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Tulimieri DT, Semrau JA. Impaired proprioception and magnified scaling of proprioceptive error responses in chronic stroke. J Neuroeng Rehabil 2024; 21:51. [PMID: 38594762 PMCID: PMC11003069 DOI: 10.1186/s12984-024-01350-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 03/29/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Previous work has shown that ~ 50-60% of individuals have impaired proprioception after stroke. Typically, these studies have identified proprioceptive impairments using a narrow range of reference movements. While this has been important for identifying the prevalence of proprioceptive impairments, it is unknown whether these error responses are consistent for a broad range of reference movements. The objective of this study was to characterize proprioceptive accuracy as function of movement speed and distance in stroke. METHODS Stroke (N = 25) and controls (N = 21) completed a robotic proprioception test that varied movement speed and distance. Participants mirror-matched various reference movement speeds (0.1-0.4 m/s) and distances (7.5-17.5 cm). Spatial and temporal parameters known to quantify proprioception were used to determine group differences in proprioceptive accuracy, and whether patterns of proprioceptive error were consistent across testing conditions within and across groups. RESULTS Overall, we found that stroke participants had impaired proprioception compared to controls. Proprioceptive errors related to tested reference movement scaled similarly to controls, but some errors showed amplified scaling (e.g., significantly overshooting or undershooting reference speed). Further, interaction effects were present for speed and distance reference combinations at the extremes of the testing distribution. CONCLUSIONS We found that stroke participants have impaired proprioception and that some proprioceptive errors were dependent on characteristics of the movement (e.g., speed) and that reference movements at the extremes of the testing distribution resulted in significantly larger proprioceptive errors for the stroke group. Understanding how sensory information is utilized across a broad spectrum of movements after stroke may aid design of rehabilitation programs.
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Affiliation(s)
- Duncan Thibodeau Tulimieri
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, USA
- Program in Biomechanics and Movement Science (BIOMS), University of Delaware, 100 Discovery Blvd, Tower at STAR, Rm 234, Newark, DE, 19713, USA
| | - Jennifer A Semrau
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, USA.
- Program in Biomechanics and Movement Science (BIOMS), University of Delaware, 100 Discovery Blvd, Tower at STAR, Rm 234, Newark, DE, 19713, USA.
- Department of Biomedical Engineering, University of Delaware, Newark, USA.
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Kuska EC, Steele KM. Does crouch alter the effects of neuromuscular impairments on gait? A simulation study. J Biomech 2024; 165:112015. [PMID: 38394953 PMCID: PMC10939721 DOI: 10.1016/j.jbiomech.2024.112015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 12/18/2023] [Accepted: 02/19/2024] [Indexed: 02/25/2024]
Abstract
Cerebral palsy (CP) is a neurologic injury that impacts control of movement. Individuals with CP also often develop secondary impairments like weakness and contracture. Both altered motor control and secondary impairments influence how an individual walks after neurologic injury. However, understanding the complex interactions between and relative effects of these impairments makes analyzing and improving walking capacity in CP challenging. We used a sagittal-plane musculoskeletal model and neuromuscular control framework to simulate crouch and nondisabled gait. We perturbed each simulation by varying the number of synergies controlling each leg (altered control), and imposed weakness and contracture. A Bayesian Additive Regression Trees (BART) model was also used to parse the relative effects of each impairment on the muscle activations required for each gait pattern. By using these simulations to evaluate gait-pattern specific effects of neuromuscular impairments, we identified some advantages of crouch gait. For example, crouch tolerated 13 % and 22 % more plantarflexor weakness than nondisabled gait without and with altered control, respectively. Furthermore, BART demonstrated that plantarflexor weakness had twice the effect on total muscle activity required during nondisabled gait than crouch gait. However, crouch gait was also disadvantageous in the presence of vasti weakness: crouch gait increased the effects of vasti weakness on gait without and with altered control. These simulations highlight gait-pattern specific effects and interactions between neuromuscular impairments. Utilizing computational techniques to understand these effects can elicit advantages of gait deviations, providing insight into why individuals may select their gait pattern and possible interventions to improve energetics.
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Affiliation(s)
- Elijah C Kuska
- Department of Mechanical Engineering, University of Washington, Seattle, WA, United States.
| | - Katherine M Steele
- Department of Mechanical Engineering, University of Washington, Seattle, WA, United States
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Lidbeck C, Bartonek Å, Ferrari A, Alboresi S, Örtqvist M. Signs of perceptual disorder during movement were reliably assessed in children with cerebral palsy in Sweden. Acta Paediatr 2024; 113:344-352. [PMID: 37874018 DOI: 10.1111/apa.17012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 10/03/2023] [Accepted: 10/12/2023] [Indexed: 10/25/2023]
Abstract
AIM The aim of this Swedish study was to evaluate the assessment of clinical signs of perceptual disorder in children with cerebral palsy (CP). METHODS Three experienced raters assessed 56 videos of 19 children from 1 to 18 years of age with bilateral spastic CP, which were recorded by colleagues at an Italian hospital. Six signs were evaluated for inter-rater reliability and criterion validity. Clinical applicability was evaluated by assessing inter-rater reliability between 47 Swedish clinicians, who examined 15 of the videos during face-to-face and online education seminars. There were 41 physiotherapists, two occupational therapists and four doctors, with 1-37 years of clinical experience and a median of 10 years. RESULTS The experienced raters demonstrated moderate to almost perfect inter-rater reliability (kappa 0.54-0.81) and criterion validity (0.54-0.87) for startle reaction, upper limbs in startle position, averted eye gaze and eye blinking. The clinicians recognised these signs with at least moderate reliability (0.56-0.88). Grimacing and posture freezing were less reliable (0.22-0.35) and valid (0.09-0.50). CONCLUSION Four of the six signs of perceptual disorder were reliably recognised by experienced raters and by clinicians after education seminars. Extended education and larger study samples are needed to recognise all the signs.
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Affiliation(s)
- Cecilia Lidbeck
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Åsa Bartonek
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Adriano Ferrari
- Department of Neuroscience, University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | - Silvia Alboresi
- Children Rehabilitation Unit of S. M. Nuova Hospital, AUSL-IRCCS, Reggio Emilia, Italy
| | - Maria Örtqvist
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
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Sansare A, Arcodia M, Lee SCK, Jeka J, Reimann H. Immediate application of low-intensity electrical noise reduced responses to visual perturbations during walking in individuals with cerebral palsy. J Neuroeng Rehabil 2024; 21:14. [PMID: 38281953 PMCID: PMC10822182 DOI: 10.1186/s12984-023-01299-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 12/19/2023] [Indexed: 01/30/2024] Open
Affiliation(s)
- Ashwini Sansare
- Department of Physical Therapy, University of Delaware, Newark, DE, USA
| | - Maelyn Arcodia
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA
| | - Samuel C K Lee
- Department of Physical Therapy, University of Delaware, Newark, DE, USA
| | - John Jeka
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA
| | - Hendrik Reimann
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA.
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Illman M, Jaatela J, Vallinoja J, Nurmi T, Mäenpää H, Piitulainen H. Altered excitation-inhibition balance in the primary sensorimotor cortex to proprioceptive hand stimulation in cerebral palsy. Clin Neurophysiol 2024; 157:25-36. [PMID: 38039924 DOI: 10.1016/j.clinph.2023.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 10/13/2023] [Accepted: 10/27/2023] [Indexed: 12/03/2023]
Abstract
OBJECTIVE Our objective was to clarify the primary sensorimotor (SM1) cortex excitatory and inhibitory alterations in hemiplegic (HP) and diplegic (DP) cerebral palsy (CP) by quantifying SM1 cortex beta power suppression and rebound with magnetoencephalography (MEG). METHODS MEG was recorded from 16 HP and 12 DP adolescents, and their 32 healthy controls during proprioceptive stimulation of the index fingers evoked by a movement actuator. The related beta power changes were computed with Temporal Spectral Evolution (TSE). Peak strengths of beta suppression and rebound were determined from representative channels over the SM1 cortex. RESULTS Beta suppression was stronger contralateral to the stimulus and rebound was weaker ipsilateral to the stimulation in DP compared to controls. Beta modulation strengths did not differ significantly between HP and the control group. CONCLUSIONS The emphasized beta suppression in DP suggests less efficient proprioceptive processing in the SM1 contralateral to the stimulation. Their weak rebound further indicates reduced intra- and/or interhemispheric cortical inhibition, which is a potential neuronal mechanism for their bilateral motor impairments. SIGNIFICANCE The excitation-inhibition balance of the SM1 cortex related to proprioception is impaired in diplegic CP. Therefore, the cortical and behavioral proprioceptive deficits should be better diagnosed and considered to better target individualized effective rehabilitation in CP.
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Affiliation(s)
- Mia Illman
- Faculty of Sport and Health Sciences, University of Jyväskylä, P.O.BOX 35, FI-40014 Jyväskylä, Finland; Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, P.O.BOX 12200, FI-00760 AALTO, Espoo, Finland; Aalto NeuroImaging, Aalto University School of Science, P.O.BOX 12200, FI-00760 AALTO, Espoo, Finland.
| | - Julia Jaatela
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, P.O.BOX 12200, FI-00760 AALTO, Espoo, Finland
| | - Jaakko Vallinoja
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, P.O.BOX 12200, FI-00760 AALTO, Espoo, Finland
| | - Timo Nurmi
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, P.O.BOX 12200, FI-00760 AALTO, Espoo, Finland
| | - Helena Mäenpää
- Pediatric Neurology, New Children's Hospital, University of Helsinki and Helsinki University Hospital, FI-00029 Helsinki, Finland
| | - Harri Piitulainen
- Faculty of Sport and Health Sciences, University of Jyväskylä, P.O.BOX 35, FI-40014 Jyväskylä, Finland; Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, P.O.BOX 12200, FI-00760 AALTO, Espoo, Finland; Pediatric Neurology, New Children's Hospital, University of Helsinki and Helsinki University Hospital, FI-00029 Helsinki, Finland
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Nip ISB, Arias CR, Corcoran J, Ishihara N, Goble DJ. Proprioceptive Acuity Influences Speech Motor Control in Healthy Adult Talkers. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:4353-4362. [PMID: 37850887 DOI: 10.1044/2023_jslhr-23-00149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
PURPOSE Somatosensory feedback, including proprioception, is important for speech production. This study evaluates proprioceptive acuity of the tongue using a position-matching task and determining if proprioceptive acuity impacts speech motor control in healthy adult talkers. METHOD Twenty-five young adults with no history of speech, language, or hearing disorders had their tongue movements recorded with an electromagnetic articulograph while completing a position-matching task. Participants were also asked to repeat two sentences that differed in the somatosensory feedback obtained. One sentence provided both tactile and proprioceptive feedback, whereas the other primarily provided proprioceptive feedback. RESULTS Participants ranged in proprioceptive acuity as measured by the position-matching task. Talkers with smaller position-matching errors and, therefore, higher proprioceptive acuity had smaller movements and slower speeds for both sentences. Talkers with lower proprioceptive acuity had reduced speech movement stability for the sentence that primarily provides proprioceptive feedback. CONCLUSION Proprioceptive acuity of the tongue can be evaluated using a position-matching task, and acuity is associated with more efficient speech movements and greater speech movement stability, particularly when producing utterances that provide less tactile feedback. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.24293740.
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Hill NM, Malone LA, Sun LR. Stroke in the Developing Brain: Neurophysiologic Implications of Stroke Timing, Location, and Comorbid Factors. Pediatr Neurol 2023; 148:37-43. [PMID: 37651976 DOI: 10.1016/j.pediatrneurol.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 08/02/2023] [Accepted: 08/07/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Pediatric stroke, which is unique in that it represents a static insult to a developing brain, often leads to long-term neurological disability. Neuroplasticity in infants and children influences neurophysiologic recovery patterns after stroke; therefore outcomes depend on several factors including the timing and location of stroke and the presence of comorbid conditions. METHODS In this review, we discuss the unique implications of stroke occurring in the fetal, perinatal, and childhood/adolescent time periods. First, we highlight the impact of the developmental stage of the brain at the time of insult on the motor, sensory, cognitive, speech, and behavioral domains. Next, we consider the influence of location of stroke on the presence and severity of motor and nonmotor outcomes. Finally, we discuss the impact of associated conditions on long-term outcomes and risk for stroke recurrence. RESULTS Hemiparesis is common after stroke at any age, although the severity of impairment differs by age group. Risk of epilepsy is elevated in all age groups compared with those without stroke. Outcomes in other domains vary by age, although several studies suggest worse cognitive outcomes when stroke occurs in early childhood compared with fetal and later childhood epochs. Conditions such as congenital heart disease, sickle cell disease, and moyamoya increase the risk of stroke and leave patients differentially vulnerable to neurodevelopmental delay, stroke recurrence, silent infarcts, and cognitive impairment. CONCLUSIONS A comprehensive understanding of the interplay of various factors is essential in guiding the clinical care of patients with pediatric stroke.
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Affiliation(s)
- Nayo M Hill
- Center for Movement Studies, Kennedy Krieger Institute, Baltimore, Maryland; Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Laura A Malone
- Center for Movement Studies, Kennedy Krieger Institute, Baltimore, Maryland; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Lisa R Sun
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Tulimieri DT, Semrau JA. Aging increases proprioceptive error for a broad range of movement speed and distance estimates in the upper limb. Front Hum Neurosci 2023; 17:1217105. [PMID: 37886690 PMCID: PMC10598783 DOI: 10.3389/fnhum.2023.1217105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 09/22/2023] [Indexed: 10/28/2023] Open
Abstract
Previous work has identified age-related declines in proprioception within a narrow range of limb movements. It is unclear whether these declines are consistent across a broad range of movement characteristics that more closely represent daily living. Here we aim to characterize upper limb error in younger and older adults across a range of movement speeds and distances. The objective of this study was to determine how proprioceptive matching accuracy changes as a function of movement speed and distance, as well as understand the effects of aging on these accuracies. We used an upper limb robotic test of proprioception to vary the speed and distance of movement in two groups: younger (n = 20, 24.25 ± 3.34 years) and older adults (n = 21, 63 ± 10.74 years). The robot moved one arm and the participant was instructed to mirror-match the movement with their opposite arm. Participants matched seven different movement speeds (0.1-0.4 m/s) and five distances (7.5-17.5 cm) over 350 trials. Spatial (e.g., End Point Error) and temporal (e.g., Peak Speed Ratio) outcomes were used to quantify proprioceptive accuracy. Regardless of the speed or distance of movement, we found that older controls had significantly reduced proprioceptive matching accuracy compared to younger control participants (p ≤ 0.05). When movement speed was varied, we observed that errors in proprioceptive matching estimates of spatial and temporal measures were significantly higher for older adults for all but the slowest tested speed (0.1 m/s) for the majority of parameters. When movement distance was varied, we observed that errors in proprioceptive matching estimates were significantly higher for all distances, except for the longest distance (17.5 cm) for older adults compared to younger adults. We found that the magnitude of proprioceptive matching errors was dependent on the characteristics of the reference movement, and that these errors scaled increasingly with age. Our results suggest that aging significantly negatively impacts proprioceptive matching accuracy and that proprioceptive matching errors made by both groups lies along a continuum that depends on movement characteristics and that these errors are amplified due to the typical aging process.
