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Hinton EH, Busboom MT, Embury CM, Spooner RK, Wilson TW, Kurz MJ. Adults with cerebral palsy exhibit uncharacteristic cortical oscillations during an adaptive sensorimotor control task. Sci Rep 2024; 14:10788. [PMID: 38734783 PMCID: PMC11088662 DOI: 10.1038/s41598-024-61375-x] [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: 06/14/2023] [Accepted: 05/06/2024] [Indexed: 05/13/2024] Open
Abstract
Prior research has shown that the sensorimotor cortical oscillations are uncharacteristic in persons with cerebral palsy (CP); however, it is unknown if these altered cortical oscillations have an impact on adaptive sensorimotor control. This investigation evaluated the cortical dynamics when the motor action needs to be changed "on-the-fly". Adults with CP and neurotypical controls completed a sensorimotor task that required either proactive or reactive control while undergoing magnetoencephalography (MEG). When compared with the controls, the adults with CP had a weaker beta (18-24 Hz) event-related desynchronization (ERD), post-movement beta rebound (PMBR, 16-20 Hz) and theta (4-6 Hz) event-related synchronization (ERS) in the sensorimotor cortices. In agreement with normative work, the controls exhibited differences in the strength of the sensorimotor gamma (66-84 Hz) ERS during proactive compared to reactive trials, but similar condition-wise changes were not seen in adults with CP. Lastly, the adults with CP who had a stronger theta ERS tended to have better hand dexterity, as indicated by the Box and Blocks Test and Purdue Pegboard Test. These results may suggest that alterations in the theta and gamma cortical oscillations play a role in the altered hand dexterity and uncharacteristic adaptive sensorimotor control noted in adults with CP.
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Affiliation(s)
- Erica H Hinton
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE, USA
- Center for Pediatric Brain Health, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Morgan T Busboom
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE, USA
- Center for Pediatric Brain Health, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Christine M Embury
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE, USA
- Center for Pediatric Brain Health, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Rachel K Spooner
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE, USA
- Center for Pediatric Brain Health, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Tony W Wilson
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE, USA
- Center for Pediatric Brain Health, Boys Town National Research Hospital, Boys Town, NE, USA
- Department of Pharmacology and Neuroscience, Creighton University, Omaha, NE, USA
| | - Max J Kurz
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE, USA.
- Center for Pediatric Brain Health, Boys Town National Research Hospital, Boys Town, NE, USA.
- Department of Pharmacology and Neuroscience, Creighton University, Omaha, NE, USA.
- Institute for Human Neuroscience, Boys Town National Research Hospital, 14090 Mother Teresa Lane, Boys Town, NE, 68010, USA.
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Srinivasan S, Kumavor P, Morgan K. A Training Program Using Modified Joystick-Operated Ride-on Toys to Complement Conventional Upper Extremity Rehabilitation in Children with Cerebral Palsy: Results from a Pilot Study. Bioengineering (Basel) 2024; 11:304. [PMID: 38671726 PMCID: PMC11048159 DOI: 10.3390/bioengineering11040304] [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: 02/02/2024] [Revised: 02/22/2024] [Accepted: 03/21/2024] [Indexed: 04/28/2024] Open
Abstract
The pilot study assessed the utility of a training program using modified, commercially available dual-joystick-operated ride-on toys to promote unimanual and bimanual upper extremity (UE) function in children with cerebral palsy (CP). The ride-on-toy training was integrated within a 3-week, intensive, task-oriented training camp for children with CP. Eleven children with hemiplegia between 4 and 10 years received the ride-on-toy training program 20-30 min/day, 5 days/week for 3 weeks. Unimanual motor function was assessed using the Quality of Upper Extremity Skills Test (QUEST) before and after the camp. During ride-on-toy training sessions, children wore activity monitors on both wrists to assess the duration and intensity of bimanual UE activity. Video data from early and late sessions were coded for bimanual UE use, independent navigation, and movement bouts. Children improved their total and subscale QUEST scores from pretest to post-test while increasing moderate activity in their affected UE from early to late sessions, demonstrating more equal use of both UEs across sessions. There were no significant changes in the rates of movement bouts from early to late sessions. We can conclude that joystick-operated ride-on toys function as child-friendly, intrinsically rewarding tools that can complement conventional therapy and promote bimanual motor functions in children with CP.
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Affiliation(s)
- Sudha Srinivasan
- Physical Therapy Program, Department of Kinesiology, University of Connecticut, Storrs, CT 06269, USA
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT 06268, USA
- The Institute for the Brain and Cognitive Sciences (IBACS), University of Connecticut, Storrs, CT 06268, USA
| | - Patrick Kumavor
- Biomedical Engineering Department, University of Connecticut, Storrs, CT 06268, USA; (P.K.); (K.M.)
| | - Kristin Morgan
- Biomedical Engineering Department, University of Connecticut, Storrs, CT 06268, USA; (P.K.); (K.M.)
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Erkek S, Çekmece Ç. Investigation of the Relationship between Sensory-Processing Skills and Motor Functions in Children with Cerebral Palsy. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1723. [PMID: 38002814 PMCID: PMC10670370 DOI: 10.3390/children10111723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/12/2023] [Accepted: 10/21/2023] [Indexed: 11/26/2023]
Abstract
The main purpose of this study is to examine the relationship between sensory-processing skills and gross motor functions, bimanual motor functions, and balance in children with cerebral palsy (CP). A total of 47 patients between the ages of 3 and 10, diagnosed with CP, who received or applied for treatment in our physical therapy and rehabilitation unit were included in the study. Sensory profiling (SP), assisting hand assessment (AHA), the Gross Motor Function Measure-66 (GMFM-66), and the Pediatric Berg Balance Scale (PBBS) were used in the evaluation of the children with CP who participated in the study. The Gross Motor Function Classification System (GMFCS) was used to classify the children based on functional abilities and limitations, and the Manual Ability Classification System (MACS) was used to classify the children based on manual dexterity. The SP parameters were compared with AHA, GMFM-66, and PBBS results, and with GMFCS and MACS levels. Statistically significant relationships were found between AHA and SP, PBBS, and SP and between GMFM-66 and SP (p < 0.05). Our study shows that there are some disorders in sensory processing in children with CP. We think that sensory evaluations should be included in the CP rehabilitation program.
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Affiliation(s)
- Serhat Erkek
- Department of Occupational Therapy, Yalova State Hospital, Baglarbası, Yalova 77100, Turkey;
| | - Çiğdem Çekmece
- Section of Occupational Therapy, Department of Therapy and Rehabilitation, Vocational School of Kocaeli Health Services, Kocaeli University, Umuttepe Campus, Izmit 41380, Turkey
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Jovellar-Isiegas P, Cuesta García C, Jaén-Carrillo D, Palomo-Carrión R, Peña Alonso C, Roche-Seruendo LE. Somatosensation and motor performance in the less-affected and more-affected hand of unilateral cerebral palsy children: a cross-sectional study. Disabil Rehabil 2023; 45:3500-3510. [PMID: 36172643 DOI: 10.1080/09638288.2022.2127938] [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: 12/28/2021] [Accepted: 09/18/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE This study aimed to examine motor performance and somatosensory processing of unilateral cerebral palsy (UCP) children in both the less-affected hand and the more-affected hand. This study is also aimed at analysing the somatosensory proccessing in the more-affected hand in relation to age and damaged hemisphere. MATERIALS AND METHODS Forty-seven children aged from 6 to 15 years (UCP = 23; TD = 24) were recruited. Grip strength, pinch strength, Box and Block Test and Jebsen Taylor Hand Function Test were used to analyse motor performance. A comprehensive somatosensory assessment battery was included: tactile registration, unilateral, bilateral and spatio-temporal perception, haptic recognition, texture perception, proprioception, pressure pain threshold and functional sensitivity. RESULTS UCP children exhibited lower performance in all aspects of motor performance measured in both the less-affected hand and the more-affected hand, except grip strength in the less-affected hand. Significant differences were found for all tests included in the somatosensory assessment in both the less-affected hand and the more-affected hand, except unilateral perception tests in the less-affected hand. CONCLUSIONS UCP children present difficulties in motor performance and somatosensory processing not only in the more-affected hand, but also in the less-affected hand. Somatosensation may be a critical driver of functional performance.Implications for rehabilitationThe less-affected hand of children with unilateral cerebral palsy should be included in both assessment and intervention programmes.Somatosensory processing should be assessed through a comprehensive battery, both in the less-affected hand and in the more-affected hand of unilateral cerebral palsy children.Somatosensory treatment must be taken into account if functional performance in the activities of daily living of unilateral cerebral palsy children is to be improved.
