

University

Name [1]

School of Psychology (student funds), University of Queensland

Address [1]

School of Psychology
UQ, St Lucia
QLD 4072

Country [1]

Australia

Primary sponsor type

Individual

Name

Koa Whittingham

Address

Queensland Cerebral Palsy and Rehabilitation
Research Centre,
UQ Dept of Paediatrics
Level 3, Foundation Building
Royal Children's Hospital
Herston Road, Herston QLD 4029

Country

Australia

Secondary sponsor category [1]

University

Name [1]

A/Prof Roslyn Boyd

Address [1]

Queensland Cerebral Palsy and Rehabilitation
Research Centre,
UQ Dept of Paediatrics
Level 3, Foundation Building
Royal Children's Hospital
Herston Road, Herston QLD 4029

Country [1]

Australia

Secondary sponsor category [2]

University

Name [2]

Harriet Bodimeade

Address [2]

Queensland Cerebral Palsy and Rehabilitation
Research Centre,
UQ Dept of Paediatrics
Level 3, Foundation Building
Royal Children's Hospital
Herston Road, Herston QLD 4029

Country [2]

Australia

Secondary sponsor category [3]

Individual

Name [3]

Owen Lloyd

Address [3]

Dept of Rehabilitation
Royal Children's Hospital
Herston Road, Herston QLD 4029

Country [3]

Australia

Secondary sponsor category [4]

Individual

Name [4]

Lonneke Weierink

Address [4]

Queensland Cerebral Palsy and Rehabilitation
Research Centre,
UQ Dept of Paediatrics
Level 3, Foundation Building
Royal Children's Hospital
Herston Road, Herston QLD 4029

Country [4]

Australia

Ethics approval

Ethics application status

Approved

Ethics committee name [1]

Royal Children's Hospital and Health Services

Ethics committee address [1]

Department of Paediatrics and Child Health
Level 3, Foundation Building
Royal Children's Hopsital
Herston Road, Herston QLD 4029

Ethics committee country [1]

Australia

Date submitted for ethics approval [1]

Approval date [1]

24/05/2010

Ethics approval number [1]

HREC/10/QRCH/31

Summary

Brief summary

BROAD AIM: This investigation aims to examine executive functioning (EF) and related constructs (i.e., intelligence, memory, attention, concentration, psychological functioning, adaptive functioning, and functional ability) in children with congenital hemiplegia. It also aims to examine the relationship between EF and the underlying brain structure alterations and abnormalities including location of the lesions, extent of the lesions, and the presumed timing of the lesions, using MRI. 
In addition the relationship between performance on EF and white matter density as measured by DTI and functional connectivity will be analysed.
Finally, it aims to examine the brain structure-function relationship between performance on an EF task (the Flanker task) which focuses on executive attention and brain lesion location and extent and the neurovascular changes based on the Blood Oxygen Level Dependent (BOLD) response, as measured with functional MRI.

HYPOTHESES: 
1.It is hypothesised that compared to matched controls, children with hemiplegia would show EF impairments in the following specific domains: (a) attentional control; (b) cognitive flexibility; (c) goal setting; (d) information processing; (e) working memory; (f) verbal fluency; and, (e) in everyday life (as measured by parent and teacher report).
2.It is hypothesised that EF will correlate with the lesion site, and in particular, we will test correlations with: (a) side; (b) location; and, (c) extent (as measured by structural MRI).
3.It is hypothesised that poor EF will correlate with the nature, density, and location of white matter damage/connectivity (as measured by DTI).
4. It is hypothesised that poor performance on the Flanker task will correlate with altered activiation patterns which can be mapped based on the changes in the Blood Oxygen Level Dependent (BOLD) response as measured by functional MRI. The changes in blood axygenation resulting from brain activation produce a measurable effect in MR images.
SPECIFIC AIMS:
1.To examine executive function (i.e., skills necessary for novel, goal-directed, and complex activity, such as planning and organisation) in children with congenital hemiplegia 
2.To examine the relationship between the presence, location, extent, and timing of brain lesions (using structural MRI scans) and executive function in children with hemiplegia. 
3.Establish whether children with left and right hemiplegia exhibit the same executive function profile; alternatively, do children with right hemiplegia have different strengths/impairments on executive function compared to children with left hemiplegia, and vice versa. 
4.To examine the relationship between white matter connectivity and executive functions using diffusion tension imaging (i.e., a technique that is part of an MRI that evaluates white matter pathways in the brain).
5. to examine the relationship between the performance on a specific executive function task (the Flanker) task and neurovascular changes using the BOLD response as measured by fMRI (i.e., a technique which shows changes in cerebral blood flow in response to behavioural activation).