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Affiliation(s)
- Duncan Thibodeau Tulimieri
- Biomechanics and Movement Science (BIOMS), University of Delaware, Newark, DE, United States
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, United States
| | - Jennifer A. Semrau
- Biomechanics and Movement Science (BIOMS), University of Delaware, Newark, DE, United States
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, United States
- Department of Biomedical Engineering, University of Delaware, Newark, DE, United States
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Katırcı E, Adıgüzel H, Katırcı Kırmacı Zİ, Ergun N. The relationship between the backward walking and proprioception, trunk control, and muscle strength in children with cerebral palsy. Ir J Med Sci 2023; 192:2391-2399. [PMID: 36604372 DOI: 10.1007/s11845-022-03270-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 12/30/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVE This study was planned to determine the factors affecting backward walking in children with cerebral palsy (CP). METHODS The study included 30 children with CP, with a mean age of 10.43 ± 2.76 years. Backward walking abilities were evaluated with the 3-Meter Back Walk Test (3MBWT). A digital goniometer was used to evaluate proprioception, the Trunk Control Measurement Scale (TCMS) was used for trunk control, a digital muscle dynamometer was used for muscle strength, and the Gillette Functional Assessment Questionnaire (FAQ) was used for gait evaluation. RESULTS When the spasticity of children at levels I and II according to the Gross Motor Function Classification System (GMFCS) was compared, a significant difference was found in favor of level I in hamstring, gastro-soleus, and gastrocnemius spasticity (p < 0.05). When the results of the 3MBWT, TCMS, and FAQ were compared, a significant difference was found in favor of level I (p < 0.05). No significant relationship was revealed between the 3MBWT and lower extremity proprioception and TCMS (p > 0.05). A significant negative correlation was observed between the 3MBWT and FAQ (p < 0.05). No significant correlation was found between the 3MBWT and lower extremity muscle strengths (p > 0.05). A significant positive correlation was found only between hip extension proprioception and iliopsoas muscle strength (p = 0.023). There was no significant correlation between the FAQ and lower extremity muscle strength (p > 0.05). CONCLUSION It was revealed that the backward walking ability increased as the forward walking function improved in children with CP, but it was not affected by proprioception, trunk control, and muscle strength. CLINICAL TRIALS NCT05088629 (10/11/2021).
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Affiliation(s)
- Enver Katırcı
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, SANKO University, 27090, Gaziantep, Turkey
| | - Hatice Adıgüzel
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Kahramanmaras Sutcu Imam University, 46100, Kahramanmaras, Turkey
| | - Zekiye İpek Katırcı Kırmacı
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Kahramanmaras Sutcu Imam University, 46100, Kahramanmaras, Turkey.
| | - Nevin Ergun
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, SANKO University, 27090, Gaziantep, Turkey
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Sansare A, Reimann H, Crenshaw J, Arcodia M, Verma K, Lee SCK. Subthreshold electrical noise alters walking balance control in individuals with cerebral palsy. Gait Posture 2023; 106:47-52. [PMID: 37659222 DOI: 10.1016/j.gaitpost.2023.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 05/24/2023] [Accepted: 08/17/2023] [Indexed: 09/04/2023]
Abstract
BACKGROUND Sensory deficits in individuals with cerebral palsy (CP) play a critical role in balance control. However, there is a lack of effective interventions that address sensory facilitation to improve walking balance. Stochastic Resonance (SR) stimulation involves delivering sub threshold noise to improve balance in patients with sensory deficits by enhancing the detection of sensory input. RESEARCH QUESTION To investigate the immediate effects of SR on walking balance in individuals with and without CP. METHODS Thirty-four participants (17 CP, 17 age-and sex-matched typically developing controls or TD) between 8 and 24 years of age were recruited. SR stimulation was applied to the muscles and ligaments of ankle and hip joint. An optimal SR intensity during walking was determined for each subject. Participants walked on a self-paced treadmill for three trials of two minutes each using a random order of SR stimulation (SR) and no stimulation (noSR) control conditions. Our primary outcome measure was minimum lateral margin of stability (MOS). Secondary outcome measures include anterior MOS before heelstrike and spatiotemporal gait parameters. We performed two-way mixed ANOVAs with group (CP, TD) as between-subject and condition (noSR, SR) as within subject factors. RESULTS Compared to walking without SR, there was a small but significant increase in the lateral and anterior MOS with SR stimulation, implying that a larger impulse was needed to become unstable, in turn implying higher stability. Step width and step ength decreased with SR for the CP group with SR stimulation. There were no significant effects for other spatiotemporal variables. SIGNIFICANCE Sub threshold electrical noise can slightly improve walking balance control in individuals with CP. SR stimulation, through enhanced proprioception, may have improved the CP group's awareness of body motion during walking, thus leading them to adopt a more conservative stability strategy to prevent a potential fall.
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Affiliation(s)
- Ashwini Sansare
- Department of Physical Therapy, University of Delaware, Newark, DE, USA
| | - Hendrik Reimann
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA
| | - Jeremy Crenshaw
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA
| | - Maelyn Arcodia
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA
| | - Khushboo Verma
- Department of Physical Therapy, University of Delaware, Newark, DE, USA
| | - Samuel C K Lee
- Department of Physical Therapy, University of Delaware, Newark, DE, USA.
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Bartonek Å, Eriksson M, Ericson A, Reimeringer M, Lidbeck C. Evaluation of Knee Position Sense in Children with Motor Disabilities and Children with Typical Development: A Cross-Sectional Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1056. [PMID: 37371287 DOI: 10.3390/children10061056] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/07/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND In children with motor disabilities, knee position during walking is often of concern in rehabilitation. This study aimed to investigate knee joint position sense. Thirty-seven children with Cerebral Palsy (CP), 21 with Myelomeningocele (MMC), 19 with Arthrogryposis (AMC), and 42 TD children participated in the study. Knee joint position sense, i.e., the difference between the criterion angle and the reproduced angle (JPS-error), was assessed in sitting while 3D motion capture was recorded at flexed knee 70 (Knee70), 45 (Knee45), and 20 (Knee20) degrees, and after three seconds at maintained criterion angle (CAM) and maintained reproduced angle (RAM). No differences were found between the groups in JPS-error, CAM, and RAM. At Knee70, CAM differed between the right and left legs in the TD group (p = 0.014) and RAM in the MMC group (p = 0.021). In the CP group, CAM was greater than RAM at Knee70 in the left leg (p = 0.002), at Knee45 in both legs (p = 0.004, p = 0.025), and at Knee20 in the right leg (p = 0.038). Difficulties in maintaining the knee position at CAM in the CP group sheds light on the need for complementary judgments of limb proprioception in space to explore the potential influence on knee position during walking.
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Affiliation(s)
- Åsa Bartonek
- Division of Paediatric Neurology, Department of Women's and Children's Health, Karolinska Institutet, 17176 Stockholm, Sweden
| | - Marie Eriksson
- Division of Paediatric Neurology, Department of Women's and Children's Health, Karolinska Institutet, 17176 Stockholm, Sweden
| | - Annika Ericson
- Division of Paediatric Neurology, Department of Women's and Children's Health, Karolinska Institutet, 17176 Stockholm, Sweden
- Motor Control Laboratory QA:27, Astrid Lindgren's Children's Hospital, Karolinska University Hospital, Karolinska Vägen 37A, 17176 Stockholm, Sweden
| | - Mikael Reimeringer
- Division of Paediatric Neurology, Department of Women's and Children's Health, Karolinska Institutet, 17176 Stockholm, Sweden
- Motor Control Laboratory QA:27, Astrid Lindgren's Children's Hospital, Karolinska University Hospital, Karolinska Vägen 37A, 17176 Stockholm, Sweden
| | - Cecilia Lidbeck
- Division of Paediatric Neurology, Department of Women's and Children's Health, Karolinska Institutet, 17176 Stockholm, Sweden
- Motor Control Laboratory QA:27, Astrid Lindgren's Children's Hospital, Karolinska University Hospital, Karolinska Vägen 37A, 17176 Stockholm, Sweden
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Ipek Erdem F, Gunel MK, Alemdaroglu-Gurbuz I. Lower extremity proprioception and its association with activity and participation in children with unilateral spastic cerebral palsy. Arch Pediatr 2023; 30:158-164. [PMID: 36907729 DOI: 10.1016/j.arcped.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 11/07/2022] [Accepted: 01/15/2023] [Indexed: 03/12/2023]
Abstract
OBJECTIVE This cross-sectional study aimed to assess lower extremity proprioception and investigate its relationship to activity and participation levels in children with unilateral spastic cerebral palsy (USCP). METHODS A total of 22 children with USCP between the ages of 5 and 16 years participated in this study. Lower extremity proprioception was evaluated with a protocol that consisted of verbal and location identification, unilateral and contralateral limb matching, and static and dynamic balance tests performed with the impaired and less impaired lower extremities under eyes-open and eyes-closed conditions. Furthermore, the Functional Independence Measure (WeeFIM) and Pediatric Outcomes Data Collection Instrument (PODCI) were used to evaluate the independence levels in daily living activities and participation levels. RESULTS Children demonstrated proprioceptive loss, as evidenced by an increase in matching errors under the eyes-closed condition compared to the eyes-open condition (p<0.05). Also, the impaired extremity had greater proprioceptive loss than the less impaired extremity (p<0.05). The 5-6-year age group experienced greater proprioceptive deficits than did the 7-11 and 12-16 age groups (p<0.05). Children's lower extremity proprioceptive deficit was moderately associated with their activity and participation levels (p<0.05). CONCLUSIONS Our findings suggest that treatment programs based on comprehensive assessments, including proprioception, may be more effective in these children.
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Affiliation(s)
- Fulya Ipek Erdem
- Faculty of Physical Therapy and Rehabilitation, Dokuz Eylül University, İzmir, Turkey.
| | - Mintaze Kerem Gunel
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
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13
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Trevarrow MP, Bergwell HE, Groff BR, Wiesman AI, Wilson TW, Kurz MJ. Youth with Cerebral Palsy Display Abnormal Somatosensory Cortical Activity During a Haptic Exploration Task. Neuroscience 2023; 515:53-61. [PMID: 36796750 PMCID: PMC10023489 DOI: 10.1016/j.neuroscience.2023.01.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 01/22/2023] [Accepted: 01/25/2023] [Indexed: 02/16/2023]
Abstract
There are numerous clinical reports that youth with cerebral palsy (CP) have proprioceptive, stereognosis and tactile discrimination deficits. The growing consensus is that the altered perceptions in this population are attributable to aberrant somatosensory cortical activity seen during stimulus processing. It has been inferred from these results that youth with CP likely do not adequately process ongoing sensory feedback during motor performance. However, this conjecture has not been tested. Herein, we address this knowledge gap using magnetoencephalographic (MEG) brain imaging by applying electrical stimulation to the median nerve of youth with CP (N = 15, Age = 15.8 ± 0.83 yrs, Males = 12, MACS levels I-III) and neurotypical (NT) controls (N = 18, Age = 14.1 ± 2.4 yrs, Males = 9) while at rest (i.e., passive) and during a haptic exploration task. The results illustrated that the somatosensory cortical activity was reduced in the group with CP compared to controls during the passive and haptic conditions. Furthermore, the strength of the somatosensory cortical responses during the passive condition were positively associated with the strength of somatosensory cortical responses during the haptic condition (r = 0.75, P = 0.004). This indicates that the aberrant somatosensory cortical responses seen in youth with CP during rest are a good predictor of the extent of somatosensory cortical dysfunction during the performance of motor actions. These data provide novel evidence that aberrations in somatosensory cortical function in youth with CP likely contribute to the difficulties in sensorimotor integration and the ability to effectively plan and execute motor actions.
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Affiliation(s)
- Michael P Trevarrow
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE, USA
| | - Hannah E Bergwell
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE, USA
| | - Boman R Groff
- Department of Psychology & Neuroscience, University of Colorado, Boulder, CO, USA
| | | | - Tony W Wilson
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE, USA; Department of Pharmacology & Neuroscience, Creighton University, Omaha, NE, USA
| | - Max J Kurz
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE, USA; Department of Pharmacology & Neuroscience, Creighton University, Omaha, NE, USA.
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14
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Robotic Ankle Training Improves Sensorimotor Functions in Children with Cerebral Palsy-A Pilot Study. J Clin Med 2023; 12:jcm12041475. [PMID: 36836010 PMCID: PMC9965715 DOI: 10.3390/jcm12041475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/29/2023] [Accepted: 02/10/2023] [Indexed: 02/15/2023] Open
Abstract
Children with cerebral palsy (CP) have sensorimotor impairments including weakness, spasticity, reduced motor control and sensory deficits. Proprioceptive dysfunction compounds the decreased motor control and mobility. The aims of this paper were to (1) examine proprioceptive deficit of lower extremities of children with CP; (2) study improvement in proprioception and clinical impairments through robotic ankle training (RAT). Eight children with CP participated in a 6-week RAT with pre and post ankle proprioception, clinical, biomechanical assessment compared to the assessment of eight typically developing children (TDC). The children with CP participated in passive stretching (20 min/session) and active movement training (20 to 30 min/session) using an ankle rehabilitation robot (3 sessions/week over 6 weeks, total of 18 sessions). Proprioceptive acuity measured as the plantar and dorsi-flexion motion at which the children recognized the movement was 3.60 ± 2.28° in dorsiflexion and -3.72 ± 2.38° in plantar flexion for the CP group, inferior to that of the TDC group's 0.94 ± 0.43° in dorsiflexion (p = 0.027) and -0.86 ± 0.48° in plantar flexion (p = 0.012). After training, ankle motor and sensory functions were improved in children with CP, with the dorsiflexion strength increased from 3.61 ± 3.75 Nm to 7.48 ± 2.75 Nm (p = 0.018) and plantar flexion strength increased from -11.89 ± 7.04 Nm to -17.61 ± 6.81 Nm after training (p = 0.043). The dorsiflexion AROM increased from 5.58 ± 13.18° to 15.97 ± 11.21° (p = 0.028). The proprioceptive acuity showed a trend of decline to 3.08 ± 2.07° in dorsiflexion and to -2.59 ± 1.94° in plantar flexion (p > 0.05). The RAT is a promising intervention for children with CP to improve sensorimotor functions of the lower extremities. It provided an interactive and motivating training to engage children with CP in rehabilitation to improve clinical and sensorimotor performance.