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Affiliation(s)
| | - César Cuesta García
- Department of Occupational Therapy, Centre for Advanced University Studies La Salle, Autonomous University of Madrid, Madrid, Spain
| | | | - Rocío Palomo-Carrión
- Faculty of Physiotherapy and Nursing, University of Castilla La Mancha, Toledo, Spain
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Saussez G, Bailly R, Araneda R, Paradis J, Ebner-Karestinos D, Klöcker A, Sogbossi ES, Riquelme I, Brochard S, Bleyenheuft Y. Efficacy of integrating a semi-immersive virtual device in the HABIT-ILE intervention for children with unilateral cerebral palsy: a non-inferiority randomized controlled trial. J Neuroeng Rehabil 2023; 20:98. [PMID: 37516873 PMCID: PMC10385889 DOI: 10.1186/s12984-023-01218-4] [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: 08/25/2022] [Accepted: 07/13/2023] [Indexed: 07/31/2023] Open
Abstract
BACKGROUND The implementation of virtual devices can facilitate the role of therapists (e.g., patient motivation, intensity of practice) to improve the effectiveness of treatment for children with cerebral palsy. Among existing therapeutic devices, none has been specifically designed to promote the application of principles underlying evidence-based motor skill learning interventions. Consequently, evidence is lacking regarding the effectiveness of virtual-based sessions in motor function rehabilitation with respect to promoting the transfer of motor improvements into daily life activities. We tested the effectiveness of implementing a recently developed virtual device (REAtouch®), specifically designed to enable the application of therapeutic motor skill learning principles, during a Hand Arm Bimanual Intensive Therapy Including Lower Extremities (HABIT-ILE) intervention. METHODS Forty children with unilateral cerebral palsy (5-18 years; MACS I-III; GMFCS I-II) were randomly assigned to a control group or a "REAtouch®" experimental group for a 90-h HABIT-ILE day-camp intervention (two weeks). Children in the REAtouch® group spent nearly half of their one-on-one therapeutic time using the REAtouch®. Participants underwent three testing sessions: the week before (T1), after intervention (T2), and at three months follow-up (T3). The primary outcome was the Assisting Hand Assessment (T3-T1; blinded). Secondary outcomes measured uni-bimanual hand function, stereognosis, gait endurance, daily life abilities, and functional goals. Accelerometers and a manual report of daily activities served to document therapeutic dosage and treatment characteristics. We used one-way RMANOVA to compare the efficacies of the two interventions, and non-inferiority analyses to contrast changes in the "REAtouch®" group versus the "HABIT-ILE" control group. RESULTS We found significant improvements in both groups for most of the outcome measures (p < 0.05). There was significant non-inferiority of changes in the REAtouch® group for upper extremities motor function, functional goals attainment, and abilities in daily life activities (p < 0.05). CONCLUSIONS Use of the REAtouch® device during HABIT-ILE showed non-inferior efficacy compared to the conventional evidence-based HABIT-ILE intervention in children with unilateral cerebral palsy. This study demonstrates the feasibility of using this virtual device in a high dosage camp model, and establishes the possibility of applying the therapeutic principles of motor skill learning during specifically designed virtual-based sessions. TRIAL REGISTRATION Trial registration number: NCT03930836-Registration date on the International Clinical Trials Registry Platform (ICTRP): June 21th, 2018; Registration date on NIH Clinical Trials Registry: April 29th, 2019. First patient enrollment: July 3rd, 2018.
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Affiliation(s)
- G Saussez
- UCLouvain, Institute of Neuroscience, COSY Pole, MSL-IN Lab, Brussels, Belgium.
- Motor Sciences department, FfH Lab, CeREF Santé, HELHa, Rue Trieu Kaisin, 136, 6061, Montignies-Sur-Sambre, Belgium.
| | - R Bailly
- Fondation Ildys, Brest, France
- Laboratoire de Traitement de l'information Médicale (LaTIM), Inserm U1101, Université Bretagne Occidentale, Brest, France
| | - R Araneda
- UCLouvain, Institute of Neuroscience, COSY Pole, MSL-IN Lab, Brussels, Belgium
- Exercise and Rehabilitation Science Institute, School of Physical Therapy, Faculty of Rehabilitation Science, Universidad Andres Bello, Santiago, Chile
| | - J Paradis
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Pisa, Italy
| | - D Ebner-Karestinos
- UCLouvain, Institute of Neuroscience, COSY Pole, MSL-IN Lab, Brussels, Belgium
- Exercise and Rehabilitation Science Institute, School of Physical Therapy, Faculty of Rehabilitation Science, Universidad Andres Bello, Santiago, Chile
| | - A Klöcker
- Haute Ecole Leonard de Vinci, Parnasse-ISEI, Brussels, Belgium
| | - E S Sogbossi
- UCLouvain, Institute of Neuroscience, COSY Pole, MSL-IN Lab, Brussels, Belgium
- School of Physical Therapy, Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin
| | - I Riquelme
- Research Institute of Health Sciences (IUNICS-IdISBa), University of the Balearic Islands, Palma, Spain
- Department of Nursing and Physiotherapy, University of the Balearic Islands, Palma, Spain
| | - S Brochard
- Fondation Ildys, Brest, France
- Laboratoire de Traitement de l'information Médicale (LaTIM), Inserm U1101, Université Bretagne Occidentale, Brest, France
| | - Y Bleyenheuft
- UCLouvain, Institute of Neuroscience, COSY Pole, MSL-IN Lab, Brussels, Belgium
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Gutterman J, Gordon AM. Neural Correlates of Impaired Grasp Function in Children with Unilateral Spastic Cerebral Palsy. Brain Sci 2023; 13:1102. [PMID: 37509032 PMCID: PMC10377617 DOI: 10.3390/brainsci13071102] [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: 06/29/2023] [Revised: 07/13/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023] Open
Abstract
Unilateral spastic cerebral palsy (USCP) is caused by damage to the developing brain and affects motor function, mainly lateralized to one side of the body. Children with USCP have difficulties grasping objects, which can affect their ability to perform daily activities. Although cerebral palsy is typically classified according to motor function, sensory abnormalities are often present as well and may contribute to motor impairments, including grasping. In this review, we show that the integrity and connectivity pattern of the corticospinal tract (CST) is related to execution and anticipatory control of grasping. However, as this may not explain all the variance of impairments in grasping function, we also describe the potential roles of sensory and sensorimotor integration deficits that contribute to grasp impairments. We highlight studies measuring fingertip forces during object manipulation tasks, as this approach allows for the dissection of the close association of sensory and motor function and can detect the discriminant use of sensory information during a complex, functional task (i.e., grasping). In addition, we discuss the importance of examining the interactions of the sensory and motor systems together, rather than in isolation. Finally, we suggest future directions for research to understand the underlying mechanisms of grasp impairments.
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Affiliation(s)
- Jennifer Gutterman
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY 10027, USA
| | - Andrew M Gordon
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY 10027, USA
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Liang KJ, Chen HL, Huang KL, Wang TM, Shieh JY, Wang TN. Assessment for Tactile Perception in Children With Cerebral Palsy. Am J Occup Ther 2023; 77:7704205050. [PMID: 37624995 DOI: 10.5014/ajot.2023.050106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2023] Open
Abstract
IMPORTANCE Impaired tactile perception frequently accompanies motor deficits in children with cerebral palsy (CP). Assessing tactile perception precisely for children with CP remains challenging because of a lack of assessments with robust psychometric evidence or standard procedures. OBJECTIVE To develop a standardized assessment tool, the Tactile Perceptual Test (TPT), for measuring tactile perception in children with CP and to examine its psychometric properties. DESIGN Observational study design. SETTING University research laboratory and medical center. PARTICIPANTS Children with CP (n = 100) and typical development (TD; n = 50). OUTCOMES AND MEASURES The TPT includes four subtests measuring stereognosis, roughness, hardness, and heaviness. Three comparator instruments, Semmes-Weinstein monofilaments, Two-Point Discrimination, and the stereognosis subtest of the Revised Nottingham Sensory Assessment, were used for convergent validity. RESULTS Good test-retest reliability was confirmed for all of the TPT subtests. The values of minimal detectable change were acceptable. Moderate correlations between the TPT and comparator instruments were found, as expected. For known-groups validity, the significant difference was confirmed between children with CP and those with TD. CONCLUSIONS AND RELEVANCE The TPT is a reliable and valid measure for multiple subdomains of tactile perception in children with CP. This tactile assessment may help clarify tactile performance to provide appropriate, precise interventions. What This Article Adds: The TPT measures tactile perception in children with CP. It has four subdomains of tactile perception that could facilitate prioritization of tactile treatment of specific subdomains and thereby aid in the provision of appropriate interventions.
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Affiliation(s)
- Kai-Jie Liang
- Kai-Jie Liang, PhD, is Postdoctoral Researcher, Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, Chang Gung University, Taoyuan, Taiwan. At the time this article was submitted, Liang was PhD Student, School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei City, Taiwan
| | - Hao-Ling Chen
- Hao-Ling Chen, PhD, is Associate Professor, School of Occupational Therapy, College of Medicine, National Taiwan University, and Occupational Therapist, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei City, Taiwan
| | - Kuo-Lun Huang
- Kuo-Lun Huang, MS, is Occupational Therapist, School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei City, Taiwan
| | - Ting-Ming Wang
- Ting-Ming Wang, MD, PhD, is Professor, Department of Orthopaedic Surgery, School of Medicine, National Taiwan University, Taipei City, Taiwan, and Physician, Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei City, Taiwan
| | - Jeng-Yi Shieh
- Jeng-Yi Shieh, MD, is Physician, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei City, Taiwan
| | - Tien-Ni Wang
- Tien-Ni Wang, PhD, is Professor, National Taiwan University, and Occupational Therapist, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei City, Taiwan;
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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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Lynn J, Wolf A, Bridges T, Pottanat Z, Spivey S, Rolin O. Effects of stochastic resonance stimulation on manual function in children with hemiplegic cerebral palsy: A pilot clinical trial. PM R 2023; 15:302-313. [PMID: 35187840 DOI: 10.1002/pmrj.12788] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 12/23/2021] [Accepted: 01/14/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To investigate the effect of stochastic resonance stimulation (SRS) on manual abilities in children with hemiplegic cerebral palsy. DESIGN This pilot study is a randomized, sham-controlled, one-period, crossover trial. SETTING A neuroscience clinic with specialty therapy programs at an urban, university-based children's hospital. PARTICIPANTS Sixteen children ages 3 to 16 years who were diagnosed with hemiplegic cerebral palsy and had hand Manual Abilities Classification scale score of I to III with sufficient cognitive abilities to follow instructions. INTERVENTIONS Children donned wrist and arm bands that delivered SRS via embedded piezoelectric actuators in two randomly assigned conditions: sham (devices powered off) and subthreshold stimulation (SBT-SRS). Following the randomized protocol, a subset of participants also completed an open-label, above-threshold stimulation (AT-SRS) condition. Children carried out the same uni-manual and bimanual tasks during the randomized and open-label protocols; all data were collected in a single session. MAIN OUTCOME MEASURE(S) Box and Blocks (B&B) test, a uni-manual function test, and the Shriners Hospital Upper Extremity Evaluation (SHUEE). The SHUEE was video recorded and scored by two raters who were blinded to the experimental condition. RESULTS Thirteen children completed the B&B task and 14 children completed the SHUEE. Children in the SBT-SRS condition relative to sham condition moved an average of 1.8 more blocks in 1 minute (p = .08); scored an average of 3 points higher on SHUEE spontaneous functional analysis (p < .002); and scored an average of 2.7 points higher on SHUEE dynamic positional analysis (p = .20). In the open-label protocol, children in the AT-SRS condition relative to sham moved 3.9 more blocks than in the sham condition (n = 8, p < .001); scored an average of 4.5 points higher on SHUEE spontaneous functional analysis (n = 6, p = .08); and scored an average of 10.5 points higher on SHUEE dynamic positional analysis (n = 6, p = .01). CONCLUSION(S) In this pilot study, we found preliminary evidence that children with hemiplegic cerebral palsy demonstrated improved uni-manual abilities and increased function of the impaired hand on bimanual tasks when receiving a single session of SBT-SRS. Preliminary evidence also suggests that some children with hemiplegic cerebral palsy may improve more when receiving a single session of AT-SRS. Future research using larger, controlled studies should evaluate the optimal intensity, duration, and long-term effect of SRS for improving impaired manual abilities.