BACKGROUND: Congenital hemiplegia is the most common type of CP among children born full term and the second most common type in children born prematurely. In addition to motor deficits seen in congenital hemiplegia, associated difficulties, such as cognitive impairments, have been identified. In spite of this, there is a paucity of literature on congenital hemiplegia examining neuropsychological consequences, in particular EF. Dysfunction in the executive system can result in numerous cognitive deficits that negatively influence daily functioning, such as impaired planning, monitoring, reasoning, concept formation, mental flexibility, social judgments, and attention. Having a better understanding of potential EF deficits in congenital hemiplegia will aid future rehabilitative interventions aimed at improving functional independence in this population. Further, if we are able to correlation EF with specific lesion sites, we will be able to predict potential EF impairments in children and thus provide earlier rehabilitative interventions.
The Flanker task is used to emphasize the stimulus-response inhibitory processing which is an important part of attention. The task activates the executive attention network, including the midline frontal areas (anterior cingulated) and the lateral prefrontal cortex (Bush et al., 2000; MacDonald & Carter, 2000), which is associated with conflict in responses (Fan et al., 2002). The Flanker task challenges the ability to inhibit irrelevant information (Hazeltine et al., 2000). It is found that during tasks which explore inhibitory processes the main focus of increased brain activity is at the right inferior frontal cortex (Collette et al., 2006; Hazeltine et al., 2000). 
Problems with attention and EF are associated with lesions in the periventricular white matter in anterior (Schatz et al., 2001; White & Christ, 2005) or parietal regions (Pavlova et al., 2008). Furthermore, it is suggested that lesions of the basal ganglia, the thalamic systems, or both affect focused attention (Mirsky, 1989) as well as EF. The changes in cerebral blood flow as measured with fMRI will show activation patterns associated with the Flanker task. Poor performance on the Flanker task in children with congenital hemiplegia may correlate with an altered pattern of cerebral blood flow compared to normal children. 


RESEARCH PLAN: 40 children with congenital hemiplegia aged 8 – 16 years (20 with right congenital hemiplegia and 20 with left congenital hemiplegia) will be recruited. Twenty further children without congenital hemiplegia will also be recruited and will be matched as closetly as possible for age and gender (N = 60). All 60 children will complete a battery of neuropsychological assessments and parents will be asked to complete self-report measures in approximately a 2 1/2 hour assessment session. School teachers will also be asked to complete one self-report measure. Children with congenital hemiplegia will also either complete an MRI scan or previous MRI scans will be accessed from the Queensland Cerebral Palsy Children’s Health Services Database.
In the second phase of this study the children are invited to complete a first or second scan (if they had a previous scan in phase 1) in which the diffusion tensor imaging and functional MRI data will be collected. Before the real scan the children have the chance to practice in a “mock scanner”. During the fMRI scan the Flanker task is performed which can also be practised outside the scanner before the scanning procedure. This phase of the study will approximately take 1 1/2 hour of which 40 to 50 minutes will be spend inside the scanner.

Trial website

Trial related presentations / publications

Public notes

Contacts

Principal investigator

Name

Address

Country

Phone

Fax

Contact person for public queries

Name

A/Prof Roslyn Boyd

Address

Queensland Cerebral Palsy and Rehabilitation
Research Centre,
UQ Dept of Paediatrics
Level 3, Foundation Building
Royal Children's Hospital
Herston Road, Herston QLD 4029

Country

Australia

Phone

+61 7 3365 5315

Fax

r.boyd@uq.edu.au

Contact person for scientific queries

Name

A/Prof Roslyn Boyd

Address

Queensland Cerebral Palsy and Rehabilitation
Research Centre,
UQ Dept of Paediatrics
Level 3, Foundation Building
Royal Children's Hospital
Herston Road, Herston QLD 4029

Country

Australia

Phone

+61 7 3365 5315

Fax

r.boyd@uq.edu.au

No information has been provided regarding IPD availability

What supporting documents are/will be available?

No Supporting Document Provided

Results publications and other study-related documents

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Documents added automatically

No additional documents have been identified.

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