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15
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Hilderley AJ, Wright FV, Taylor MJ, Chen JL, Fehlings D. Functional Neuroplasticity and Motor Skill Change Following Gross Motor Interventions for Children With Diplegic Cerebral Palsy. Neurorehabil Neural Repair 2023; 37:16-26. [PMID: 36524254 PMCID: PMC9896542 DOI: 10.1177/15459683221143503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Gross motor intervention designs for children with diplegic cerebral palsy (DCP) require an improved understanding of the children's potential for neuroplasticity. OBJECTIVE To identify relations between functional neuroplasticity and motor skill changes following gross motor interventions for children with DCP. METHODS There were 17 participants with DCP (ages 8-16 years; 6 females; Gross Motor Function Classification System Level I [n = 9] and II [n = 8]). Each completed a 6-week gross motor intervention program that was directed toward achievement of individualized motor/physical activity goals. Outcomes were assessed pre/post and 4 to 6 months post-intervention (follow-up). An active ankle dorsiflexion task was completed during functional magnetic resonance imaging. The ratio of motor cortical activation volume in each hemisphere was calculated using a laterality index. The Challenge was the primary gross motor skill measure. Change over time and relations among outcomes were evaluated. RESULTS Challenge scores improved post-intervention (4.57% points [SD 4.45], P = .004) and were maintained at follow-up (0.75% [SD 6.57], P = 1.000). The laterality index for dominant ankle dorsiflexion increased (P = .033), while non-dominant change was variable (P = .534). Contralateral activation (laterality index ≥+0.75) was most common for both ankles. Challenge improvements correlated with increased ipsilateral activity (negative laterality index) during non-dominant dorsiflexion (r = -.56, P = .045). Smaller activation volume during non-dominant dorsiflexion predicted continued gross motor gains at follow-up (R2 = .30, P = .040). CONCLUSIONS Motor cortical activation during non-dominant ankle dorsiflexion is a modest indicator of the potential for gross motor skill change. Further investigation of patterns of neuroplastic change will improve our understanding of effects. CLINICALTRIALS.GOV REGISTRY NCT02584491 and NCT02754128.
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Affiliation(s)
- Alicia J. Hilderley
- Bloorview Research Institute, Holland
Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - F. Virginia Wright
- Bloorview Research Institute, Holland
Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada,Department of Physical Therapy,
University of Toronto, Toronto, ON, Canada
| | - Margot J. Taylor
- Diagnostic Imaging, The Hospital for
Sick Children, Toronto, ON, Canada,Department of Medical Imaging,
University of Toronto, Toronto, ON, Canada,Department of Psychology, University of
Toronto, Toronto, ON, Canada
| | - Joyce L. Chen
- Faculty of Kinesiology and Physical
Education, University of Toronto, Toronto, ON, Canada,Hurvitz Brain Sciences Program,
Canadian Partnership for Stroke Recovery, Sunnybrook Research Institute, Toronto,
ON, Canada
| | - Darcy Fehlings
- Bloorview Research Institute, Holland
Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada,Department of Paediatrics, Faculty of
Medicine, University of Toronto, Toronto, ON, Canada,Darcy Fehlings, Holland Bloorview Kids
Rehabilitation Hospital, 150 Kilgour Road, Toronto, ON M4G 1R8, Canada.
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16
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Guérin M, Sijobert B, Zaragoza B, Cambon F, Boyer L, Patte K. Combining intensive rehabilitation with a non-functional isokinetic strengthening program in adolescents with cerebral palsy: a study protocol for a randomized controlled trial. JMIR Res Protoc 2022; 12:e43221. [PMID: 36790338 DOI: 10.2196/43221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 12/16/2022] [Accepted: 12/28/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Cerebral palsy (CP) is the most common brain injury in the pediatric population. CP patients present different affectations such as decreased muscle strength, gait deviations, impaired proprioception, and spasticity. Isokinetic strengthening programs combined with an intensive rehabilitation may improve muscle strength and therefore gait efficiency. Clinical Trials: The protocol has been accepted by the French National Ethics Committee (IDRCB: 2022-A00431-42). OBJECTIVE The primary aim of this randomized controlled trial is to compare the effect of an intensive rehabilitation combined with a non-functional isokinetic progressive strengthening program to an intensive rehabilitation alone on gait parameters and muscle strength in CP patients. Another goal of the current study is to determine whether adding an isokinetic program to an intensive rehabilitation is more effective than an intensive reha-bilitation alone on decreasing spasticity and improving joint position sense in CP patients. METHODS Thirty adolescents with spastic diplegia CP (GMFCS level I to III) will be randomized, by an independent researcher, into a 3-week intensive rehabilitation and isokinetic pro-gressive strengthening group or an intensive rehabilitation control group. Gait param-eters, muscle strength, spasticity and knee joint position sense will be assessed. These variables will be evaluated at baseline (T0) and at the end of the intervention (T1). The intensive rehabilitation will consist of physiotherapy sessions twice a day and hydro-therapy and virtual reality gait training once a day. The isokinetic training group will have a total of 9 supervised isokinetic strength training focusing on knee flexors and extensors with different execution speeds. RESULTS The protocol has been accepted by the French National Ethics Committee in October 2022. Inclusion of patients will start in November 2022. CONCLUSIONS The combination of an intensive rehabilitation with an isokinetic program on knee flexors and extensors have not been studied yet. The findings of this study may determine if an isokinetic strength training program of knee flexors and extensors is benefic to improve gait parameters, muscle strength, spasticity, and joint position sense in adolescents with spastic diplegia. CLINICALTRIAL The protocol has been accepted by the French National Ethics Committee (IDRCB: 2022-A00431-42).
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Affiliation(s)
- Mathias Guérin
- Unité de rééducation, institut Saint-Pierre, 371, avenue de l'Évêché-de-Maguelone 34250 Palavas-les-Flots, France, Palavas-les-Flots, FR
| | - Benoit Sijobert
- Unité de rééducation, institut Saint-Pierre, 371, avenue de l'Évêché-de-Maguelone 34250 Palavas-les-Flots, France, Palavas-les-Flots, FR
| | - Benjamin Zaragoza
- Unité de rééducation, institut Saint-Pierre, 371, avenue de l'Évêché-de-Maguelone 34250 Palavas-les-Flots, France, Palavas-les-Flots, FR
| | - Flore Cambon
- Unité de rééducation, institut Saint-Pierre, 371, avenue de l'Évêché-de-Maguelone 34250 Palavas-les-Flots, France, Palavas-les-Flots, FR
| | - Laurence Boyer
- Unité de rééducation, institut Saint-Pierre, 371, avenue de l'Évêché-de-Maguelone 34250 Palavas-les-Flots, France, Palavas-les-Flots, FR
| | - Karine Patte
- Unité de rééducation, institut Saint-Pierre, 371, avenue de l'Évêché-de-Maguelone 34250 Palavas-les-Flots, France, Palavas-les-Flots, FR
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17
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Oleksy Ł, Królikowska A, Mika A, Reichert P, Kentel M, Kentel M, Poświata A, Roksela A, Kozak D, Bienias K, Smoliński M, Stolarczyk A, Mikulski M. A Reliability of Active and Passive Knee Joint Position Sense Assessment Using the Luna EMG Rehabilitation Robot. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15885. [PMID: 36497961 PMCID: PMC9739924 DOI: 10.3390/ijerph192315885] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 11/21/2022] [Accepted: 11/25/2022] [Indexed: 06/17/2023]
Abstract
Joint position sense (JPS) is the awareness of joint location in space, indicating accuracy and precision of the movement. Therefore, the aim of the present study is to determine the reliability of active and passive JPS assessment regarding the knee joint. This was carried out using the Luna EMG rehabilitation robot. Further analysis assessed whether the examination of only the dominant site is justified and if there are differences between sites. The study comprised 24 healthy male participants aged 24.13 ± 2.82 years, performing sports at a recreational level. Using the Luna EMG rehabilitation robot, JPS tests were performed for the right and left knees during flexion and extension in active and passive mode, in two separate sessions with a 1-week interval. Both knee flexion and extension in active and passive modes demonstrated high reliability (ICC = 0.866-0.982; SEM = 0.63-0.31). The mean JPS angle error did not differ significantly between the right and left lower limbs (p < 0.05); however, no between-limb correlation was noted (r = 0.21-0.34; p > 0.05). The Bland-Altman plots showed that the between-limb bias was minimal, with relatively wide limits of agreement. Therefore, it was concluded that the Luna EMG rehabilitation robot is a reliable tool for active and passive knee JPS assessment. In our study, JPS angle error did not differ significantly between left and right sides; however, the slight asymmetry was observed (visible in broad level of agreement exceeding 5° in Bland-Altman plots), what may suggest that in healthy subjects, e.g., active athletes, proprioception should always be assessed on both sides.
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Affiliation(s)
- Łukasz Oleksy
- Department of Physiotherapy, Faculty of Health Sciences, Jagiellonian University Medical College Krakow, 31-008 Krakow, Poland
- Oleksy Medical & Sport Sciences, 37-100 Łańcut, Poland
| | - Aleksandra Królikowska
- Ergonomics and Biomedical Monitoring Laboratory, Department of Physiotherapy, Faculty of Health Sciences, Wrocław Medical University, 50-368 Wrocław, Poland
| | - Anna Mika
- Institute of Clinical Rehabilitation, University of Physical Education in Kraków, 31-571 Kraków, Poland
| | - Paweł Reichert
- Department of Trauma Surgery, Clinical Department of Trauma and Hand Surgery, Faculty of Medicine, Wrocław Medical University, 50-368 Wrocław, Poland
| | | | | | | | - Anna Roksela
- Faculty of Automatic Control, Electronics and Computer Science, Silesian University of Technology, 44-100 Gliwice, Poland
| | | | | | - Marcel Smoliński
- Faculty of Automatic Control, Electronics and Computer Science, Silesian University of Technology, 44-100 Gliwice, Poland
| | - Artur Stolarczyk
- Department of Orthopaedics and Rehabilitation, Medical Faculty, Medical University of Warsaw, 02-091 Warsaw, Poland
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18
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Sansare A, Arcodia M, Lee SCK, Jeka J, Reimann H. Individuals with cerebral palsy show altered responses to visual perturbations during walking. Front Hum Neurosci 2022; 16:977032. [PMID: 36158616 PMCID: PMC9493200 DOI: 10.3389/fnhum.2022.977032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 08/02/2022] [Indexed: 11/13/2022] Open
Abstract
Individuals with cerebral palsy (CP) have deficits in processing of somatosensory and proprioceptive information. To compensate for these deficits, they tend to rely on vision over proprioception in single plane upper and lower limb movements and in standing. It is not known whether this also applies to walking, an activity where the threat to balance is higher. Through this study, we used visual perturbations to understand how individuals with and without CP integrate visual input for walking balance control. Additionally, we probed the balance mechanisms driving the responses to the visual perturbations. More specifically, we investigated differences in the use of ankle roll response i.e., the use of ankle inversion, and the foot placement response, i.e., stepping in the direction of perceived fall. Thirty-four participants (17 CP, 17 age-and sex-matched typically developing controls or TD) were recruited. Participants walked on a self-paced treadmill in a virtual reality environment. Intermittently, the virtual scene was rotated in the frontal plane to induce the sensation of a sideways fall. Our results showed that compared to their TD peers, the overall body sway in response to the visual perturbations was magnified and delayed in CP group, implying that they were more affected by changes in visual cues and relied more so on visual information for walking balance control. Also, the CP group showed a lack of ankle response, through a significantly reduced ankle inversion on the affected side compared to the TD group. The CP group showed a higher foot placement response compared to the TD group immediately following the visual perturbations. Thus, individuals with CP showed a dominant proximal foot placement strategy and diminished ankle roll response, suggestive of a reliance on proximal over distal control of walking balance in individuals with CP.
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Affiliation(s)
- Ashwini Sansare
- Department of Physical Therapy, University of Delaware, Newark, DE, United States
| | - Maelyn Arcodia
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, United States
| | - Samuel C. K. Lee
- Department of Physical Therapy, University of Delaware, Newark, DE, United States
| | - John Jeka
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, United States
| | - Hendrik Reimann
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, United States
- *Correspondence: Hendrik Reimann,
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19
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Dukkipati SS, Walker SJ, Trevarrow MP, Busboom M, Baker SE, Kurz MJ. Reduced wrist flexor H-reflex excitability is linked with increased wrist proprioceptive error in adults with cerebral palsy. Front Neurol 2022; 13:930303. [PMID: 36016542 PMCID: PMC9396222 DOI: 10.3389/fneur.2022.930303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/18/2022] [Indexed: 12/03/2022] Open
Abstract
Although most neurophysiological studies of persons with cerebral palsy (CP) have been focused on supraspinal networks, recent evidence points toward the spinal cord as a central contributor to their motor impairments. However, it is unclear if alterations in the spinal pathways are also linked to deficits in the sensory processing observed clinically. This investigation aimed to begin to address this knowledge gap by evaluating the flexor carpi radialis (FCR) H-reflex in adults with CP and neurotypical (NT) controls while at rest and during an isometric wrist flexion task. The maximal H-wave (Hmax) and M-wave (Mmax) at rest were calculated and utilized to compute Hmax/Mmax ratios (H:M ratios). Secondarily, the facilitation of the H-wave was measured while producing an isometric, voluntary wrist flexion contraction (i.e., active condition). Finally, a wrist position sense test was used to quantify the level of joint position sense. These results revealed that the adults with CP had a lower H:M ratio compared with the NT controls while at rest. The adults with CP were also unable to facilitate their H-reflexes with voluntary contraction and had greater position sense errors compared with the controls. Further, these results showed that the adults with CP that had greater wrist position sense errors tended to have a lower H:M ratio at rest. Overall, these findings highlight that aberration in the spinal cord pathways of adults with CP might play a role in the sensory processing deficiencies observed in adults with CP.