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Affiliation(s)
- Jessica Lynn
- Occupational Therapist: Children's Hospital of Richmond at VCU, Richmond, Virginia, USA
| | - Allison Wolf
- Occupational Therapist: Children's Hospital of Richmond at VCU, Richmond, Virginia, USA
| | - Travis Bridges
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University Health Systems, Richmond, Virginia, USA
| | - Zachary Pottanat
- Department of Pediatrics, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Suzanne Spivey
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University Health Systems, Richmond, Virginia, USA
| | - Olivier Rolin
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University Health Systems, Children's Hospital of Richmond, Richmond, Virginia, USA
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Steinbusch CVM, Defesche A, van der Leij B, Rameckers EAA, Knijnenburg ACS, Vermeulen JRJ, Janssen-Potten YJM. The Effect of Bimanual Intensive Functional Training on Somatosensory Hand Function in Children with Unilateral Spastic Cerebral Palsy: An Observational Study. J Clin Med 2023; 12:jcm12041595. [PMID: 36836129 PMCID: PMC9960591 DOI: 10.3390/jcm12041595] [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: 01/12/2023] [Revised: 02/10/2023] [Accepted: 02/15/2023] [Indexed: 02/19/2023] Open
Abstract
(1) Background: Next to motor impairments, children with unilateral spastic cerebral palsy (CP) often experience sensory impairments. Intensive bimanual training is well known for improving motor abilities, though its effect on sensory impairments is less known. (2) Objective: To investigate whether bimanual intensive functional therapy without using enriched sensory materials improves somatosensory hand function. (3) Methods: A total of twenty-four participants with CP (12-17 years of age) received 80-90 h of intensive functional training aimed at improving bimanual performance in daily life. Somatosensory hand function was measured before training, directly after training, and at six months follow-up. Outcome measures were: proprioception, measured by thumb and wrist position tasks and thumb localization tasks; vibration sensation; tactile perception; and stereognosis. (4) Results: Next to improving on their individual treatment goals, after training, participants also showed significant improvements in the perception of thumb and wrist position, vibration sensation, tactile perception, and stereognosis of the more affected hand. Improvements were retained at six months follow-up. Conversely, proprioception measured by the thumb localization tasks did not improve after training. (5) Conclusions: Intensive functional bimanual training without environmental tactile enrichment may improve the somatosensory function of the more affected hand in children with unilateral spastic CP.
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Affiliation(s)
- Catherine V. M. Steinbusch
- Adelante Rehabilitation Centre, 6301 KA Valkenburg, The Netherlands
- Research School CAPHRI, Department of Rehabilitation Medicine, Maastricht University, 6229 ER Maastricht, The Netherlands
- Correspondence:
| | - Anke Defesche
- Adelante Rehabilitation Centre, 6301 KA Valkenburg, The Netherlands
| | | | - Eugene A. A. Rameckers
- Research School CAPHRI, Department of Rehabilitation Medicine, Maastricht University, 6229 ER Maastricht, The Netherlands
- Adelante Centre of Expertise in Rehabilitation and Audiology, 6432 CC Hoensbroek, The Netherlands
- Paediatric Rehabilitation, Biomed, Faculty of Medicine & Health Science, Hasselt University, 3500 Hasselt, Belgium
| | - Annemarie C. S. Knijnenburg
- Department of Neurology, Maastricht University Medical Centre+, 6229 ER Maastricht, The Netherlands
- Research School Mental Health and NeuroScience, Maastricht University Medical Centre+, 6229 ER Maastricht, The Netherlands
| | - Jeroen R. J. Vermeulen
- Department of Neurology, Maastricht University Medical Centre+, 6229 ER Maastricht, The Netherlands
- Research School Mental Health and NeuroScience, Maastricht University Medical Centre+, 6229 ER Maastricht, The Netherlands
| | - Yvonne J. M. Janssen-Potten
- Research School CAPHRI, Department of Rehabilitation Medicine, Maastricht University, 6229 ER Maastricht, The Netherlands
- Adelante Centre of Expertise in Rehabilitation and Audiology, 6432 CC Hoensbroek, The Netherlands
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11
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Reedich EJ, Genry LT, Singer MA, Cavarsan CF, Mena Avila E, Boudreau DM, Brennan MC, Garrett AM, Dowaliby L, Detloff MR, Quinlan KA. Enhanced nociceptive behavior and expansion of associated primary afferents in a rabbit model of cerebral palsy. J Neurosci Res 2022; 100:1951-1966. [PMID: 35839339 PMCID: PMC9388620 DOI: 10.1002/jnr.25108] [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: 01/03/2022] [Revised: 07/01/2022] [Accepted: 07/03/2022] [Indexed: 11/07/2022]
Abstract
Spastic cerebral palsy (CP) is a movement disorder marked by hypertonia and hyperreflexia; the most prevalent comorbidity is pain. Since spinal nociceptive afferents contribute to both the sensation of painful stimuli as well as reflex circuits involved in movement, we investigated the relationship between prenatal hypoxia-ischemia (HI) injury which can cause CP, and possible changes in spinal nociceptive circuitry. To do this, we examined nociceptive afferents and mechanical and thermal sensitivity of New Zealand White rabbit kits after prenatal HI or a sham surgical procedure. As described previously, a range of motor deficits similar to spastic CP was observed in kits born naturally after HI (40 min at ~70%-80% gestation). We found that HI caused an expansion of peptidergic afferents (marked by expression of calcitonin gene-related peptide) in both the superficial and deep dorsal horn at postnatal day (P)5. Non-peptidergic nociceptive afferent arborization (labeled by isolectin B4) was unaltered in HI kits, but overlap of the two populations (peptidergic and non-peptidergic nociceptors) was increased by HI. Density of glial fibrillary acidic protein was unchanged within spinal cord white matter regions important in nociceptive transmission at P5. We found that mechanical and thermal nociception was enhanced in HI kits even in the absence of motor deficits. These findings suggest that prenatal HI injury impacts spinal sensory pathways in addition to the more well-established disruptions to descending motor circuits. In conclusion, changes to spinal nociceptive circuitry could disrupt spinal reflexes and contribute to pain experienced by individuals with CP.
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Affiliation(s)
- Emily J Reedich
- George and Anne Ryan Institute for Neuroscience, University of Rhode Island, Kingston, Rhode Island, USA
- Department of Biomedical and Pharmaceutical Sciences, College of Pharmacy, University of Rhode Island, Kingston, Rhode Island, USA
| | - Landon T Genry
- George and Anne Ryan Institute for Neuroscience, University of Rhode Island, Kingston, Rhode Island, USA
- Department of Biomedical and Pharmaceutical Sciences, College of Pharmacy, University of Rhode Island, Kingston, Rhode Island, USA
- Interdisciplinary Neuroscience Program, University of Rhode Island, Kingston, Rhode Island, USA
| | - Meredith A Singer
- Department of Neurobiology and Anatomy, Marion Murray Spinal Cord Research Center, College of Medicine, Drexel University, Philadelphia, Pennsylvania, USA
| | - Clarissa Fantin Cavarsan
- George and Anne Ryan Institute for Neuroscience, University of Rhode Island, Kingston, Rhode Island, USA
- Department of Biomedical and Pharmaceutical Sciences, College of Pharmacy, University of Rhode Island, Kingston, Rhode Island, USA
| | - Elvia Mena Avila
- George and Anne Ryan Institute for Neuroscience, University of Rhode Island, Kingston, Rhode Island, USA
- Department of Biomedical and Pharmaceutical Sciences, College of Pharmacy, University of Rhode Island, Kingston, Rhode Island, USA
| | - Daphne M Boudreau
- George and Anne Ryan Institute for Neuroscience, University of Rhode Island, Kingston, Rhode Island, USA
- Department of Biomedical and Pharmaceutical Sciences, College of Pharmacy, University of Rhode Island, Kingston, Rhode Island, USA
| | - Michael C Brennan
- George and Anne Ryan Institute for Neuroscience, University of Rhode Island, Kingston, Rhode Island, USA
- Department of Biomedical and Pharmaceutical Sciences, College of Pharmacy, University of Rhode Island, Kingston, Rhode Island, USA
| | - Alyssa M Garrett
- George and Anne Ryan Institute for Neuroscience, University of Rhode Island, Kingston, Rhode Island, USA
- Department of Biomedical and Pharmaceutical Sciences, College of Pharmacy, University of Rhode Island, Kingston, Rhode Island, USA
- Rhode Island Institutional Development Award (IDeA) Network for Biomedical Research Excellence (INBRE) Summer Undergraduate Research Fellowship (SURF) Program, University of Rhode Island, Kingston, Rhode Island, USA
| | - Lisa Dowaliby
- George and Anne Ryan Institute for Neuroscience, University of Rhode Island, Kingston, Rhode Island, USA
- Department of Biomedical and Pharmaceutical Sciences, College of Pharmacy, University of Rhode Island, Kingston, Rhode Island, USA
| | - Megan R Detloff
- Department of Neurobiology and Anatomy, Marion Murray Spinal Cord Research Center, College of Medicine, Drexel University, Philadelphia, Pennsylvania, USA
| | - Katharina A Quinlan
- George and Anne Ryan Institute for Neuroscience, University of Rhode Island, Kingston, Rhode Island, USA
- Department of Biomedical and Pharmaceutical Sciences, College of Pharmacy, University of Rhode Island, Kingston, Rhode Island, USA
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12
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Trevarrow M, Sanmann JN, Wilson TW, Kurz MJ. A Val 66Met polymorphism is associated with weaker somatosensory cortical activity in individuals with cerebral palsy. Heliyon 2022; 8:e10545. [PMID: 36119851 PMCID: PMC9474307 DOI: 10.1016/j.heliyon.2022.e10545] [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: 09/09/2021] [Revised: 06/21/2022] [Accepted: 08/31/2022] [Indexed: 11/27/2022] Open
Abstract
Background The brain-derived neurotrophic factor (BDNF) protein plays a prominent role in the capacity for neuroplastic change. However, a single nucleotide polymorphism at codon 66 of the BDNF gene results in significant reductions in neuroplastic change. Potentially, this polymorphism also contributes to the weaker somatosensory cortical activity that has been extensively reported in the neuroimaging literature on cerebral palsy (CP). Aims The primary objective of this study was to use magnetoencephalography (MEG) to probe if BDNF genotype affects the strength of the somatosensory-evoked cortical activity seen within individuals with CP. Methods and procedures and Procedures: Twenty individuals with CP and eighteen neurotypical controls participated. Standardized low resolution brain electromagnetic tomography (sLORETA) was used to image the somatosensory cortical activity evoked by stimulation of the tibial nerve. BDNF genotypes were determined from saliva samples. Outcomes and results The somatosensory cortical activity was weaker in individuals with CP compared to healthy controls (P = 0.04). The individuals with a Val66Met or Met66Met BDNF polymorphism also showed a reduced response compared to the individuals without the polymorphism (P = 0.03), had higher GMFCS levels (P = 0.04), and decreased walking velocity (P = 0.05). Conclusions and implications These results convey that BDNF genotype influences the strength of the somatosensory activity and mobility in individuals with CP. What this paper adds Previous literature has extensively documented altered sensorimotor cortical activity in individuals with CP, which ultimately contributes to the clinical deficits in sensorimotor processing documented in this population. While some individuals with CP see vast improvements in their sensorimotor functioning following therapeutic intervention, others are clear non-responders. The underlying basis for this discrepancy is not well understood. Our study is the first to identify that a polymorphism at the gene that codes for brain derived neurotrophic factor (BDNF), a protein well-known to be involved in the capacity for neuroplastic change, may influence the altered sensorimotor cortical activity within this population. Potentially, individuals with CP that have a polymorphism at the BDNF gene may reflect those that have difficulties in achieving beneficial outcomes following intervention. Thus, these individuals may require different therapeutic approaches in order to stimulate neuroplastic change and get similar benefits from therapy as their neurotypical peers.
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Affiliation(s)
- Michael Trevarrow
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE, USA
| | - Jennifer N Sanmann
- Department of Genetic Medicine, Munroe-Meyer Institute, University of Nebraska Medical Center, Omaha, NE, USA
| | - Tony W Wilson
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE, USA.,Department of Pharmacology and Neuroscience, College of Medicine, Creighton University, Omaha, NE, USA
| | - Max J Kurz
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE, USA.,Department of Pharmacology and Neuroscience, College of Medicine, Creighton University, Omaha, NE, USA
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13
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Hand Ownership Is Altered in Teenagers with Unilateral Cerebral Palsy. J Clin Med 2022; 11:jcm11164869. [PMID: 36013105 PMCID: PMC9409779 DOI: 10.3390/jcm11164869] [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: 07/21/2022] [Revised: 08/17/2022] [Accepted: 08/18/2022] [Indexed: 12/04/2022] Open
Abstract
We explored hand ownership in teenagers with unilateral cerebral palsy (UCP) compared with typically developing teenagers. Eighteen participants with UCP and 16 control teenagers participated. We used the rubber hand illusion to test hand ownership (HO). Both affected/non-affected hands (UCP) and dominant/non-dominant hands (controls) were tested during synchronous and asynchronous strokes. HO was assessed by measuring the proprioceptive drift toward the fake hand (as a percentage of arm length) and conducting a questionnaire on subjective HO. Both groups had significantly higher proprioceptive drift in the synchronous stroking condition for both hands. Teenagers with UCP showed a significantly higher proprioceptive drift when comparing their paretic hand (median 3.4% arm length) with the non-dominant hand of the controls (median 1.7% arm length). The questionnaires showed that synchronous versus asynchronous stroking generated a robust change in subjective HO in the control teenagers, but not in the teenagers with UCP. Teenagers with UCP have an altered sense of HO and a distorted subjective experience of HO that may arise from the early dysfunction of complex sensory–motor integration related to their brain lesions. HO may influence motor impairment and prove to be a target for early intervention.
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14
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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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15
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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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16
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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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17
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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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18
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Santana CAS, Dos Santos MM, de Campos AC. Interrelationships of Touch and Proprioception with Motor Impairments in Individuals with Cerebral Palsy: A Systematic Review. Percept Mot Skills 2022; 129:570-590. [PMID: 35452588 DOI: 10.1177/00315125221093904] [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: 11/15/2022]
Abstract
Considering that somatosensory impairments may impact motor performance in individuals with cerebral palsy (CP), a better understanding of these relations is relevant to planning interventions. To synthesize research evidence to date on the interrelationships between the somatosensory functions of touch and proprioception with motor functions in persons with CP, we systematically searched Embase, CINAHL, PsycINFO, and Medline databases for studies relating these variables that were published in English from the inception of these databases to November 2020. We targeted the following content categories in our literature search: (a) cerebral palsy; (b) sensory functions; (c) tactile functions; (d) proprioception functions; and (e) motor functions. The selection, data extraction, and methodological quality assessment of these studies were performed in duplicate. We retrieved and analyzed information regarding the studies' methodological approaches and synthesized results. The 11 studies that met our inclusion criteria showed that, in individuals with CP, impairments in tactile discrimination, proprioception, and stereognosis are related to motor functions in terms of overall manual ability, grip strength, postural control and locomotion. Thus, clinical practitioners should attend to somatosensory aspects of motor impairment in individuals with CP. More research is needed to clarify the direction of these associations.
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Affiliation(s)
- Camila A S Santana
- Department of Physical Therapy, 67828Federal University of São Carlos, Brazil
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19
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Trevarrow MP, Reelfs A, Ott LR, Penhale SH, Lew BJ, Goeller J, Wilson TW, Kurz MJ. Altered spontaneous cortical activity predicts pain perception in individuals with cerebral palsy. Brain Commun 2022; 4:fcac087. [PMID: 35441137 PMCID: PMC9014448 DOI: 10.1093/braincomms/fcac087] [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: 10/13/2021] [Revised: 01/13/2022] [Accepted: 03/31/2022] [Indexed: 12/04/2022] Open
Abstract
Cerebral palsy is the most common paediatric neurological disorder and results in extensive impairment to the sensorimotor system. However, these individuals also experience increased pain perception, resulting in decreased quality of life. In the present study, we utilized magnetoencephalographic brain imaging to examine whether alterations in spontaneous neural activity predict the level of pain experienced in a cohort of 38 individuals with spastic diplegic cerebral palsy and 67 neurotypical controls. Participants completed 5 min of an eyes closed resting-state paradigm while undergoing a magnetoencephalography recording. The magnetoencephalographic data were then source imaged, and the power within the delta (2–4 Hz), theta (5–7 Hz), alpha (8–12 Hz), beta (15–29 Hz), low gamma (30–59 Hz) and high gamma (60–90 Hz) frequency bands were computed. The resulting power spectral density maps were analysed vertex-wise to identify differences in spontaneous activity between groups. Our findings indicated that spontaneous cortical activity was altered in the participants with cerebral palsy in the delta, alpha, beta, low gamma and high gamma bands across the occipital, frontal and secondary somatosensory cortical areas (all pFWE < 0.05). Furthermore, we also found that the altered beta band spontaneous activity in the secondary somatosensory cortices predicted heightened pain perception in the individuals with cerebral palsy (P = 0.039). Overall, these results demonstrate that spontaneous cortical activity within individuals with cerebral palsy is altered in comparison to their neurotypical peers and may predict increased pain perception in this patient population. Potentially, changes in spontaneous resting-state activity may be utilized to measure the effectiveness of current treatment approaches that are directed at reducing the pain experienced by individuals with cerebral palsy.
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Affiliation(s)
- Michael P. Trevarrow
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE, USA
| | - Anna Reelfs
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE, USA
| | - Lauren R. Ott
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE, USA
| | - Samantha H. Penhale
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE, USA
| | - Brandon J. Lew
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE, USA
| | - Jessica Goeller
- Department of Anesthesiology, University of Nebraska Medical Center, 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, 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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20
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Val66et Polymorphism Is Associated with Altered Motor-Related Oscillatory Activity in Youth with Cerebral Palsy. Brain Sci 2022; 12:brainsci12040435. [PMID: 35447966 PMCID: PMC9027490 DOI: 10.3390/brainsci12040435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/15/2022] [Accepted: 03/17/2022] [Indexed: 01/27/2023] Open
Abstract
Brain-derived neurotrophic factor (BDNF) plays a critical role in the capacity for neuroplastic change. A single nucleotide polymorphism of the BDNF gene is well known to alter the activity-dependent release of the protein and may impact the capacity for neuroplastic change. Numerous studies have shown altered sensorimotor beta event-related desynchronization (ERD) responses in youth with cerebral palsy (CP), which is thought to be directly related to motor planning. The objective of the current investigation was to use magnetoencephalography (MEG) to evaluate whether the BDNF genotype affects the strength of the sensorimotor beta ERD seen in youth with CP while youth with CP performed a leg isometric target matching task. In addition, we collected saliva samples and used polymerase chain reaction (PCR) amplification to determine the status of the amino acid fragment containing codon 66 of the BDNF gene. Our genotyping results identified that 25% of the youth with CP had a Val66Met or Met66Met polymorphism at codon 66 of the BDNF gene. Furthermore, we identified that the beta ERD was stronger in youth with CP who had the Val66Met or Met66Met polymorphism in comparison to those without the polymorphism (p = 0.042). Overall, these novel findings suggest that a polymorphism at the BDNF gene may alter sensorimotor cortical oscillations in youth with CP.