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Affiliation(s)
- S. Shekar Dukkipati
- Boys Town National Research Hospital, Omaha, NE, United States
- College of Medicine, University of Nebraska Medical Center, Omaha, NE, United States
| | - Sarah J. Walker
- Boys Town National Research Hospital, Omaha, NE, United States
| | | | - Morgan Busboom
- Boys Town National Research Hospital, Omaha, NE, United States
| | - Sarah E. Baker
- Boys Town National Research Hospital, Omaha, NE, United States
| | - Max J. Kurz
- Boys Town National Research Hospital, Omaha, NE, United States
- School of Medicine, Creighton University, Omaha, NE, United States
- *Correspondence: Max J. Kurz
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20
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Zbytniewska-Mégret M, Decraene L, Mailleux L, Kleeren L, Kanzler CM, Gassert R, Ortibus E, Feys H, Lambercy O, Klingels K. Reliable and Valid Robotic Assessments of Hand Active and Passive Position Sense in Children With Unilateral Cerebral Palsy. Front Hum Neurosci 2022; 16:895080. [PMID: 35978982 PMCID: PMC9376476 DOI: 10.3389/fnhum.2022.895080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 06/22/2022] [Indexed: 11/16/2022] Open
Abstract
Impaired hand proprioception can lead to difficulties in performing fine motor tasks, thereby affecting activities of daily living. The majority of children with unilateral cerebral palsy (uCP) experience proprioceptive deficits, but accurately quantifying these deficits is challenging due to the lack of sensitive measurement methods. Robot-assisted assessments provide a promising alternative, however, there is a need for solutions that specifically target children and their needs. We propose two novel robotics-based assessments to sensitively evaluate active and passive position sense of the index finger metacarpophalangeal joint in children. We then investigate test-retest reliability and discriminant validity of these assessments in uCP and typically developing children (TDC), and further use the robotic platform to gain first insights into fundamentals of hand proprioception. Both robotic assessments were performed in two sessions with 1-h break in between. In the passive position sense assessment, participant's finger is passively moved by the robot to a randomly selected position, and she/he needs to indicate the perceived finger position on a tablet screen located directly above the hand, so that the vision of the hand is blocked. Active position sense is assessed by asking participants to accurately move their finger to a target position shown on the tablet screen, without visual feedback of the finger position. Ten children with uCP and 10 age-matched TDC were recruited in this study. Test-retest reliability in both populations was good (intraclass correlation coefficients (ICC) >0.79). Proprioceptive error was larger for children with uCP than TDC (passive: 11.49° ± 5.57° vs. 7.46° ± 4.43°, p = 0.046; active: 10.17° ± 5.62° vs. 5.34° ± 2.03°, p < 0.001), indicating discriminant validity. The active position sense was more accurate than passive, and the scores were not correlated, underlining the need for targeted assessments to comprehensively evaluate proprioception. There was a significant effect of age on passive position sense in TDC but not uCP, possibly linked to disturbed development of proprioceptive acuity in uCP. Overall, the proposed robot-assisted assessments are reliable, valid and a promising alternative to commonly used clinical methods, which could help gain a better understanding of proprioceptive impairments in uCP, facilitating the design of novel therapies.
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Affiliation(s)
- Monika Zbytniewska-Mégret
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, Institute of Robotics and Intelligent Systems, ETH Zurich, Zurich, Switzerland
- *Correspondence: Monika Zbytniewska-Mégret
| | - Lisa Decraene
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Faculty of Rehabilitation Sciences, Rehabilitation Research Center (REVAL), University of Hasselt, Diepenbeek, Belgium
| | - Lisa Mailleux
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Lize Kleeren
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Christoph M. Kanzler
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, Institute of Robotics and Intelligent Systems, ETH Zurich, Zurich, Switzerland
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
| | - Roger Gassert
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, Institute of Robotics and Intelligent Systems, ETH Zurich, Zurich, Switzerland
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
| | - Els Ortibus
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Hilde Feys
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Olivier Lambercy
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, Institute of Robotics and Intelligent Systems, ETH Zurich, Zurich, Switzerland
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence and Technological Enterprise (CREATE), Singapore, Singapore
| | - Katrijn Klingels
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Faculty of Rehabilitation Sciences, Rehabilitation Research Center (REVAL), University of Hasselt, Diepenbeek, Belgium
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21
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Marsico P, Mercer TH, van Hedel HJA, van der Linden ML. What are the relevant categories, modalities, and outcome measures for assessing lower limb somatosensory function in children with upper motor neuron lesions? A Delphi study. Disabil Rehabil 2022:1-10. [PMID: 35906774 DOI: 10.1080/09638288.2022.2102257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE Somatosensory function of the lower limbs is rarely assessed in children with upper motor neuron lesions despite its potential relevance for motor function. We explored consensus regarding somatosensory categories (exteroception, proprioception, interoception, and body awareness), modalities, and outcome measures relevant to lower limb motor function. METHODS Fifteen international experts with experience of somatosensory function assessment participated in this Delphi study. Surveys of four rounds, conducted online, included questions on the relevance of somatosensory categories and modalities for motor function and on the use of potential outcome measures in clinical practice. RESULTS The experts reached consensus on the relevance of six modalities of the categories exteroception, proprioception, and body awareness. Based on their feedback, we formulated three core criteria for somatosensory outcome measures, namely suitability for clinical practice, child-friendliness, and relevance for motor function. None of the nine available outcome measures fulfilled each criterion. The experts also highlighted the importance of using and interpreting the tests in relation to the child's activity and participation. CONCLUSION There was expert consensus on three categories and six modalities of somatosensory function relevant for lower limb motor function. However, existing outcome measures will need to be adapted for use in paediatric clinical practice. IMPLICATION FOR REHABILITATIONConsensus was established for the categories and modalities of somatosensory function relevant for lower limb motor function of children with UMN lesion.Outcome measures should cover tactile function, joint movement and joint position and dynamic position sense, and spatial and structural body representation.None of the nine existing outcome measures fulfilled the core criteria: feasibility for clinical practice, child-friendliness, and relevance to motor function.
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Affiliation(s)
- Petra Marsico
- Research Department, Swiss Children's Rehab, University Children's Hospital Zurich, Affoltern am Albis, Switzerland.,Children's Research Center CRC, University Children's Hospital Zurich, Zurich, Switzerland.,Centre for Health, Activity and Rehabilitation Research, Queen Margaret University, Edinburgh, UK
| | - Tom H Mercer
- Centre for Health, Activity and Rehabilitation Research, Queen Margaret University, Edinburgh, UK
| | - Hubertus J A van Hedel
- Research Department, Swiss Children's Rehab, University Children's Hospital Zurich, Affoltern am Albis, Switzerland.,Children's Research Center CRC, University Children's Hospital Zurich, Zurich, Switzerland.,Centre for Health, Activity and Rehabilitation Research, Queen Margaret University, Edinburgh, UK
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22
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Marsico P, Meier L, van der Linden ML, Mercer TH, van Hedel HJA. Psychometric Properties of Lower Limb Somatosensory Function and Body Awareness Outcome Measures in Children with Upper Motor Neuron Lesions: A Systematic Review. Dev Neurorehabil 2022; 25:314-327. [PMID: 34872425 DOI: 10.1080/17518423.2021.2011976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE A systematic review of the psychometric properties and feasibility of outcome measures assessing lower limb somatosensory function and body awareness in children with upper motor neuron lesion. METHODS We followed the COnsensus-based Standards for the selection of health Measurement INstruments guidelines. Two raters independently judged the quality and risk of bias of each study. Data synthesis was performed, and aspects of feasibility were extracted. RESULTS Twelve studies investigated eleven somatosensory function measures quantifying four modalities and eight body awareness measures quantifying two modalities. The best evidence synthesis was very low to low for somatosensory function modalities and low for body awareness modalities. Few feasibility aspects were reported (e.g., the percentage or minimum age of participants able to perform the tests). CONCLUSION Current evidence on the psychometric characteristics of somatosensory function and body awareness outcome measures are relatively sparse. Further research on psychometric properties and practical application is needed.
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Affiliation(s)
- Petra Marsico
- Swiss Children's Reha, Affoltern am Albis, Switzerland.,University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland.,Queen Margaret University, Edinburgh, Scotland
| | - Lea Meier
- Swiss Children's Reha, Affoltern am Albis, Switzerland.,University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | | | - Hubertus J A van Hedel
- Swiss Children's Reha, Affoltern am Albis, Switzerland.,University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland.,Queen Margaret University, Edinburgh, Scotland
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23
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Taylor S, Elliott C, McLean B, Parsons R, Falkmer T, Carey LM, Blair E, Girdler S. Construct validity, reliability, and responsiveness of the Wrist Position Sense Test for use in children with hemiplegic cerebral palsy. Aust Occup Ther J 2022; 69:637-646. [PMID: 35768897 DOI: 10.1111/1440-1630.12825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 06/11/2022] [Accepted: 06/12/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION We investigate the construct validity, test re-test reliability, and responsiveness of the Wrist Position Sense Test (WPST) for children with hemiplegic cerebral palsy (CP). METHODS Twenty-eight children with spastic hemiplegic CP [mean age 10.8 years; SD 2.4 years] and 39 typically developing (TD) children [mean age 11 years; SD 2.9 years] participated in a cross-sectional study to investigate construct validity and association with an upper limb activity measure, the Box and Block Test (BBT). Twenty-two TD children were tested at a second time-point to examine reliability. Test responsiveness was determined by random allocation of 17 children with CP to a treatment (n = 10) or control (n = 7) group with assessments completed at four time-points. RESULTS Significantly greater differences were observed in mean error of indicated wrist position (p < 0.01) in children with CP at baseline (M = 21.6°, SD = 21.6°) than in TD children (M = 12.8°, SD = 11.0°). Larger WPST errors were associated with poorer performance on the BBT (p < 0.01) indicating a substantial association, and there were no consistent differences between time-points indicating test re-test reliability within a TD population. The WPST demonstrated responsiveness to intervention with a statistically significant reduction in mean error following treatment (p < 0.001), not seen in the control group (p = 0.28). CONCLUSION The WPST demonstrated construct validity in this preliminary study. Scores were associated with an upper limb activity measure, and scores changed significantly following somatosensory training. These findings support further research and future psychometric investigation of the WPST in children with CP. KEY POINTS FOR OCCUPATIONAL THERAPY This study provides psychometric knowledge about the WPST tool The WPST shows promise as a discriminative measure with preliminary evidence of responsiveness and intra-rater reliability Until further testing, the WPST can be used cautiously in future research studies to measure wrist position sense.
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Affiliation(s)
- Susan Taylor
- School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia.,Kids Rehab Western Australia, Child and Adolescent Health Service, Perth, Western Australia, Australia
| | - Catherine Elliott
- School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia.,Kids Rehab Western Australia, Child and Adolescent Health Service, Perth, Western Australia, Australia.,Telethon Kids Institute, Perth, Western Australia, Australia
| | - Belinda McLean
- School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia.,Kids Rehab Western Australia, Child and Adolescent Health Service, Perth, Western Australia, Australia.,School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia
| | - Richard Parsons
- School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Torbjorn Falkmer
- School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Leeanne M Carey
- Occupational Therapy, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia.,Neurorehabilitation and Recovery, The Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
| | - Eve Blair
- Neurorehabilitation and Recovery, The Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
| | - Sonya Girdler
- School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia.,School of Allied Health, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia.,Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women's and Children's Health, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.,Child and Adolescent Psychiatry, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
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24
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Trevarrow MP, Taylor BK, Reelfs AM, Wilson TW, Kurz MJ. Aberrant movement-related somatosensory cortical activity mediates the extent of the mobility impairments in persons with cerebral palsy. J Physiol 2022; 600:3537-3548. [PMID: 35723200 PMCID: PMC9357205 DOI: 10.1113/jp282898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 06/13/2022] [Indexed: 11/08/2022] Open
Abstract
KEY POINTS Persons with cerebral palsy (CP) have reduced somatosensory cortical responses at rest and during movement. The somatosensory cortical responses during movement mediate the relationship between the somatosensory cortical responses at rest and mobility. Persons with CP may have altered sensorimotor feedback that ultimately contributes to impaired mobility. ABSTRACT There are numerous clinical reports that persons with cerebral palsy (CP) have proprioceptive, stereognosis and tactile discrimination deficits. The current consensus is that these altered perceptions are attributable to aberrant somatosensory cortical activity. It has been inferred from these data that persons with CP do not adequately process ongoing sensory feedback during motor actions, which accentuates the extent of their mobility impairments. However, this hypothesis has yet to be directly tested. We used magnetoencephalographic (MEG) brain imaging to address this knowledge gap by quantifying the somatosensory dynamics evoked by applying electrical stimulation to the tibial nerve in 22 persons with CP and 25 neurotypical (NT) controls while at rest and during an ankle plantarflexion isometric force motor task. We also quantified the spatiotemporal gait biomechanics of participants outside the scanner. Consistent with the literature, our results confirmed that the strength of somatosensory cortical activity was weaker in the persons with CP compared to the NT controls. Our results also showed that the strength of the somatosensory cortical responses were significantly weaker during the isometric ankle force task than at rest. Most importantly, our results showed that the strength of somatosensory cortical activity during the ankle plantarflexion force production task mediated the relationship between somatosensory cortical activity at rest and both walking velocity and step length. These results suggest that youth with CP have aberrant somatosensory cortical activity during isometric force generation, which ultimately contributes to the extent of mobility impairments seen in this patient population. Abstract figure legend Magnetoencephalographic brain imaging was used to determine the effect of sensory feedback during movement on mobility in persons with cerebral palsy. Persons with cerebral palsy had reduced somatosensory cortical activity at rest and during movement compared with their neurotypical peers. Further, the somatosensory cortical activity during movement mediated the relationship between somatosensory cortical activity at rest and mobility. These results indicate that difficulties in sensorimotor integration may contribute to the mobility impairments seen in this patient population. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Michael P Trevarrow
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE, USA
| | - Brittany K Taylor
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE, USA
| | - Anna M Reelfs
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE, USA
| | - Tony W Wilson
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE, USA.,Department of Pharmacology & Neuroscience, Creighton University, Omaha, Nebraska
| | - Max J Kurz
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE, USA.,Department of Pharmacology & Neuroscience, Creighton University, Omaha, Nebraska
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25
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Bergwell H, Trevarrow M, Corr B, Baker S, Reelfs H, Wilson TW, Moreau NG, Kurz MJ. Power training alters somatosensory cortical activity of youth with cerebral palsy. Ann Clin Transl Neurol 2022; 9:659-668. [PMID: 35297546 PMCID: PMC9082383 DOI: 10.1002/acn3.51545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 02/23/2022] [Accepted: 02/25/2022] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Our prior magnetoencephalographic (MEG) investigations demonstrate that persons with cerebral palsy (CP) have weaker somatosensory cortical activity than neurotypical (NT) controls, which is associated with reduced muscular strength and mobility. Power training can improve lower extremity isokinetic strength, muscular power, and walking performance of youth with CP. Potentially, these clinically relevant improvements are partially driven by changes in somatosensory processing. The objective of this investigation was to determine if power training has complementary changes in muscular function and somatosensory cortical activity in youth with CP. METHODS A cohort of youth with CP (N = 11; age = 15.90 ± 1.1 years) and NT controls (N = 10; Age = 15.93 ± 2.48 years) participated in this investigation. Youth with CP underwent 24 power training sessions. Pre-post bilateral leg press 1-repetition maximum (1RM), peak power production, 10-m walking speed, and distance walked 1-min were used as outcome measures. MEG neuroimaging assessed the changes in somatosensory cortical activity while at rest. NT controls only underwent a baseline MEG assessment. RESULTS Youth with CP had a 56% increase in 1RM (p < 0.001), a 33% increase in peak power production (p = 0.019), and a 4% improvement in 1-min walk (p = 0.029). Notably, there was a 46% increase in somatosensory cortical activity (p = 0.02). INTERPRETATION These results are the first to show that power training is associated with improvements in muscular function, walking performance, and the resting somatosensory cortical activity in individuals with CP. This treatment approach might be advantageous due to the potential to promote cortical and muscular plasticity, which appear to have carryover effects for improved walking performance.
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Affiliation(s)
- Hannah Bergwell
- Institute for Human NeuroscienceBoys Town National Research HospitalBoys TownNebraskaUSA
| | - Mike Trevarrow
- Institute for Human NeuroscienceBoys Town National Research HospitalBoys TownNebraskaUSA
| | - Brad Corr
- Institute for Human NeuroscienceBoys Town National Research HospitalBoys TownNebraskaUSA
| | - Sarah Baker
- Institute for Human NeuroscienceBoys Town National Research HospitalBoys TownNebraskaUSA
| | - Heidi Reelfs
- Department of Physical Therapy, Munroe‐Meyer InstituteUniversity of Nebraska Medical CenterOmahaNebraskaUSA
| | - Tony W. Wilson
- Institute for Human NeuroscienceBoys Town National Research HospitalBoys TownNebraskaUSA
- Department of Pharmacology and Neuroscience, School of MedicineCreighton UniversityOmahaNebraskaUSA
| | - Noelle G. Moreau
- Department of Physical Therapy, School of Allied Health ProfessionsLouisiana State UniversityNew OrleansLouisianaUSA
| | - Max J. Kurz
- Institute for Human NeuroscienceBoys Town National Research HospitalBoys TownNebraskaUSA
- Department of Pharmacology and Neuroscience, School of MedicineCreighton UniversityOmahaNebraskaUSA
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26
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Stronger proprioceptive BOLD-responses in the somatosensory cortices reflect worse sensorimotor function in adolescents with and without cerebral palsy. Neuroimage Clin 2022; 32:102795. [PMID: 34474316 PMCID: PMC8411230 DOI: 10.1016/j.nicl.2021.102795] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 08/16/2021] [Accepted: 08/17/2021] [Indexed: 12/18/2022]
Abstract
Cerebral palsy (CP) is a motor disorder where the motor defects are partly due to impaired proprioception. We studied cortical proprioceptive responses and sensorimotor performance in adolescents with CP and their typically-developed (TD) peers. Passive joint movements were used to stimulate proprioceptors during functional magnetic resonance imaging (fMRI) session to quantify the proprioceptive responses whose associations to behavioral sensorimotor performance were also examined. Twenty-three TD (15 females, age: mean ± standard deviation 14.2 ± 2.4 years) and 18 CP (12 females, age: mean ± standard deviation, 13.8 ± 2.3 years; 12 hemiplegic, 6 diplegic) participants were included in this study. Participants' index fingers and ankles were separately stimulated at 3 Hz and 1 Hz respectively with pneumatic movement actuators. Regions-of-interest were used to quantify BOLD-responses from the primary sensorimotor (SM1) and secondary (SII) somatosensory cortices and were compared across the groups. Associations between responses strengths and sensorimotor performance measures were also examined. Proprioceptive responses were stronger for the individuals with CP compared to their TD peers in SM1 (p < 0.001) and SII (p < 0.05) cortices contralateral to their more affected index finger. The ankle responses yielded no significant differences between the groups. The CP group had worse sensorimotor performance for hands and feet (p < 0.001). Stronger responses to finger stimulation in the dominant SM1 (p < 0.001) and both dominant and non-dominant SII (p < 0.01, p < 0.001) cortices were associated with the worse hand sensorimotor performance across all participants. Worse hand function was associated with stronger cortical activation to the proprioceptive stimulation. This association was evident both in adolescents with CP and their typically-developed controls, thus it likely reflects both clinical factors and normal variation in the sensorimotor function. The specific mechanisms need to be clarified in future studies.
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27
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Jobst C, D'Souza SJ, Causton N, Master S, Switzer L, Cheyne D, Fehlings D. Somatosensory Plasticity in Hemiplegic Cerebral Palsy Following Constraint Induced Movement Therapy. Pediatr Neurol 2022; 126:80-88. [PMID: 34742103 DOI: 10.1016/j.pediatrneurol.2021.09.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 08/16/2021] [Accepted: 09/25/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Children with hemiplegic cerebral palsy (HCP) experience upper limb somatosensory and motor deficits. Although constraint-induced movement therapy (CIMT) improves motor function, its impact on somatosensory function remains underinvestigated. OBJECTIVE The objective of this study was to evaluate somatosensory perception and related brain responses in children with HCP, before and after a somatosensory enhanced CIMT protocol, as measured using clinical sensory and motor assessments and magnetoencephalography. METHODS Children with HCP attended a somatosensory enhanced CIMT camp. Clinical somatosensory (tactile registration, 2-point discrimination, stereognosis, proprioception, kinesthesia) and motor outcomes (Quality of Upper Extremity Skills [QUEST] Total/Grasp, Jebsen-Taylor Hand Function Test, grip strength, Assisting Hand Assessment), as well as latency and amplitude of magnetoencephalography somatosensory evoked fields (SEF), were assessed before and after the CIMT camp with paired sample t-tests or Wilcoxon signed-rank tests. RESULTS Twelve children with HCP (mean age: 7.5 years, standard deviation: 2.4) participated. Significant improvements in tactile registration for the affected (hemiplegic) hand (Z = 2.39, P = 0.02) were observed in addition to statistically and clinically significant improvements in QUEST total (t = 3.24, P = 0.007), QUEST grasp (t = 3.24, P = 0.007), Assisting Hand Assessment (Z = 2.25, P = 0.03), and Jebsen-Taylor Hand Function Test (t = -2.62, P = 0.03). A significant increase in the SEF peak amplitude was also found in the affected hand 100 ms after stimulus onset (t = -2.22, P = 0.04). CONCLUSIONS Improvements in somatosensory clinical function and neural processing in the affected primary somatosensory cortex in children with HCP were observed after a somatosensory enhanced CIMT program. Further investigation is warranted to continue to evaluate the effectiveness of a sensory enhanced CIMT program in larger samples and controlled study designs.
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Affiliation(s)
- Cecilia Jobst
- Program in Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Samantha J D'Souza
- Rehabilitation Science Institute, University of Toronto, Toronto, Ontario, Canada; Holland Bloorview Kids Rehabilitation Hospital, Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Natasha Causton
- Holland Bloorview Kids Rehabilitation Hospital, Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Sabah Master
- Program in Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Lauren Switzer
- Holland Bloorview Kids Rehabilitation Hospital, Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Douglas Cheyne
- Program in Neurosciences and Mental Health, The Hospital for Sick Children, Toronto, Ontario, Canada; Holland Bloorview Kids Rehabilitation Hospital, Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Darcy Fehlings
- Rehabilitation Science Institute, University of Toronto, Toronto, Ontario, Canada; Holland Bloorview Kids Rehabilitation Hospital, Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada.
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Cristella G, Allighieri M, Pasquini G, Simoni L, Antonetti A, Beni C, Macchi C, Ferrari A. Evaluation of sense of position and agency in children with diplegic cerebral palsy: A pilot study. J Pediatr Rehabil Med 2022; 15:181-191. [PMID: 35275586 DOI: 10.3233/prm-200703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE This study explores non-motor impairment of the upper dominant limb in children with diplegic cerebral palsy (CP). Specifically, it firstly investigates sense of position without visual control, ability to compare visual and proprioceptive information, and capacity to recognize effects of self-movement. Secondly, it explores the possible association between these items with cognitive function, perceptual disorder (PD), and manual ability (Manual Ability Classification System -MACS). METHODS Ten subjects (7 female; 3 male) were tested with three protocols: the first one (A) explored sense of position, the second one (B) collimation between visual and proprioceptive information, and the last one (C) sense of agency with the use of videogames. RESULTS All subjects executed Protocol A without making any mistakes, while in Protocol B the median percentage of mistakes was 4.8%. Mistakes were recorded more frequently in positions characterized by wrist extension. Data reported a significant correlation with Processing Speed Index (PSI). Sense of agency was positively associated with cognitive functioning, with a significant correlation with PSI.PD, MACS, and Video-Gaming Experience (VGE) showed no correlation with Protocol C. CONCLUSION In the observed sample with diplegic CP, preliminary data support the hypothesis that there is an alteration of both sense of position and sense of agency. They were both associated to PSI, with a positive trend of correlation with cognitive functioning. PD seemed to have no influence. Further studies, with a larger sample size, a control group, and involving children without CP, are required to corroborate the results obtained.
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Affiliation(s)
| | | | | | - Laura Simoni
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.,Department of Neurosciences, Biomedicine and Movement Science, University of Verona, Verona, Italy
| | | | - Chiara Beni
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | | | - Adriano Ferrari
- Physical and Rehabilitation Medicine, CHIMOMO Department, University of Modena and Reggio Emilia, Modena, Italy
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29
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Brun C, Traverse É, Granger É, Mercier C. Somatosensory deficits and neural correlates in cerebral palsy: a scoping review. Dev Med Child Neurol 2021; 63:1382-1393. [PMID: 34145582 PMCID: PMC9290873 DOI: 10.1111/dmcn.14963] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/19/2021] [Indexed: 12/15/2022]
Abstract
AIM To synthetize studies assessing somatosensory deficits and alterations in cerebral responses evoked by somatosensory stimulation in individuals with cerebral palsy (CP) compared to typically developing individuals. METHOD A scoping review of the literature was performed in the MEDLINE, Embase, PsycInfo, CINAHL, Evidence-Based Medicine Reviews, and Web of Science databases (last search carried out on 6th and 7th August 2020) with a combination of keywords related to CP and somatosensory functions. Somatosensory deficits were measured with clinical tests and alterations in cerebral responses were measured with functional magnetic resonance imaging, electroencephalography, and magnetoencephalography. RESULTS Forty-eight articles were included. Overall, 1463 participants with CP (mean [SD] age 13y 1mo [4y 11mo], range 1-55y; 416 males, 319 females, sex not identified for the remaining participants) and 1478 controls (mean [SD] age 13y 1mo [5y 8mo], range 1-42y; 362 males, 334 females, sex not identified for the remaining participants) were included in the scoping review. For tactile function, most studies reported registration (8 out of 13) or perception (21 out of 21) deficits in participants with CP. For proprioception, most studies also reported registration (6 out of 8) or perception (10 out of 15) deficits. Pain function has not been studied as much, but most studies reported registration (2 out of 3) or perception (3 out of 3) alterations. Neuroimaging findings (18 studies) showed alterations in the somatotopy, morphology, latency, or amplitude of cortical responses evoked by somatosensory stimuli. INTERPRETATION Despite the heterogeneity in the methods employed, most studies reported somatosensory deficits. The focus has been mainly on tactile and proprioceptive function, whereas pain has received little attention. Future research should rigorously define the methods employed and include a sample that is more representative of the population with CP. What this paper adds Most of the papers reviewed found tactile registration and perception deficits in the upper limbs. Proprioceptive deficits were generally observed in cerebral palsy but results were heterogeneous. Pain has received little attention compared to tactile and proprioceptive functions. Neuroimaging studies supported behavioral observations. Alterations were observed for both the most and least affected limb.
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Affiliation(s)
- Clémentine Brun
- Center for Interdisciplinary Research in Rehabilitation and Social IntegrationQuebec CityQuebecCanada
| | - Élodie Traverse
- Center for Interdisciplinary Research in Rehabilitation and Social IntegrationQuebec CityQuebecCanada,Department of RehabilitationLaval UniversityQuebec CityQuebecCanada
| | - Élyse Granger
- Centre IntégréUniversitaire de Santé et de Services Sociaux de la Capitale‐NationaleQuebec CityQuebecCanada
| | - Catherine Mercier
- Center for Interdisciplinary Research in Rehabilitation and Social IntegrationQuebec CityQuebecCanada,Department of RehabilitationLaval UniversityQuebec CityQuebecCanada
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30
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Chrysagis N, Koumantakis GA, Grammatopoulou E, Skordilis E. Active Joint Position Sense in Children With Unilateral Cerebral Palsy. Cureus 2021; 13:e18075. [PMID: 34671539 PMCID: PMC8521485 DOI: 10.7759/cureus.18075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2021] [Indexed: 11/15/2022] Open
Abstract
Objective The aim of the study was to examine the differences in joint position sense at the elbow joint between 15 children with unilateral cerebral palsy (CP) and 15 typically developing (TD) controls without neurological or other health deficits. Methodology Joint position sense, a major proprioceptive component, was evaluated actively using a Kin Com 125 AP isokinetic dynamometer (Chattanooga Group, Chattanooga, TN). Results A significant interaction was found (p<0.05) between disability and side, with respect to the active reproduction movement scores. Post-hoc independent t-tests, with Bonferroni adjustments, revealed significant differences for the dominant (t=-3.63, p=0.001) and non-dominant sides respectively (t=-6.19, p=0.000). Repeated measures t-test revealed wider errors with the non-dominant (affected side) in the active reproduction test, compared to the dominant (nonaffected) side for the CP group of children (t=-4.73, p=0.000). A positive correlation was evident between the level of spasticity and joint position sense (Rho=0.71, p=0.003). Conclusions Based on our findings, joint position sense is impaired at the elbow joint in children with spastic hemiplegia. The proprioceptive deficit is present at both the affected and unaffected sides and is related to the level of spasticity.