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21
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Gordon AM, Ferre CL, Robert MT, Chin K, Brandao M, Friel KM. HABIT+tDCS: a study protocol of a randomised controlled trial (RCT) investigating the synergistic efficacy of hand-arm bimanual intensive therapy (HABIT) plus targeted non-invasive brain stimulation to improve upper extremity function in school-age children with unilateral cerebral palsy. BMJ Open 2022; 12:e052409. [PMID: 35190424 PMCID: PMC8860006 DOI: 10.1136/bmjopen-2021-052409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 01/27/2022] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Unilateral spastic cerebral palsy (USCP) is characterised by movement deficits primarily on one body side. The best available upper extremity (UE) therapies are costly and intensive. Thus, there is an urgent need for better, more efficient and thus more accessible therapies. Transcranial direct current stimulation (tDCS) is non-invasive and may enhance physical rehabilitation approaches. The aim of this study is to determine whether tDCS targeted to the hemisphere with corticospinal tract (CST) connectivity enhances the efficacy of UE training in children with USCP. Our central hypothesis is that hand-arm bimanual intensive therapy (HABIT) combined with a tDCS montage targeting the hemisphere with CST connectivity to the impaired UE muscles will improve UE function more than HABIT plus sham stimulation. We will test this by conducting a randomised clinical trial with clinical and motor cortex physiology outcomes. METHODS AND ANALYSES 81 children, aged 6-17 years, will be randomised to receive 2 mA anodal tDCS targeted to the affected UE motor map, 2 mA cathodal tDCS to the contralesional motor cortex or sham tDCS during the first 20 min of each HABIT session (10 hours: 2 hours/day for 5 days). Primary outcomes will be Box and Blocks Test, Assisting Hand Assessment and motor cortex excitability, determined with single-pulse transcranial magnetic stimulation. Secondary outcomes include ABILHAND-Kids, Canadian Occupational Performance Measure, Cooper Stereognosis, Dimension of Mastery Questionnaire and Participation and Environment Measure-Children and Youth. All measures will be collected before, immediately and 6 months after treatment. A group × test session Analysis of Variance will test differences among groups on all measures. ETHICS AND DISSEMINATION The study has been approved by the BRANY Institutional Review Board (#18-10-285-512). We will leverage our subject and family relationships to maximise dissemination and share results with the academic and patient/family advocacy groups. TRIAL REGISTRATION NUMBER NCT03402854.
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Affiliation(s)
- Andrew M Gordon
- Department of Biobehavioral Science, Teachers College, Columbia University, New York, New York, USA
| | - Claudio L Ferre
- Burke Neurological Institute, White Plains, New York, USA
- Department of Occupational Therapy, Boston University, Boston, Massachusetts, USA
| | - Maxime T Robert
- Department of Rehabilitation, Laval University, Quebec City, Quebec, Canada
| | - Karen Chin
- Department of Biobehavioral Science, Teachers College, Columbia University, New York, New York, USA
- Burke Neurological Institute, White Plains, New York, USA
| | - Marina Brandao
- Department of Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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22
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Shrader MW, Gross PH, Bailes AF, Whitaker AT. Hip surveillance for patients with cerebral palsy in the United States. J Pediatr Rehabil Med 2022; 15:25-30. [PMID: 35311728 DOI: 10.3233/prm-220013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
| | - Paul H Gross
- Cerebral Palsy Research Network, Salt Lake City, UT, USA
| | - Amy F Bailes
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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23
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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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24
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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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25
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Barati AA, Rajabi R, Shahrbanian S, Sedighi M. Investigation of the effect of sensorimotor exercises on proprioceptive perceptions among children with spastic hemiplegic cerebral palsy. J Hand Ther 2021; 33:411-417. [PMID: 32169259 DOI: 10.1016/j.jht.2019.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 10/20/2019] [Accepted: 12/31/2019] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN This is a blinded randomized clinical trial. INTRODUCTION Sensorimotor exercises may be an effective, noninvasive treatment modality for treating patients with pediatric spastic hemiplegic cerebral palsy (CP). PURPOSE OF THE STUDY We aim to evaluate the effect of sensorimotor exercises on the proprioceptive capability among children with spastic hemiplegic CP. METHODS This randomized clinical trial was performed on children with spastic hemiplegic CP. Thirty children aged 8 to 12 years old, with spastic hemiplegic CP, were randomly selected and equally divided into experimental and control groups (N = 15 for each). A joint positioning test was used to measure the patients' baseline proprioceptive ability. The exercise program included sensory and motor exercises which lasted for 8 weeks (three 60-min sessions per week). The data were analyzed by using Welch and paired-sample t-test at the significance level of P < .05. RESULTS The results indicated that the proprioceptive capability of the upper limb could significantly improve (P = .001, effect size = 0.41, observed power = 0.99) by using simultaneous exercising of the sensorimotor complex. The mean increased from 8.53 ± 1.6 to 10.53 ± 1.19 in the experimental group, whereas it changed from 6.66 ± 3.44 to 6.73 ± 3.15 in the control group. DISCUSSION In consistent with other studies, the exercises used in the present study enhanced the proprioceptive capability but not sensory performance of the hands of children with hemiplegic. Synchronous sensory and motor training in children with hemiplegic CP may improve the function and organization of the somatosensory cortex and reduce sensory disturbances. Although parents were subjectively satisfied with the outcome of the exercises, such as independency and life style, however these recordings were not measured in this study. CONCLUSION Implementing simultaneous sensorimotor exercises can improve the proprioceptive capability of the hand. Therefore, these exercises can be used in the rehabilitation programs to meet the children's needs with hemiplegic CP.
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Affiliation(s)
- Akram Ahmadi Barati
- Department of Physical Education and Sport Science, University of Tehran Alborz Campus, Tehran, Iran
| | - Reza Rajabi
- Faculty of Physical Education and Sport Sciences, Department of Health and Sports Medicine, University of Tehran, Tehran, Iran.
| | - Shahnaz Shahrbanian
- Department of Sports Medicine, University of Tehran, Tehran, Iran; Department of Sport Injuries & Corrective Exercise, Faculty of Physical Education and Sport Sciences, Bu-Ali Sina University, Hamedan, Iran
| | - Mostafa Sedighi
- Department of Neurology, Kermanshah University of Medical Sciences, Kermanshah, Iran
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26
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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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27
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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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28
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Effect of additional load on angular parameters during gait and balance in children with hemiparesis – Cross sectional study. BIOMEDICAL HUMAN KINETICS 2021. [DOI: 10.2478/bhk-2021-0016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Study aim: To study the effect of additional load over ankle and knee joints on angular parameters during gait and balance in children with hemiparesis.
Material and methods: 10 children with hemiparesis were recruited and stratified into 2 chronological age groups: group A (4–8 years) and group B (9–12 years). Additional loads of 0.7 kg and 1.1 kg were placed on the affected and non-affected lower limb at the ankle and knee joint for group A and group B respectively. Angular parameters during gait were assessed using Kinovea software (version 0.8.15) and balance using the Pediatric Balance Scale.
Results: Application of additional load of 0.7 kg over the non-affected leg knee joint is able to produce significant changes in ankle joint angles (p < 0.05) at initial contact and knee joint angles at heel-off (p < 0.05), toe-off (p < 0.001), acceleration (p < 0.05) and deceleration (p < 0.05) phases of gait and balance in group A, whereas on application of additional load of 1.1 kg over the affected leg at the ankle joint significant improvement in knee joint angles at initial contact (p < 0.001) and the deceleration (p < 0.05) phase of gait in group B was observed. There was significant improvement in the Pediatric Balance Scale score in both groups (p < 0.05).
Conclusions: Additional load over knee and ankle joints of the affected and non-affected leg showed more improvement in angular parameters during gait and balance in younger children with hemiparesis than older children, as they present an immature form of gait that can be modified, corrected and brought back to a normal angle.
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29
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Araneda R, Dricot L, Ebner-Karestinos D, Paradis J, Gordon AM, Friel KM, Bleyenheuft Y. Brain activation changes following motor training in children with unilateral cerebral palsy: An fMRI study. Ann Phys Rehabil Med 2021; 64:101502. [PMID: 33647530 DOI: 10.1016/j.rehab.2021.101502] [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] [Received: 06/15/2020] [Revised: 12/18/2020] [Accepted: 12/21/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Intensive motor-learning-based interventions have demonstrated efficacy for improving motor function in children with unilateral spastic cerebral palsy (USCP). Although this improvement has been associated mainly with neuroplastic changes in the primary sensori-motor cortices, this plasticity may also involve a wider fronto-parietal network for motor learning. OBJECTIVE To determine whether hand-arm bimanual intensive therapy including lower extremities (HABIT-ILE) induces brain activation changes in an extensive network for motor skill learning and whether these changes are related to functional changes observed after HABIT-ILE. METHODS In total, 25 children with USCP were behaviourally assessed in manual dexterity and everyday activities before and after HABIT-ILE. Functional imagery monitored brain activity while participants manipulated objects using their less-affected, more-affected or both hands. Two random-effects-group analyses performed at the whole-brain level assessed the brain activity network before and after therapy. Three other random-effects-group analyses assessed brain activity changes after therapy. Spearman's correlations were used to evaluate the correlation between behavioural and brain activity changes. RESULTS The same fronto-parietal network was identified before and after therapy. After the intervention, the more-affected hand manipulation elicited a decrease in activity on the motor cortex of the non-lesional hemisphere and an increase in activity on motor areas of the lesional hemisphere. The less-affected hand manipulation generated a decrease in activity of sensorimotor areas in the non-lesional hemisphere. Both-hands manipulation elicited an increase in activity of both hemispheres. Furthermore, we observed an association between brain activity changes and changes in everyday activity assessments. CONCLUSION Brain activation changes were observed in a fronto-parietal network underlying motor skill learning with HABIT-ILE in children with USCP. Two different patterns were observed, probably related to different phases of motor skill learning, representing an increased practice-dependent brain recruitment or a brain activation refinement by more efficient means. CLINICALTRIALS.GOV: NCT01700777 &NCT02667613.
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Affiliation(s)
- Rodrigo Araneda
- Institute of neuroscience, Université catholique de Louvain, Brussels, Belgium
| | - Laurance Dricot
- Institute of neuroscience, Université catholique de Louvain, Brussels, Belgium
| | | | - Julie Paradis
- Institute of neuroscience, Université catholique de Louvain, Brussels, Belgium
| | - Andrew M Gordon
- Department of biobehavioural sciences, Teachers college, Columbia University, New York, USA
| | - Kathleen M Friel
- Burke-Cornell medical research institute, White Plains, New York, USA
| | - Yannick Bleyenheuft
- Institute of neuroscience, Université catholique de Louvain, Brussels, Belgium.