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Affiliation(s)
- Nikolaos Chrysagis
- Laboratory of Advanced Physiotherapy (LAdPhys) Physiotherapy Department, School of Health and Care Sciences, University of West Attica (UNIWA), Athens, GRC
| | - George A Koumantakis
- Laboratory of Advanced Physiotherapy (LAdPhys) Physiotherapy Department, School of Health and Care Sciences, University of West Attica (UNIWA), Athens, GRC
| | - Eirini Grammatopoulou
- Laboratory of Advanced Physiotherapy (LAdPhys) Physiotherapy Department, School of Health and Care Sciences, University of West Attica (UNIWA), Athens, GRC
| | - Emmanouil Skordilis
- School of Physical Education and Sport Science, National and Kapodistrian University of Athens, Athens, GRC
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Khumlee N, Suriyaamarit D, Boonyong S. Effects of sensory cues on dynamic trunk control in children with spastic diplegic cerebral palsy. Physiother Theory Pract 2021; 38:2621-2628. [PMID: 34424142 DOI: 10.1080/09593985.2021.1967541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Background:There is a lack of evidence whether the combined visual and verbal cues could improve dynamic trunk control in the sitting position in children with spastic diplegic cerebral palsy (SDCP). Objective:To investigate the immediate effects of visual, verbal, and combined visual and verbal cues on dynamic trunk control in the sitting position in children with and without SDCP. Methods:Twenty children with SDCP and 20 typically developing (TD) children aged eight to 12 years in sitting positions maneuvered their trunks to lean forward, backward, to the left, and to the right under conditions of no sensory cues, visual cues, verbal cues, and combined visual and verbal cues. Dynamic trunk control in the sitting position was assessed using the center of force (CoF) trajectory and limit of stability (LOS). Results:Verbal cues and combined visual and verbal cues could improve CoF trajectories in the forward, backward, and leftward directions in TD children and children with SDCP. Combined visual and verbal cues could improve the LOS in both groups. Conclusion:This study provides evidence that combined visual and verbal cues are more effective at enhancing dynamic trunk control than either visual or verbal cues alone in TD children and children with SDCP.
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Affiliation(s)
- Nalin Khumlee
- Human Movement Performance Enhancement Research Unit, Department of Physical Therapy, Faculty of Allied Health Sciences, Chulalongkorn University, Pathumwan, Bangkok Thailand.,Department of Physical Therapy, Physical Medicine and Rehabilitation, Queen Sirikit National Institute of Child Health, Khet Ratchathewi, Bangkok, Thailand
| | - Duangporn Suriyaamarit
- Human Movement Performance Enhancement Research Unit, Department of Physical Therapy, Faculty of Allied Health Sciences, Chulalongkorn University, Pathumwan, Bangkok Thailand
| | - Sujitra Boonyong
- Human Movement Performance Enhancement Research Unit, Department of Physical Therapy, Faculty of Allied Health Sciences, Chulalongkorn University, Pathumwan, Bangkok Thailand
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32
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Monica S, Nayak A, Joshua AM, Mithra P, Amaravadi SK, Misri Z, Unnikrishnan B. Relationship between Trunk Position Sense and Trunk Control in Children with Spastic Cerebral Palsy: A Cross-Sectional Study. Rehabil Res Pract 2021; 2021:9758640. [PMID: 34462670 PMCID: PMC8403037 DOI: 10.1155/2021/9758640] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 06/25/2021] [Accepted: 08/05/2021] [Indexed: 11/25/2022] Open
Abstract
METHODS In this study, 24 children with spastic CP aged between 8 and 15 years were recruited. They were classified based on their functional performance using Gross Motor Function Classification System (GMFCS). Trunk control and trunk position sense were assessed using the trunk control measurement scale (TCMS) and digital goniometer, respectively. The correlation between these variables was tested using Spearman's correlation coefficient. RESULTS Significant negative correlation was found between trunk position sense and TCMS score. Similarly, a significant moderate correlation was found between trunk position sense and GMFCS. A strong negative correlation was also found between GMFCS and TCMS. CONCLUSION Children with spastic CP with better trunk position sense had better trunk control. Similarly, children with higher functional performance had better trunk control and lesser error in trunk position sense. The current findings imply the relevance of proprioceptive training of the trunk for enhancing trunk motor control in children with spastic CP.
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Affiliation(s)
- Shilpa Monica
- Department of Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Akshatha Nayak
- Department of Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Abraham M. Joshua
- Department of Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Prasanna Mithra
- Department of Community Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Sampath Kumar Amaravadi
- Department of Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
- Department of Physiotherapy, College of Health Sciences, Gulf Medical University, Ajman, UAE
| | - Zulkifli Misri
- Department of Neurology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Bhaskaran Unnikrishnan
- Department of Community Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Song Y, Renoul E, Acord S, Johnson YR, Marks W, Alexandrakis G, Papadelis C. Aberrant somatosensory phase synchronization in children with hemiplegic cerebral palsy. Neurosci Lett 2021; 762:136169. [PMID: 34390772 DOI: 10.1016/j.neulet.2021.136169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 08/06/2021] [Accepted: 08/09/2021] [Indexed: 11/17/2022]
Abstract
Children with hemiplegic cerebral palsy (HCP) often show disturbances of somatosensation. Despite extensive evidence of somatosensory deficits, neurophysiological alterations associated with somatosensory deficits in children with HCP have not been elucidated. Here, we aim to assess phase synchrony within and between contralateral primary (S1) and secondary (S2) somatosensory areas in children with HCP. Intra-regional and inter-regional phase synchronizations within and between S1 and S2 were estimated from somatosensory evoked fields (SEFs) in response to passive pneumatic stimulation of contralateral upper extremities and recorded with pediatric magnetoencephalography (MEG) in children with HCP and typically developing (TD) children. We found aberrant phase synchronizations within S1 and between S1 and S2 in both hemispheres in children with HCP. Specifically, the less-affected (LA) hemisphere demonstrated diminished phase synchronizations after the stimulus onset up to ~120 ms compared to the more-affected (MA) hemisphere and the dominant hemisphere of TD children, while the MA hemisphere showed enhanced phase synchronizations after ~100 ms compared to the LA hemisphere and the TD dominant hemisphere. Our findings indicate abnormal somatosensory functional connectivity in both hemispheres of children with HCP.
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Affiliation(s)
- Yanlong Song
- Jane and John Justin Neurosciences Center, Cook Children's Health Care System, Fort Worth, TX, USA; Department of Bioengineering, University of Texas at Arlington, Arlington, TX, USA
| | - Emmanuelle Renoul
- Jane and John Justin Neurosciences Center, Cook Children's Health Care System, Fort Worth, TX, USA; Biomedical Engineering, Université de Paris, Paris, France
| | - Stephanie Acord
- Jane and John Justin Neurosciences Center, Cook Children's Health Care System, Fort Worth, TX, USA
| | - Yvette R Johnson
- NEST Developmental Follow-up Center, Neonatology, Cook Children's Health Care System, Fort Worth, TX, USA; Department of Pediatrics, Texas Christian University and University of North Texas Health Science Center School of Medicine, Fort Worth, TX, USA
| | - Warren Marks
- Jane and John Justin Neurosciences Center, Cook Children's Health Care System, Fort Worth, TX, USA
| | - George Alexandrakis
- Department of Bioengineering, University of Texas at Arlington, Arlington, TX, USA
| | - Christos Papadelis
- Jane and John Justin Neurosciences Center, Cook Children's Health Care System, Fort Worth, TX, USA; Department of Bioengineering, University of Texas at Arlington, Arlington, TX, USA; Department of Pediatrics, Texas Christian University and University of North Texas Health Science Center School of Medicine, Fort Worth, TX, USA; Division of Newborn Medicine, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
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Poitras I, Martinie O, Robert MT, Campeau-Lecours A, Mercier C. Impact of Sensory Deficits on Upper Limb Motor Performance in Individuals with Cerebral Palsy: A Systematic Review. Brain Sci 2021; 11:brainsci11060744. [PMID: 34205153 PMCID: PMC8227331 DOI: 10.3390/brainsci11060744] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 05/27/2021] [Accepted: 05/31/2021] [Indexed: 12/28/2022] Open
Abstract
People living with cerebral palsy (CP) exhibit motor and sensory impairments that affect unimanual and bimanual functions. The importance of sensory functions for motor control is well known, but the association between motor and sensory functions remains unclear in people living with CP. The objective of this systematic review was to characterize the relationship between sensory deficits and upper limb motor function in individuals living with CP. METHODS Five databases were screened. The inclusion criteria were: (1) including people living with CP, (2) reporting measurements of upper limb motor and sensory functions. A qualitative analysis of the studies' level of evidence was done. RESULTS Thirty-three articles were included. Twenty-five articles evaluated tactile functions, 10 proprioceptive functions and 7 visual functions; 31 of the articles reported on unimanual functions and 17 of them reported on bimanual functions. Tactile functions showed a moderate to high association; it was not possible to reach definitive conclusions for proprioceptive and visual functions. CONCLUSIONS The heterogeneity of the results limits the ability to draw definitive conclusions. Further studies should aim to perform more comprehensive assessments of motor and sensory functions, to determine the relative contribution of various sensory modalities to simple and more complex motor functions.
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Affiliation(s)
- Isabelle Poitras
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, QC G1M 2S8, Canada; (I.P.); (O.M.); (M.T.R.); (A.C.-L.)
- Department of Rehabilitation, Laval University, Quebec City, QC G1V 0A6, Canada
| | - Ophélie Martinie
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, QC G1M 2S8, Canada; (I.P.); (O.M.); (M.T.R.); (A.C.-L.)
- Department of Rehabilitation, Laval University, Quebec City, QC G1V 0A6, Canada
| | - Maxime T. Robert
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, QC G1M 2S8, Canada; (I.P.); (O.M.); (M.T.R.); (A.C.-L.)
- Department of Rehabilitation, Laval University, Quebec City, QC G1V 0A6, Canada
| | - Alexandre Campeau-Lecours
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, QC G1M 2S8, Canada; (I.P.); (O.M.); (M.T.R.); (A.C.-L.)
- Department of Mechanical Engineering, Laval University, Quebec City, QC G1V 0A6, Canada
| | - Catherine Mercier
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, QC G1M 2S8, Canada; (I.P.); (O.M.); (M.T.R.); (A.C.-L.)
- Department of Rehabilitation, Laval University, Quebec City, QC G1V 0A6, Canada
- Correspondence:
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Kuczynski AM, Kirton A, Semrau JA, Dukelow SP. Relative independence of upper limb position sense and reaching in children with hemiparetic perinatal stroke. J Neuroeng Rehabil 2021; 18:80. [PMID: 33980254 PMCID: PMC8117512 DOI: 10.1186/s12984-021-00869-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 04/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Studies using clinical measures have suggested that proprioceptive dysfunction is related to motor impairment of the upper extremity following adult stroke. We used robotic technology and clinical measures to assess the relationship between position sense and reaching with the hemiparetic upper limb in children with perinatal stroke. METHODS Prospective term-born children with magnetic resonance imaging-confirmed perinatal ischemic stroke and upper extremity deficits were recruited from a population-based cohort. Neurotypical controls were recruited from the community. Participants completed two tasks in the Kinarm robot: arm position-matching (three parameters: variability [Varxy], contraction/expansion [Areaxy], systematic spatial shift [Shiftxy]) and visually guided reaching (five parameters: posture speed [PS], reaction time [RT], initial direction error [IDE], speed maxima count [SMC], movement time [MT]). Additional clinical assessments of sensory (thumb localization test) and motor impairment (Assisting Hand Assessment, Chedoke-McMaster Stroke Assessment) were completed and compared to robotic measures. RESULTS Forty-eight children with stroke (26 arterial, 22 venous, mean age: 12.0 ± 4.0 years) and 145 controls (mean age: 12.8 ± 3.9 years) completed both tasks. Position-matching performance in children with stroke did not correlate with performance on the visually guided reaching task. Robotic sensory and motor measures correlated with only some clinical tests. For example, AHA scores correlated with reaction time (R = - 0.61, p < 0.001), initial direction error (R = - 0.64, p < 0.001), and movement time (R = - 0.62, p < 0.001). CONCLUSIONS Robotic technology can quantify complex, discrete aspects of upper limb sensory and motor function in hemiparetic children. Robot-measured deficits in position sense and reaching with the contralesional limb appear to be relatively independent of each other and correlations for both with clinical measures are modest. Knowledge of the relationship between sensory and motor impairment may inform future rehabilitation strategies and improve outcomes for children with hemiparetic cerebral palsy.
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Affiliation(s)
- Andrea M Kuczynski
- University of Calgary, 1403 29th St. NW, Foothills Medical Centre, Calgary, AB, T2N 0P8, Canada. .,Section of Neurology, Department of Pediatrics, Alberta Children's Hospital Research Institute, Calgary, AB, Canada.
| | - Adam Kirton
- University of Calgary, 1403 29th St. NW, Foothills Medical Centre, Calgary, AB, T2N 0P8, Canada.,Section of Neurology, Department of Pediatrics, Alberta Children's Hospital Research Institute, Calgary, AB, Canada.,Department of Clinical Neurosciences, Hotchkiss Brain Institute, Calgary, AB, Canada
| | - Jennifer A Semrau
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Calgary, AB, Canada.,Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA
| | - Sean P Dukelow
- University of Calgary, 1403 29th St. NW, Foothills Medical Centre, Calgary, AB, T2N 0P8, Canada.,Department of Clinical Neurosciences, Hotchkiss Brain Institute, Calgary, AB, Canada
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Santana CAS, Tudella E, Rocha NACF, de Campos AC. Lower Limb Sensorimotor Training (LoSenseT) for Children and Adolescents with Cerebral Palsy: A Brief Report of a Feasibility Randomized Protocol. Dev Neurorehabil 2021; 24:276-286. [PMID: 33393402 DOI: 10.1080/17518423.2020.1858458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Motor disorders in cerebral palsy (CP) are often accompanied by disturbances of sensation and impaired somatosensory functions have been reported in individuals with CP. To test the feasibility of a sensorimotor training protocol for lower limbs in children and adolescents with unilateral and bilateral CP, and to analyze the preliminary effects of this training on sensory and motor variables. This is a single-blind, prospective phase I feasibility randomized protocol. A total of twenty participants with uni or bilateral cerebral palsy, GMFCS level I-III, ages 5 to 20 years will be recruited. The LoSenseT protocol is composed of tactile and proprioceptive activities in a child-friendly format. An original qualitative feedback questionnaire was developed to assess the protocol feasibility. Additionally, proprioception, tactile discrimination, postural stability, and gait parameters will be assessed. The LoSenseT protocol can support the implementation of interventions targeting lower limbs somatosensory impairments in individuals with CP.
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Affiliation(s)
| | - Eloisa Tudella
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, São Paulo State, Brazil
| | | | - Ana Carolina de Campos
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, São Paulo State, Brazil
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Elnaggar RK. An Analytical Insight Into How Walking Speed and Spatial and Temporal Symmetry Are Related to Ankle Dysfunctions in Children With Hemiplegic Cerebral Palsy. Am J Phys Med Rehabil 2021; 100:458-464. [PMID: 32858535 DOI: 10.1097/phm.0000000000001576] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE The aim of the study was to identify the major determining factors among ankle dysfunctions for walking speed and symmetry in children with hemiplegic cerebral palsy. DESIGN This was a prospective analysis that included 52 children with hemiplegic cerebral palsy, aged between 5 and 8 yrs, had mild spasticity, and were functioning at Gross Motor Function Classification System level I or II. The dorsiflexor and plantar flexor strength, dynamic spasticity (represented by gastrocnemius muscle lengthening velocity during stance phase), plantar flexors stiffness, ankle joint position sense, and walking performance (spatiotemporal parameter) were assessed. RESULTS The least absolute shrinkage and selection operator regression analyses showed that the dorsiflexor strength of the paretic limb was the major determining factor of walking speed (R2 = 0.38, P < 0.001). Dynamic spasticity of the plantar flexors explained a portion of the variance in walking speed (R2 = 0.15, P < 0.001) and the highest portion of the variance in spatial walking symmetry (R2 = 0.18, P = 0.002). In addition, the ankle joint position sense was the primary determinant of temporal walking symmetry (R2 = 0.10, P = 0.021). CONCLUSIONS In children with hemiplegic cerebral palsy, walking speed is mostly influenced by dorsiflexor muscle strength, temporal walking symmetry is associated with the joint position sense, whereas spatial walking symmetry is explicated by the dynamic spasticity of the plantar flexor muscles.
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Affiliation(s)
- Ragab K Elnaggar
- From the Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia; and Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
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Uzun Akkaya K, Elbasan B. An investigation of the effect of the lower extremity sensation on gait in children with cerebral palsy. Gait Posture 2021; 85:25-30. [PMID: 33508563 DOI: 10.1016/j.gaitpost.2020.12.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/07/2020] [Accepted: 12/23/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Sensory disorders frequently accompany the motor disorders in children with cerebral palsy (CP). RESEARCH QUESTION Do children with CP have sensory disturbances in their lower extremities? If there are sensory impairments, do these impairments affect gait? METHODS In total, 45 children (18 females, 27 males) in an age range between 5 and 18 years were included in the study: 15 typically developing children, 15 unilaterally affected children with cerebral palsy, and 15 bilaterally affected children with cerebral palsy. They could walk independently at the levels of I or II according to the gross motor function classification. After the demographic data of the children were recorded, their tactile sense, vibration sense, two-point discrimination, and proprioception were evaluated, and the Edinburgh Visual Gait Score (EVGS) was used for gait assessment. RESULTS Failures were discovered in lower extremity tactile (p = 0.001), two-point discrimination (p = 0.001), and proprioceptive senses of the children with CP (p = 0.001), and the loss of tactile sense was found to be related to gait disorders (p = 0.02, r = 0.41). SIGNIFICANCE There were deficiencies in the lower extremity senses, and deficiencies in the tactile sense negatively affected gait. Performing sensory assessments, which are considered to be fundamental for gait training in the rehabilitation of children with CP, and providing support for the lacking parameters in the intervention programs may create positive effects on gait.
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Affiliation(s)
- Kamile Uzun Akkaya
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Yuksek Ihtisas University, Ankara, Turkey.
| | - Bulent Elbasan
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Gazi University, Ankara, Turkey.
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Vallinoja J, Jaatela J, Nurmi T, Piitulainen H. Gating Patterns to Proprioceptive Stimulation in Various Cortical Areas: An MEG Study in Children and Adults using Spatial ICA. Cereb Cortex 2021; 31:1523-1537. [PMID: 33140082 PMCID: PMC7869097 DOI: 10.1093/cercor/bhaa306] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 09/16/2020] [Accepted: 09/16/2020] [Indexed: 12/16/2022] Open
Abstract
Proprioceptive paired-stimulus paradigm was used for 30 children (10-17 years) and 21 adult (25-45 years) volunteers in magnetoencephalography (MEG). Their right index finger was moved twice with 500-ms interval every 4 ± 25 s (repeated 100 times) using a pneumatic-movement actuator. Spatial-independent component analysis (ICA) was applied to identify stimulus-related components from MEG cortical responses. Clustering was used to identify spatiotemporally consistent components across subjects. We found a consistent primary response in the primary somatosensory (SI) cortex with similar gating ratios of 0.72 and 0.69 for the children and adults, respectively. Secondary responses with similar transient gating behavior were centered bilaterally in proximity of the lateral sulcus. Delayed and prolonged responses with strong gating were found in the frontal and parietal cortices possibly corresponding to larger processing network of somatosensory afference. No significant correlation between age and gating ratio was found. We confirmed that cortical gating to proprioceptive stimuli is comparable to other somatosensory and auditory domains, and between children and adults. Gating occurred broadly beyond SI cortex. Spatial ICA revealed several consistent response patterns in various cortical regions which would have been challenging to detect with more commonly applied equivalent current dipole or distributed source estimates.
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Affiliation(s)
- Jaakko Vallinoja
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, 00076 Espoo, Finland
| | - Julia Jaatela
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, 00076 Espoo, Finland
| | - Timo Nurmi
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, 00076 Espoo, Finland
- Faculty of Sport and Health Sciences, University of Jyväskylä, FI-40014 Jyväskylä, Finland
| | - Harri Piitulainen
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, 00076 Espoo, Finland
- Faculty of Sport and Health Sciences, University of Jyväskylä, FI-40014 Jyväskylä, Finland
- Aalto NeuroImaging, MEG Core, Aalto University School of Science, 00076 Espoo, Finland
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Piitulainen H, Kulmala JP, Mäenpää H, Rantalainen T. The gait is less stable in children with cerebral palsy in normal and dual-task gait compared to typically developed peers. J Biomech 2021; 117:110244. [PMID: 33493716 DOI: 10.1016/j.jbiomech.2021.110244] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 12/21/2020] [Accepted: 01/03/2021] [Indexed: 11/30/2022]
Abstract
There is limited evidence about gait stability and its alteration by concurrent motor and cognitive tasks in children with cerebral palsy (CP). We examined gait stability and how it is altered by constrained cognitive or motor task in CP and their typically developed (TD) controls. Gait kinematics were recorded using inertial-measurement units (IMU) from 18 patients with hemiplegia (13.5 ± 2.4 years), 12 with diplegia (13.0 ± 2.1 years), and 31 TD controls (13.5 ± 2.2 years) during unconstrained gait, and motor (carrying a tray) and cognitive (word naming) task constrained gait at preferred speed (~400 steps/task). Step duration, its standard deviation and refined-compound-multiscale entropy (RCME) were computed independently for vertical and resultant horizontal accelerations. Gait complexity was higher for patients with CP than TD in all tasks and directions (p < 0.001-0.01), being pronounced in vertical direction, cognitive task and for diplegic patients (p < 0.05-0.001). The gait complexity increased more (i.e. higher dual-task cost) from the unconstrained to the constrained gait in CP compared to TD (p < 0.05). Step duration was similar in all groups (p > 0.586), but its variation was higher in CP than TD (p < 0.001-0.05), and during the constrained than unconstrained gait in all groups (p < 0.01-0.001). The gait in children with CP was more complex and the dual-task cost was higher primarily for children with diplegic CP than TD during cognitive task, indicating that attentional load hinders their gait more. This raises the hypothesis that more attention and cortical resources are needed to compensate for the impaired gait in children with CP.
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Affiliation(s)
- Harri Piitulainen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland; Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland; Motion Analysis Laboratory, Helsinki University Hospital and University of Helsinki, Children and Adolescents, Helsinki, Finland.
| | - Juha-Pekka Kulmala
- Motion Analysis Laboratory, Helsinki University Hospital and University of Helsinki, Children and Adolescents, Helsinki, Finland
| | - Helena Mäenpää
- Motion Analysis Laboratory, Helsinki University Hospital and University of Helsinki, Children and Adolescents, Helsinki, Finland
| | - Timo Rantalainen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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Lidbeck C, Bartonek Å. Motor function at increasing postural demands in children with bilateral cerebral palsy. Eur J Phys Rehabil Med 2021; 57:731-737. [PMID: 33393279 DOI: 10.23736/s1973-9087.20.06662-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Among children with cerebral palsy (CP) some choose to be mobile by crawling or walking on their knees despite some bipedal walking ability. This motor behaviour raises questions and we wanted to enhance understanding of the child's choice of mobility. AIM To explore gross motor abilities in positions with various postural demands focusing on floor mobility among children with CP. DESIGN A cross-sectional observational study was performed at the neuropediatric outpatient department at Karolinska University Hospital. POPULATION Thirty-six children with bilateral CP, median age 11.2 years, functioning at Gross Motor Function Classification System (GMFCS) level I-IV. METHODS Motor skills using the Gross Motor Function Measure (GMFM-88), and lower leg muscles strength in hip flexors, knee extensors, ankle dorsiflexors and plantarflexors with a hand-held dynamometer were assessed. A Kruskal-Wallis Test with post hoc Bonferroni corrections were used to compare GMFM percentage (%) scores and muscle strength between the GMFCS levels. RESULTS GMFM-88 (%) scores in Walking (E) and Standing (D) dimensions were significantly higher at GMFCS levels I and II, compared to levels III and IV. In Crawling & Kneeling (C) level I achieved higher score than levels III and IV, and in Sitting (B) than level IV. Muscle strength values in the plantarflexors were significantly higher at GMFCS level I compared to level II. CONCLUSIONS As expected the children at GMFCS III performed less than those at GMFCS II at high postural demands in GMFM dimensions including standing and walking. Identical GMFM-scores in dimension C confirm similar motor function in items including kneeling and knee walking. Since lower limb muscle strength was similar, the difference in postural behaviour between the groups at high level motor activities may be associated with sensorimotor disturbances along with the children's motor disorder. CLINICAL REHABILITATION IMPACT The GMFM-88, in particular dimension C, including kneeling and walking items can be used as an identification of preference of floor mobility in children with CP. Awareness and understanding of how postural positions affect movement is of importance for prognosis, and physiotherapy.
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Affiliation(s)
- Cecilia Lidbeck
- Neuropediatric Unit, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden -
| | - Åsa Bartonek
- Neuropediatric Unit, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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Zarkou A, Lee SCK, Prosser L, Hwang S, Franklin C, Jeka J. Foot and ankle somatosensory deficits in children with cerebral palsy: A pilot study. J Pediatr Rehabil Med 2021; 14:247-255. [PMID: 33896853 DOI: 10.3233/prm-190643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To investigate foot and ankle somatosensory function in children with cerebral palsy (CP). METHODS Ten children with spastic diplegia (age 15 ± 5 y; GMFCS I-III) and 11 typically developing (TD) peers (age 15 ± 10 y) participated in the study. Light touch pressure and two-point discrimination were assessed on the plantar side of the foot by using a monofilament kit and an aesthesiometer, respectively. The duration of vibration sensation at the first metatarsal head and medial malleolus was tested by a 128 Hz tuning fork. Joint position sense and kinesthesia in the ankle joint were also assessed. RESULTS Children with CP demonstrated significantly higher light touch pressure and two-point discrimination thresholds compared to their TD peers. Individuals with CP perceived the vibration stimulus for a longer period compared to the TD participants. Finally, the CP group demonstrated significant impairments in joint position sense but not in kinesthesia of the ankle joints. CONCLUSIONS These findings suggest that children with CP have foot and ankle tactile and proprioceptive deficits. Assessment of lower extremity somatosensory function should be included in clinical practice as it can guide clinicians in designing more effective treatment protocols to improve functional performance in CP.