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30
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McLean B, Taylor S, Valentine J, Carey L, Thornton A, Elliott C. Somatosensory discrimination impairment in children with hemiplegic cerebral palsy as measured by the sense_assess© kids. Aust Occup Ther J 2021; 68:317-326. [PMID: 33738799 DOI: 10.1111/1440-1630.12729] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/19/2021] [Accepted: 03/02/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION To characterise somatosensory discrimination impairment of the upper-limb across domains of tactile discrimination, limb position sense and haptic object recognition using the sense_assess© kids and examine associations with upper-limb motor performance in children with hemiplegic cerebral palsy (CP). METHODS The sense_assess© kids was administered at one timepoint to 28 children, aged 6-15.5 years (M = 10.1, SD = 2.4), with hemiplegic CP (right hemiplegia n = 15) and Manual Ability Classification System Levels I (n = 11) and II (n = 17). Unimanual motor performance was quantified using the Box and Block Test. RESULTS Tactile discrimination was impaired in 18, limb position sense in 20, and haptic object recognition was impaired in 21 of 28 children. Over 80% (23/28) of children had impaired somatosensory discrimination in one or more domains. Low to moderate correlations were observed between each measure of somatosensory discrimination and motor performance. Manual ability classification was associated with limb position sense and haptic object recognition. A moderate inverse correlation (r = -.57, p < .01) exists between the number of somatosensory domains impaired and motor performance. CONCLUSION The frequency of somatosensory impairment in the upper limb of children in our sample was high and associated with manual ability, suggesting a need for routine assessment of somatosensation in this population.
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Affiliation(s)
- Belinda McLean
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, WA, Australia.,Kids Rehab Western Australia, Child and Adolescent Health Service, Perth, WA, Australia
| | - Susan Taylor
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, WA, Australia.,Occupational Therapy Department, Child and Adolescent Health Service, Perth, WA, Australia
| | - Jane Valentine
- Kids Rehab Western Australia, Child and Adolescent Health Service, Perth, WA, Australia
| | - Leeanne Carey
- Occupational Therapy, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Vic., Australia.,Neurorehabilitation and Recovery, The Florey Institute of Neuroscience and Mental Health, Melbourne, Vic., Australia
| | - Ashleigh Thornton
- Kids Rehab Western Australia, Child and Adolescent Health Service, Perth, WA, Australia.,Division of Paediatrics, University of Western Australia, Perth, WA, Australia
| | - Catherine Elliott
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, WA, Australia.,Kids Rehab Western Australia, Child and Adolescent Health Service, Perth, WA, Australia.,Telethon Kids Institute, Perth, WA, Australia
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31
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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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32
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Khoshbakht M, Raji P, Ansari NN, Mahmodian M. Impact of somatosensory interventions on upper limb function in children with hemiplegic cerebral palsy: a single-subject design study. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2021. [DOI: 10.12968/ijtr.2019.0122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background/aims Hemiplegia is one of the most common types of cerebral palsy. Upper limb dysfunction in these children can affect their quality of life. The aim of this study was to investigate the effects of somatosensory interventions on upper extremity sensory and motor functions in spastic hemiplegic children. Methods This single-subject study was performed in the occupational therapy clinic of Tehran University of Medical Sciences. Three participants (two boys and one girl) aged 8–12 years with spastic hemiplegia were assessed during baseline, treatment and follow-up phases. During the treatment phase, the children received 12 tactile and proprioceptive stimulation (active, passive and playful) sessions over 4 weeks. Four sensory measures (tactile localisation, stereognosis, two-point discrimination, proprioception) and one motor measure (Box and Block Test) were assessed during each phase. Results Improvement in function was seen in all three children based on visual analysis, with significant differences between the baseline and treatment scores in the majority of measures for all participants. Changes were sustained at follow up for most tests. The effect size was large for all three children. Conclusions Despite the small number of participants, sensory intervention with a focus on sensory deficits could help to improve upper extremity sensory and motor function in children with spastic hemiplegia.
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Affiliation(s)
- Moloud Khoshbakht
- Department of Occupational Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Iran
| | - Parvin Raji
- Department of Occupational Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Iran
| | - Noureddin Nakhostin Ansari
- Department of Physical Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Iran
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Iran
- Neuromusculoskeletal Research Center, Iran University of Medical Sciences, Iran
| | - Mahmoud Mahmodian
- Department of Occupational Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Iran
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Trevarrow MP, Kleinsmith J, Taylor BK, Wilson TW, Kurz MJ. The somatosensory cortical activity in individuals with cerebral palsy displays an aberrant developmental trajectory. J Physiol 2020; 599:1281-1289. [PMID: 33296078 DOI: 10.1113/jp280400] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 11/16/2020] [Indexed: 12/31/2022] Open
Abstract
KEY POINTS Individuals with cerebral palsy (CP) have a reduced somatosensory cortical response Somatosensory cortical response strength decreases from adolescence to early adulthood Somatosensory cortical responses in youth with CP are similar to adult controls Individuals with CP may have aberrant maturation of the somatosensory system ABSTRACT: Numerous studies have documented tactile and proprioceptive deficits in children with cerebral palsy (CP) and linked these with weaker somatosensory cortical activity. However, whether such aberrations in somatosensory processing extend and/or progress into adulthood remains poorly understood. In the current study, we used magnetoencephalography (MEG) to investigate the primary somatosensory responses in a sample of individuals with CP (N = 42; age = 9-28 years) and a cohort of healthy controls (N = 23; age range = 11-23 years). Briefly, transient electrical stimulation was applied to the right tibial nerve, and standardized low-resolution brain electromagnetic tomography (sLORETA) was used to image the dynamic somatosensory cortical response. We found that the strength of somatosensory cortical activity within the 112-252 ms time window was significantly reduced in the individuals with CP compared with the healthy controls (HC = 286.53 ± 30.51, 95% CI [226.74, 346.32]; CP = 208.30 ± 19.66,CI [169.77, 246.83], P = 0.0126). These results corroborate previous findings of aberrant somatosensory cortical activity in individuals with CP. Our results also suggest that the somatosensory cortical activity tends to become weaker with age, with a similar rate of neurophysiological change in individuals with CP and healthy controls (P = 0.8790). Visualization of regression models fitted to the data imply that youth with CP may have somatosensory cortical activity similar to adult controls. These findings suggest that some individuals with CP exhibit an aberrant developmental trajectory of their somatosensory system.
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Affiliation(s)
- Michael P Trevarrow
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE, USA
| | | | - Brittany K Taylor
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Tony W Wilson
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Max J Kurz
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE, USA
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(Re)organisation of the somatosensory system after early brain lesion: A lateralization index fMRI study. Ann Phys Rehabil Med 2020; 63:416-421. [DOI: 10.1016/j.rehab.2019.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 01/14/2019] [Accepted: 02/03/2019] [Indexed: 12/16/2022]
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Alwhaibi R, Alsakhawi R, ElKholi S. Effects of auditovisual feedback on eye-hand coordination in children with cerebral palsy. RESEARCH IN DEVELOPMENTAL DISABILITIES 2020; 101:103635. [PMID: 32268257 DOI: 10.1016/j.ridd.2020.103635] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 02/26/2020] [Accepted: 03/18/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Children with spastic hemiplegic cerebral palsy have deficits in eye-hand coordination. This limits manual actions performed with the affected hand, especially fine motor skills such as grasping and manipulation. Visual-motor integration, grasping skills, and visual perception are collectively involved in eye-hand coordination. AIMS We investigated the effects of augmented biofeedback training on eye-hand coordination in children with spastic hemiplegic cerebral palsy. METHODS AND PROCEDURES Forty-five spastic hemiplegic cerebral palsy children (5-8 years old) were included. Children were assigned randomly into three equal groups. One group received traditional physical therapy to facilitate visual-motor integration and grasping skills for 3 months. The second group received augmented biofeedback training. The third group received a combination of augmented biofeedback training and traditional physical therapy. Children were evaluated with the Peabody Developmental Motor Scale (2nd edition) (PDMS-2). Treatment sessions were conducted for 60 min, three times a week, for 3 consecutive months. OUTCOMES AND RESULTS Children that received augmented biofeedback training alongside traditional physical therapy had significantly improved scores in the Visual-Motor Integration and grasping subtests compared to children that received only one intervention. CONCLUSIONS AND IMPLICATIONS Augmented biofeedback training alongside physical therapy improved eye-hand coordination in children with spastic hemiplegic cerebral palsy.
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Affiliation(s)
- Reem Alwhaibi
- Rehabilitation Sciences Department, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, P.O. Box 25058, Riyadh, 11466, Saudi Arabia.
| | - Reham Alsakhawi
- Rehabilitation Sciences Department, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia; Pediartic Department, Faculty of Physical Therapy, Cairo University, Egypt
| | - Safaa ElKholi
- Rehabilitation Sciences Department, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia; Pediartic Department, Faculty of Physical Therapy, Cairo University, Egypt
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36
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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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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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Lee SJ, Jin D, Kang SH, Gaebler-Spira D, Zhang LQ. Combined Ankle/Knee Stretching and Pivoting Stepping Training for Children With Cerebral Palsy. IEEE Trans Neural Syst Rehabil Eng 2019; 27:1743-1752. [PMID: 31403432 DOI: 10.1109/tnsre.2019.2934139] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Although various treatment methods have been investigated to reduce spasticity and intoeing gait in children with cerebral palsy (CP), methods to concurrently reduce an intoeing gait and associated ankle/knee stiffness and spasticity according to a child's specific needs are lacking. This study aimed to develop a training program to improve walking function and transverse-plane (pivoting) neuromuscular control and reduce spasticity and intoeing gait deviations. Eight children with diplegic CP and intoeing gait participated in this 6-week combined robotic ankle and/or knee intelligent stretching and pivoting neuromuscular control training program (Subject-specific Stretching and Pivoting Off-axis Neuromuscular control Training, [SS-POINT]). The effects of SS-POINT were evaluated using neuromechanical, functional, and clinical outcome measures and compared to those for eight children with CP and intoeing gait who participated in pivoting neuromuscular control training (POINT) alone in a previous study. RESULTS After the SS-POINT program, subjects with CP showed reduced knee stiffness and intoeing angle, and improvements in both joint and leg functions in terms of ankle and knee active range of motion, ankle dorsiflexor strength, proprioception, walking speed, balance, and minimum pivoting angle. Furthermore, improvements in proprioceptive acuity and minimum pivoting angle after the SS-POINT were greater than those after the POINT. CONCLUSION The SS-POINT approach can be used as a subject-specific training program for improving leg and walking functions and reducing intoeing during gait. SIGNIFICANCE This approach can serve as an individualized intervention at the joint and walking levels to maximize intervention effects by adjusting training targets, sequences, and intensities to meet the individual needs of children with CP.
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Beani E, Maselli M, Sicola E, Perazza S, Cecchi F, Dario P, Braito I, Boyd R, Cioni G, Sgandurra G. Actigraph assessment for measuring upper limb activity in unilateral cerebral palsy. J Neuroeng Rehabil 2019; 16:30. [PMID: 30795810 PMCID: PMC6387534 DOI: 10.1186/s12984-019-0499-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 02/11/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Detecting differences in upper limb use in children with unilateral cerebral palsy (UCP) is challenging and highly dependent on examiner experience. The recent introduction of technologies in the clinical environment, and in particular the use of wearable sensors, can provide quantitative measurement to overcome this issue. This study aims to evaluate ActiGraph GT3X+ as a tool for measuring asymmetry in the use of the two upper limbs (ULs) during the assessment with a standardized clinical tool, the Assisting Hand Assessment (AHA) in UCP patients aged 3-25 years compared to age-matched typically developing (TD) subjects. METHODS Fifty children with UCP and 50 TD subjects were assessed with AHA while wearing ActiGraphs GT3X+ on both wrists. The mean activity of each hand (dominant and non-dominant, MADH and MANDH, respectively) and the asymmetry index (AI) were calculated. Two linear mixed model analyses were carried out to evaluate how dependent actigraphic variables (i.e. MANDH and AI) varied by group (TD vs UCP) and among levels of manual ability based on Manual Ability Classification System (MACS). In both models age, sex, side of hemiplegia, presence/absence of mirror movements were specified as random effects. RESULTS The MANDH was significantly lower in UCP compared to TD, while the AI was significantly higher in UCP compared to TD. Moreover, in UCP group there were significant differences related to MACS levels, both for MANDH and AI. None of the random variables (i.e. age, sex, side, presence/absence of mirror movements) showed significant interaction with MANDH and AI. CONCLUSIONS These results confirm that actigraphy could provide, in a standardized setting, a quantitative description of differences between upper limbs activity. TRIAL REGISTRATION ClincalTrials.gov, NCT03054441 . Registered 15 February 2017.
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Affiliation(s)
- Elena Beani
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Viale del Tirreno 331, 56128 Calambrone, Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 56125 Pisa, Italy
| | - Martina Maselli
- The BioRobotics Institute, Scuola Superiore Sant’ Anna, Viale Rinaldo Piaggio 34, 56025 Pontedera, Pisa, Italy
| | - Elisa Sicola
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Viale del Tirreno 331, 56128 Calambrone, Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 56125 Pisa, Italy
| | - Silvia Perazza
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Viale del Tirreno 331, 56128 Calambrone, Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 56125 Pisa, Italy
| | - Francesca Cecchi
- The BioRobotics Institute, Scuola Superiore Sant’ Anna, Viale Rinaldo Piaggio 34, 56025 Pontedera, Pisa, Italy
| | - Paolo Dario
- The BioRobotics Institute, Scuola Superiore Sant’ Anna, Viale Rinaldo Piaggio 34, 56025 Pontedera, Pisa, Italy
| | - Irene Braito
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Viale del Tirreno 331, 56128 Calambrone, Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 56125 Pisa, Italy
| | - Roslyn Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine, The University of Queensland, Brisbane, Australia
| | - Giovanni Cioni
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Viale del Tirreno 331, 56128 Calambrone, Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 56125 Pisa, Italy
| | - Giuseppina Sgandurra
- Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, Viale del Tirreno 331, 56128 Calambrone, Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 56125 Pisa, Italy
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Mutalib SA, Mace M, Burdet E. Bimanual coordination during a physically coupled task in unilateral spastic cerebral palsy children. J Neuroeng Rehabil 2019; 16:1. [PMID: 30606226 PMCID: PMC6318978 DOI: 10.1186/s12984-018-0454-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 11/01/2018] [Indexed: 12/12/2022] Open
Abstract
Background Single object bimanual manipulation, or physically-coupled bimanual tasks, are ubiquitous in daily lives. However, the predominant focus of previous studies has been on uncoupled bimanual actions, where the two hands act independently to manipulate two disconnected objects. In this paper, we explore interlimb coordination among children with unilateral spastic cerebral palsy (USCP), by investigating upper limb motor control during a single object bimanual lifting task. Methods 15 children with USCP and 17 typically developing (TD) children performed a simple single-object bimanual lifting task. The object was an instrumented cube that can record the contact force on each of its faces alongside estimating its trajectory during a prescribed two-handed lifting motion. The subject’s performance was measured in terms of the duration of individual phases, linearity and monotonicity of the grasp-to-load force synergy, interlimb force asymmetry, and movement smoothness. Results Similar to their TD counterparts, USCP subjects were able to produce a linear grasp-to-load force synergy. However, they demonstrated difficulties in producing monotonic forces and generating smooth movements. No impairment of anticipatory control was observed within the USCP subjects. However, our analysis showed that the USCP subjects shifted the weight of the cube onto their more-abled side, potentially to minimise the load on the impaired side, which suggests a developed strategy of compensating for inter-limb asymmetries, such as muscle strength. Conclusion Bimanual interaction with a single mutual object has the potential to facilitate anticipation and sequencing of force control in USCP children unlike previous studies which showed deficits during uncoupled bimanual actions. We suggest that this difference could be partly due to the provision of adequate cutaneous and kinaesthetic information gathered from the dynamic exchange of forces between the two hands, mediated through the physical coupling.
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Affiliation(s)
- Sharah A Mutalib
- Department of Bioengineering, Imperial College London, South Kensington, London, SW7 2AZ, UK.
| | - Michael Mace
- Department of Bioengineering, Imperial College London, South Kensington, London, SW7 2AZ, UK
| | - Etienne Burdet
- Department of Bioengineering, Imperial College London, South Kensington, London, SW7 2AZ, UK
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Taylor S, Girdler S, McCutcheon S, McLean B, Parsons R, Falkmer T, Jacoby P, Carey L, Elliott C. Haptic Exploratory Procedures of Children and Youth with and without Cerebral Palsy. Phys Occup Ther Pediatr 2019; 39:337-351. [PMID: 29944033 DOI: 10.1080/01942638.2018.1477228] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Aims: Compare haptic exploratory procedures (EPs) and exploratory movements (EMs) of children. This study also tested the interrater reliability of a novel digital recording method. Methods: Participants were 31 children with typical development (TD) (aged 6 years 1 month to 15 years 9 months; 14 male) and 23 children with spastic unilateral cerebral palsy (CP) (aged 6 years to 15 years 5 months; 13 males; right hemiplegia, n = 12). Results: There were no statistically significant differences between groups for expected EP (p = .15), additional EPs (p = .78), or EMs (p = .69) but there was for mean duration of exploration (p < .001) and accuracy (p < .001). This suggests that although children with CP performed similar haptic EPs for each object as children with TD, they took more time and were less accurate in their identification. There was substantial agreement between the two raters' observations of expected EP, κ = .64, p < .0005. Conclusion: Children with CP performed similar haptic EPs as their TD peers. However, despite similarities, the results indicate that for children with CP manual ability was not the primary determinant of accuracy or speed of identification. This study provides evidence for a reliable method of recording haptic EPs.
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Affiliation(s)
- Susan Taylor
- a School of Occupational Therapy and Social Work , Curtin University , Perth , Australia.,c Paediatric Rehabilitation Department , Princess Margaret Hospital for Children , Perth , Australia
| | - Sonya Girdler
- a School of Occupational Therapy and Social Work , Curtin University , Perth , Australia.,f Population Sciences , Telethon Kids Institute , Perth , Australia
| | - Sara McCutcheon
- a School of Occupational Therapy and Social Work , Curtin University , Perth , Australia
| | - Belinda McLean
- b School of Paediatrics and Child Health , University of Western Australia , Perth , Australia.,c Paediatric Rehabilitation Department , Princess Margaret Hospital for Children , Perth , Australia
| | - Richard Parsons
- a School of Occupational Therapy and Social Work , Curtin University , Perth , Australia
| | - Torbjorn Falkmer
- a School of Occupational Therapy and Social Work , Curtin University , Perth , Australia
| | - Peter Jacoby
- f Population Sciences , Telethon Kids Institute , Perth , Australia
| | - Leeanne Carey
- d School of Allied Health , La Trobe University , Melbourne , Australia.,e Neurorehabilitation and Recovery , The Florey Institute of Neuroscience and Mental Health , Melbourne , Australia
| | - Catherine Elliott
- a School of Occupational Therapy and Social Work , Curtin University , Perth , Australia.,c Paediatric Rehabilitation Department , Princess Margaret Hospital for Children , Perth , Australia
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Potentials of Ultrahigh-Field MRI for the Study of Somatosensory Reorganization in Congenital Hemiplegia. Neural Plast 2018; 2018:8472807. [PMID: 30595689 PMCID: PMC6286762 DOI: 10.1155/2018/8472807] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 08/03/2018] [Accepted: 09/04/2018] [Indexed: 12/03/2022] Open
Abstract
Reorganization of somatosensory function influences the clinical recovery of subjects with congenital unilateral brain lesions. Ultrahigh-field (UHF) functional MRI (fMRI) with the use of a 7 T magnet has the potential to contribute fundamentally to the current knowledge of such plasticity mechanisms. The purpose of this study was to obtain preliminary information on the possible advantages of the study of somatosensory reorganization at UHF fMRI. We enrolled 6 young adults (mean age 25 ± 6 years) with congenital unilateral brain lesions (4 in the left hemisphere and 2 in the right hemisphere; 4 with perilesional motor reorganization and 2 with contralesional motor reorganization) and 7 healthy age-matched controls. Nondominant hand sensory assessment included stereognosis and 2-point discrimination. Task-dependent fMRI was performed to elicit a somatosensory activation by using a safe and quantitative device developed ad hoc to deliver a reproducible gentle tactile stimulus to the distal phalanx of thumb and index fingers. Group analysis was performed in the control group. Individual analyses in the native space were performed with data of hemiplegic subjects. The gentle tactile stimulus showed great accuracy in determining somatosensory cortex activation. Single-subject gentle tactile stimulus showed an S1 activation in the postcentral gyrus and an S2 activation in the inferior parietal insular cortex. A correlation emerged between an index of S1 reorganization (distance between expected and reorganized S1) and sensory deficit (p < 0.05) in subjects with hemiplegia, with higher distance related to a more severe sensory deficit. Increase in spatial resolution at 7 T allows a better localization of reorganized tactile function validated by its correlation with clinical measures. Our results support the S1 early-determination hypothesis and support the central role of topography of reorganized S1 compared to a less relevant S1-M1 integration.