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Affiliation(s)
- Anastasia Zarkou
- Spinal Cord Injury Research Laboratory, Crawford Research Institute, Shepherd Center, Atlanta, GA, USA
| | - Samuel C K Lee
- Program in Biomechanics and Movement Science, University of Delaware, Newark, DE, USA.,Department of Physical Therapy, University of Delaware, Newark, DE, USA.,Research Department, Shriners Hospital for Children, Philadelphia, PA, USA
| | - Laura Prosser
- Division of Rehabilitation Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sungjae Hwang
- Department of Kinesiology, University of Maryland Eastern Shore, Princess Anne, MD, USA
| | - Corinna Franklin
- Research Department, Shriners Hospital for Children, Philadelphia, PA, USA
| | - John Jeka
- Department of Kinesiology, University of Delaware, Newark, DE, USA
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Beyaert C, Pierret J, Vasa R, Paysant J, Caudron S. Toe walking in children with cerebral palsy: a possible functional role for the plantar flexors. J Neurophysiol 2020; 124:1257-1269. [PMID: 32877265 DOI: 10.1152/jn.00717.2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Equinus and toe walking are common locomotor disorders in children with cerebral palsy (CP) walking barefoot or with normal shoes. We hypothesized that, regardless of the type of footwear, the plantar flexors do not cause early equinus upon initial foot contact but decelerate ankle dorsiflexion during weight acceptance (WA). This latter action promoted by early flat-foot contact is hypothesized to be functional. Hence, we performed an instrumented gait analysis of 12 children with CP (Gross Motor Function Classification System class: I or II; mean age: 7.2 yr) and 11 age-matched typically developing children. The participants walked either barefoot, with unmodified footwear (4° positive-heel shoes), or with 10° negative-heel shoes (NHSs). In both groups, wearing NHSs was associated with greater ankle dorsiflexion upon initial foot contact, and greater tibialis anterior activity (but no difference in soleus activity) during the swing phase. However, the footwear condition did not influence the direction and amplitude of the first ankle movement during WA and the associated peak negative ankle power. Regardless of the footwear condition, the CP group displayed 1) early flattening of the foot and ample dorsiflexion (decelerated by the plantar flexors) during WA and 2) low tibialis anterior and soleus activities during the second half of the swing phase (contributing to passive equinus upon foot strike). In children with CP, the early action of plantar flexors (which typically decelerate the forward progression of the center of mass) may be a compensatory mechanism that contributes to the WA's role in controlling balance during gait.NEW & NOTEWORTHY Adaptation to walking in negative-heel shoes was similar in typically developing children and children with cerebral palsy: it featured ankle dorsiflexion upon initial contact, even though (in the latter group) the soleus was always spastic in a clinical examination. Hence, in children with cerebral palsy, the early deceleration of ankle dorsiflexion by the plantar flexors (promoted by early flattening of the foot, and regardless of the type of footwear) may have a functional role.
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Affiliation(s)
- C Beyaert
- Université de Lorraine, EA3450 Développement, Adaptation et Handicap (DevAH), Nancy, France.,Institut Régional de Réadaptation, Union pour la gestion des établissements de caisses d'assurance maladie UGECAM du Nord et de l'Est, Nancy, France
| | - J Pierret
- Université de Lorraine, EA3450 Développement, Adaptation et Handicap (DevAH), Nancy, France
| | - R Vasa
- R. Vasa Foundation, Centre for Brain and Spinal Injury Rehab, Mumbai, India
| | - J Paysant
- Université de Lorraine, EA3450 Développement, Adaptation et Handicap (DevAH), Nancy, France.,Institut Régional de Réadaptation, Union pour la gestion des établissements de caisses d'assurance maladie UGECAM du Nord et de l'Est, Nancy, France
| | - S Caudron
- Université de Lorraine, EA3450 Développement, Adaptation et Handicap (DevAH), Nancy, France
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Kara OK, Yardımcı BN, Livanelioglu A, Soylu AR. Examination of touch-coordinate errors of adolescents with unilateral spastic cerebral palsy at an aiming-tapping task. J Back Musculoskelet Rehabil 2020; 33:81-89. [PMID: 31033458 DOI: 10.3233/bmr-181385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND/OBJECTIVE This study aimed to investigate performance (touch-coordinate errors, inter-touch interval) of touch screen technology in adolescents with unilateral spastic cerebral palsy (USCP) and healthy peers. MATERIALS AND METHODS This prospective case-control study included 31 adolescents. The participants consisted of 15 adolescents with CP in the USCP group and 16 age-matched healthy peers in the control group. All participants performed an aiming-tapping task with an Android tablet. Four sessions were randomly applied: visual feedback (VF) and no VF with the dominant hand's index finger (DHF), and VF and no VF with the non-dominant hand's index finger (NDHF). Inter-touch interval (ITI) and touch-coordinate errors (TCE) were calculated. RESULTS There were significant differences between the groups for VF and no VF-NDHF TCE and ITI (respectively p= 0.001, p= 0.01, p= 0.001, p= 0.004) and VF and no VF-DHF TCE values (respectively p= 0.01, p= 0.008). When comparing the dominant and non-dominant hand in the USCP group, there was a significant difference on TCE with no VF (p= 0.01). CONCLUSION This study provided insight into the touch screen performance of adolescents with USCP, who performed an aiming-tapping task with a tablet. Results showed that both affected and unaffected hand performance of touch screen tasks was impaired in adolescents with USCP.
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Affiliation(s)
- Ozgun Kaya Kara
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Bilge Nur Yardımcı
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Ayse Livanelioglu
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
| | - Abdullah Ruhi Soylu
- Department of Biophysics, Faculty of Medical Sciences, Hacettepe University, Turkey
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de Andrade E Souza Mazuchi F, Mochizuki L, Hamill J, Franciulli PM, Bigongiari A, de Almeida Martins IT, Ervilha UF. Joint-Position Sense Accuracy Is Equally Affected by Vision among Children with and without Cerebral Palsy. J Mot Behav 2020; 53:209-216. [PMID: 32340568 DOI: 10.1080/00222895.2020.1756732] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We compared the effect of visual information on the dominant upper limb position sense of children with diplegic cerebral palsy (n = 10) and normally developing children (n = 10). An isokinetic dynamometer passively moved the dominant forearm in 120° of elbow flexion/extension until the volunteers stopped the machine to indicate that the elbow joint was positioned in the predetermined target angle. Participants performed this task five times in sequence with and without visual feedback of the elbow angle. We calculated the absolute and the relative position errors related to the final elbow position and the target angle. In both groups, absolute error was significantly higher when vision was occluded. Relative error was not affected by cerebral palsy or visual feedback. When vision was occluded, accuracy on this task was similarly impaired in both groups and precision was not disturbed.
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Affiliation(s)
| | - Luis Mochizuki
- School of Arts Sciences and Humanities, University of Sao Paulo, Sao Paulo, Brazil
| | - Joseph Hamill
- Department of Kinesiology, University of Massachusetts, Amherst, Massachusetts, USA
| | | | - Aline Bigongiari
- Biomechanics Laboratory, Sao Judas Tadeu University, Sao Paulo, Brazil
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46
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Bartonek Å, Piccardi L, Guariglia C. Topographical Working Memory in Children with Cerebral Palsy. J Mot Behav 2020; 53:200-208. [PMID: 32281907 DOI: 10.1080/00222895.2020.1748861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Forty children with cerebral palsy (CP) and 120 typical developing children (TD) performed a topographic working memory (WalCT) test requiring to move their body in a walked vista-space and a visuo-spatial test (CBT) requiring just reaching movements. WalCT score was significantly higher in GMFCS II/III than in TD. CBT score was significantly lower in GMFCS I than in III/IV but lower than TD in all CP groups. Similar results in WalCT between GMFCS I and TD and GMFCS II and III/IV respectively indicate that mobility is associated with topographic working memory. Differently in CBT, the absence of bodily movement allows using different cognitive strategies. Children should be provided with opportunities and active participation to enhancing spatial awareness and navigational skills.
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Affiliation(s)
- Åsa Bartonek
- Neuropediatric Unit, Department of Women's and Children's Health, Karolinska Institutet, Stockholm Sweden
| | - Laura Piccardi
- Department of Psychology, Sapienza University of Rome, Italy and Cognitive and Motor Rehabilitation and Neuroimaging Unit, IRCCS Fondazione Santa Lucia, Rome Italy
| | - Cecilia Guariglia
- Department of Psychology, Sapienza University of Rome, Italy and Cognitive and Motor Rehabilitation and Neuroimaging Unit, IRCCS Fondazione Santa Lucia, Rome Italy
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47
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Zarkou A, Lee SCK, Prosser LA, Jeka JJ. Foot and Ankle Somatosensory Deficits Affect Balance and Motor Function in Children With Cerebral Palsy. Front Hum Neurosci 2020; 14:45. [PMID: 32161527 PMCID: PMC7054234 DOI: 10.3389/fnhum.2020.00045] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 01/31/2020] [Indexed: 01/03/2023] Open
Abstract
Sensory dysfunction is prevalent in cerebral palsy (CP). Evidence suggests that sensory deficits can contribute to manual ability impairments in children with CP, yet it is still unclear how they contribute to balance and motor performance. Therefore, the objective of this study was to investigate the relationship between lower extremity (LE) somatosensation and functional performance in children with CP. Ten participants with spastic diplegia (Gross Motor Function Classification Scale: I-III) and who were able to stand independently completed the study. Threshold of light touch pressure, two-point discriminatory ability of the plantar side of the foot, duration of cutaneous vibration sensation, and error in the joint position sense of the ankle were assessed to quantify somatosensory function. The balance was tested by the Balance Evaluation System Test (BESTest) and postural sway measures during a standing task. Motor performance was evaluated by using a battery of clinical assessments: (1) Gross Motor Function Measure (GMFM-66-IS) to test gross motor ability; (2) spatiotemporal gait characteristics (velocity, step length) to evaluate walking ability; (3) Timed Up and Go (TUG) and 6 Min Walk (6MWT) tests to assess functional mobility; and (4) an isokinetic dynamometer was used to test the Maximum Volitional Isometric Contraction (MVIC) of the plantar flexor muscles. The results showed that the light touch pressure measure was strongly associated only with the 6MWT. Vibration and two-point discrimination were strongly related to balance performance. Further, the vibration sensation of the first metatarsal head demonstrated a significantly strong relationship with motor performance as measured by GMFM-66-IS, spatiotemporal gait parameters, TUG, and ankle plantar flexors strength test. The joint position sense of the ankle was only related to one subdomain of the BESTest (Postural Responses). This study provides preliminary evidence that LE sensory deficits can possibly contribute to the pronounced balance and motor impairments in CP. The findings emphasize the importance of developing a thorough LE sensory test battery that can guide traditional treatment protocols toward a more holistic therapeutic approach by combining both motor and sensory rehabilitative strategies to improve motor function in CP.
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Affiliation(s)
- Anastasia Zarkou
- Spinal Cord Injury Research Laboratory, Crawford Research Institute, Shepherd Center, Atlanta, GA, United States
| | - Samuel C K Lee
- Department of Physical Therapy and Interdisciplinary Graduate Program in Biomechanics and Movement Science, University of Delaware, Newark, DE, United States.,Research Department, Shriners Hospital for Children, Philadelphia, PA, United States
| | - Laura A Prosser
- Department of Pediatrics, University of Pennsylvania & The Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - John J Jeka
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, United States
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48
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Wingert JR, Corle CE, Saccone DF, Lee J, Rote AE. Effects of a Community-Based Tai Chi Program on Balance, Functional Outcomes, and Sensorimotor Function in Older Adults. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2020. [DOI: 10.1080/02703181.2019.1709600] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Jason R. Wingert
- Department of Health and Wellness, One University Heights, University of North Carolina Asheville, Asheville, North Carolina, USA
| | - Caitlin E. Corle
- Department of Health and Wellness, One University Heights, University of North Carolina Asheville, Asheville, North Carolina, USA
| | - Diane F. Saccone
- Healthy Aging Initiatives, YMCA of Western North Carolina, Asheville, North Carolina, USA
| | - Jimin Lee
- Department of Mathematics, One University Heights, University of North Carolina Asheville, Asheville, North Carolina, USA
| | - Aubrianne E. Rote
- Department of Health and Wellness, One University Heights, University of North Carolina Asheville, Asheville, North Carolina, USA
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49
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Yamashita H, Nishigami T, Mibu A, Tanaka K, Manfuku M, Fukuhara H, Yoshino K, Seto Y, Wand BM. Perceived Body Distortion Rather Than Actual Body Distortion Is Associated With Chronic Low Back Pain in Adults With Cerebral Palsy: A Preliminary Investigation. Pain Pract 2019; 19:826-835. [DOI: 10.1111/papr.12815] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 06/20/2019] [Accepted: 06/24/2019] [Indexed: 12/17/2022]
Affiliation(s)
| | - Tomohiko Nishigami
- Department of Nursing and Physical Therapy Konan Women's University Kobe Japan
| | - Akira Mibu
- Department of Rehabilitation Tanabe Orthopaedics Osaka Japan
| | | | | | - Hikaru Fukuhara
- Day‐care and Rehabilitation Center for Disabled Children “Asashioen” Osaka Japan
| | - Koichi Yoshino
- Department of Orthopaedic Surgery SKY Orthopaedics Clinic Ibaraki Japan
| | - Yoichi Seto
- Department of Orthopaedic Surgery SKY Orthopaedics Clinic Ibaraki Japan
| | - Benedict M. Wand
- The School of Physiotherapy The University of Notre Dame Australia Fremantle Western Australia Australia
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50
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Kurz MJ, Wiesman AI, Coolidge NM, Wilson TW. Children with Cerebral Palsy Hyper-Gate Somatosensory Stimulations of the Foot. Cereb Cortex 2019; 28:2431-2438. [PMID: 28591842 DOI: 10.1093/cercor/bhx144] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Indexed: 12/15/2022] Open
Abstract
We currently have a substantial knowledge gap in our understanding of the neurophysiological underpinnings of the sensory perception deficits often reported in the clinic for children with cerebral palsy (CP). In this investigation, we have begun to address this knowledge gap by using magnetoencephalography (MEG) brain imaging to evaluate the sensory gating of neural oscillations in the somatosensory cortices. A cohort of children with CP (Gross Motor Function Classification System II-III) and typically developing children underwent paired-pulse electrical stimulation of the tibial nerve during MEG. Advanced beamforming methods were used to image significant oscillatory responses, and subsequently the time series of neural activity was extracted from peak voxels. Our experimental results showed that somatosensory cortical oscillations (10-75 Hz) were weaker in the children with CP for both stimulations. Despite this reduction, the children with CP actually exhibited a hyper-gating response to the second, redundant peripheral stimulation applied to the foot. These results have further established the nexus of the cortical somatosensory processing deficits that are likely responsible for the degraded sensory perceptions reported in the clinic for children with CP.
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Affiliation(s)
- Max J Kurz
- Department of Physical Therapy, Munroe Meyer Institute for Genetics and Rehabilitation, University of Nebraska Medical Center, Omaha, NE, USA.,Center for Magnetoencephalography, University of Nebraska Medical Center, Omaha, NE, USA
| | - Alex I Wiesman
- Center for Magnetoencephalography, University of Nebraska Medical Center, Omaha, NE, USA.,Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | - Nathan M Coolidge
- Center for Magnetoencephalography, University of Nebraska Medical Center, Omaha, NE, USA
| | - Tony W Wilson
- Center for Magnetoencephalography, University of Nebraska Medical Center, Omaha, NE, USA.,Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA
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