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Abstract
Cerebral palsy (CP) is a neurodevelopmental disorder characterized by abnormalities of muscle tone, movement and motor skills, and is attributed to injury to the developing brain. The clinical features of this entity evolve over time and the specific CP syndrome may be recognizable only after 3-5 y of age; although suggestive signs and symptoms may be present at an earlier age. The management involves neurological rehabilitation (addressing muscle tonal abnormalities, and devising physical and occupational therapies) and diagnosis and management of co-morbidities (including epilepsy, impairment of cognition, vision, hearing, and disturbances of growth and gastrointestinal function). The management, therefore, is multidisciplinary involving the treating physician working with a team of rehabilitation-, orthopedic-, psychologic-, and social care- providers.
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Mills R, Levac D, Sveistrup H. Kinematics and postural muscular activity during continuous oscillating platform movement in children and adolescents with cerebral palsy. Gait Posture 2018; 66:13-20. [PMID: 30138742 DOI: 10.1016/j.gaitpost.2018.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 07/25/2018] [Accepted: 08/07/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Reactive and anticipatory postural activity has been described in single discrete perturbations in youth with cerebral palsy (CP) but not in continuous perturbation situations. RESEARCH QUESTION We sought to determine how the ability to control postural responses (as reflected in the number of steps taken, postural muscle activity, and marker-pair trajectory cross-correlations) compares between typically developing (TD) youth and age-matched youth with CP when exposed to various frequencies of continuous platform oscillation. We also sought to determine if youth with CP could further modify postural activity based on knowledge of platform movement. METHODS Eleven youth with CP and sixteen TD youth aged 7-17 years stood with eyes open on a movable platform progressively translated antero-posteriorly through four speeds in experimenter-triggered and self-triggered perturbations. Postural muscle activity and 3D kinematics were recorded. The Anchoring Index and marker-pair trajectories were used to quantify body stabilization strategies. Transition states and steady states were analysed. Mann Whitney-U tests analysed between-group differences at each frequency. RESULTS At lower frequencies (0.1 and 0.25 Hz) youth with CP behaved like age-matched TD controls. At higher frequencies (0.5 and 0.61 Hz), youth with CP took a greater number of steps, had a preference for stabilizing their head on the trunk, had low marker-pair correlations with high temporal lag, and showed increased tonic activity compared to their TD peers. SIGNIFICANCE Higher frequency platform movements proved more difficult for youth with CP, however, like TD youth, they shifted from reactive to anticipatory mechanisms when the platform frequency remained constant by taking advantage of knowledge of platform movement. When given control over perturbation onset, further evidence of anticipatory mechanisms was observed following the transition to a new oscillation frequency.
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Affiliation(s)
- Richard Mills
- Schools of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada; Department of Sport and Exercise Sciences, Manchester Metropolitan University, Manchester, United Kingdom
| | - Danielle Levac
- Rehabilitation Sciences, University of Ottawa, Ottawa, Ontario, Canada; Department of Physical Therapy, Movement and Rehabilitation Sciences, Northeastern University, Boston, Massachusetts, United States
| | - Heidi Sveistrup
- Schools of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada; Rehabilitation Sciences, University of Ottawa, Ottawa, Ontario, Canada.
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Taylor S, Girdler S, Parsons R, McLean B, Falkmer T, Carey L, Blair E, Elliott C. Construct validity and responsiveness of the functional Tactile Object Recognition Test for children with cerebral palsy. Aust Occup Ther J 2018; 65:420-430. [DOI: 10.1111/1440-1630.12508] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Susan Taylor
- School of Occupational Therapy and Social Work; Curtin University; Perth WA Australia
- Paediatric Rehabilitation (Kids Rehab WA); Perth Children's Hospital; Perth Western Australia Australia
| | - Sonya Girdler
- School of Occupational Therapy and Social Work; Curtin University; Perth WA Australia
- Population Sciences; Telethon Kids Institute; Perth Western Australia Australia
| | - Richard Parsons
- School of Occupational Therapy and Social Work; Curtin University; Perth WA Australia
| | - Belinda McLean
- School of Paediatrics and Child Health; University of Western Australia; Perth Western Australia Australia
- Paediatric Rehabilitation (Kids Rehab WA); Perth Children's Hospital; Perth Western Australia Australia
| | - Torbjorn Falkmer
- School of Occupational Therapy and Social Work; Curtin University; Perth WA Australia
| | - Leeanne Carey
- Neurorehabilitation and Recovery; The Florey Institute of Neuroscience and Mental Health; Melbourne Victoria Australia
- Occupational Therapy; School of Allied Health; La Trobe University; Melbourne Victoria Australia
| | - Eve Blair
- Population Sciences; Telethon Kids Institute; Perth Western Australia Australia
| | - Catherine Elliott
- School of Occupational Therapy and Social Work; Curtin University; Perth WA Australia
- Paediatric Rehabilitation (Kids Rehab WA); Perth Children's Hospital; Perth Western Australia Australia
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Surkar SM, Hoffman RM, Davies B, Harbourne R, Kurz MJ. Impaired anticipatory vision and visuomotor coordination affects action planning and execution in children with hemiplegic cerebral palsy. RESEARCH IN DEVELOPMENTAL DISABILITIES 2018; 80:64-73. [PMID: 29940386 DOI: 10.1016/j.ridd.2018.06.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 03/12/2018] [Accepted: 06/19/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Action-planning and execution deficits in children with hemiplegic cerebral palsy (HCP) are potentially due to deficits in the integration of sensory information, such as vision, with motor output. AIMS To determine differences in anticipatory visual patterns in children with HCP compared to typically developing (TD) children, and to assess visuomotor coordination in children with HCP. METHODS AND PROCEDURES We included 13 children with HCP (Age = 6.8 + 2.9 yrs) and 15 TD children (Age = 5.8 + 1.1 yrs). The experimental task used in this study is a valid action-planning task, which consisted of initially reaching and grasping an object placed at a fixed position, followed by placing the object in a random target position. Visual patterns were recorded using a head-mounted eye-tracker system and arm movements were recorded using motion capture (120 Hz). OUTCOMES AND RESULTS Children with HCP had delayed anticipatory gaze time and longer latency than TD children during the planning and execution phases. Children with HCP also had a higher frequency of gaze shifts, longer reaction times (RT) and movement times (MT) than TD children. CONCLUSIONS AND IMPLICATIONS Children with HCP may have deficits in anticipatory vision, which potentially affected planning and executing a goal-directed action. Therapeutic interventions focusing on improving visuomotor coordination may improve the motor performance in children with HCP.
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Affiliation(s)
- Swati M Surkar
- Munroe Meyer Institute of Genetics and Rehabilitation, University of Nebraska Medical Center, Sensorimotor Learning Laboratory, Department of Physical Therapy, 985450 Nebraska Medical Center Omaha, NE, 68198-5450, United States.
| | - Rashelle M Hoffman
- Munroe Meyer Institute of Genetics and Rehabilitation, University of Nebraska Medical Center, Sensorimotor Learning Laboratory, Department of Physical Therapy, 985450 Nebraska Medical Center Omaha, NE, 68198-5450, United States.
| | - Brenda Davies
- Munroe Meyer Institute of Genetics and Rehabilitation, University of Nebraska Medical Center, Sensorimotor Learning Laboratory, Department of Physical Therapy, 985450 Nebraska Medical Center Omaha, NE, 68198-5450, United States.
| | - Regina Harbourne
- John G. Rangos School of Health Sciences, Duquesne University, Department of Physical Therapy, 600 Forbes Avenue, Pittsburgh, PA, 15282, United States.
| | - Max J Kurz
- Munroe Meyer Institute of Genetics and Rehabilitation, University of Nebraska Medical Center, Sensorimotor Learning Laboratory, Department of Physical Therapy, 985450 Nebraska Medical Center Omaha, NE, 68198-5450, United States.
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Saussez G, Van Laethem M, Bleyenheuft Y. Changes in Tactile Function During Intensive Bimanual Training in Children With Unilateral Spastic Cerebral Palsy. J Child Neurol 2018; 33:260-268. [PMID: 29433419 DOI: 10.1177/0883073817753291] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Recently, an intensive bimanual intervention using sensory enriched materials resulted in improved tactile function in children with unilateral spastic cerebral palsy (USCP), raising the question of whether the observed tactile function improvement was due to the sensory enriched environment or the bimanual intervention per se. The present study investigates whether a bimanual intensive intervention improves tactile function. Nineteen children with USCP received 90 hours of bimanual training without enriched environment. Primary outcomes: Manual Form Perception Test/MFPT, Grating Orientation Task/GOT. Children were assessed before, after the training, and at the 4-month follow-up. Significant improvements were observed in MFPT for the more affected hand ( P = .015). Larger stereognosis/MFPT improvements correlated with poorer baseline motor function. Intensive bimanual training alone was sufficient to improve stereognosis, though no improvement in GOT was observed. Present and previously published findings suggest that environmental tactile enrichment incorporated into a bimanual motor training may be needed to improve spatial discrimination/GOT in children with USCP.
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Affiliation(s)
- Geoffroy Saussez
- 1 Motor Skill Learning and Intensive Neurorehabilitation lab, Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
| | - Marie Van Laethem
- 2 Faculty of Motor Sciences, Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Yannick Bleyenheuft
- 1 Motor Skill Learning and Intensive Neurorehabilitation lab, Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium
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Ghai S, Ghai I, Effenberg AO. Effect of rhythmic auditory cueing on gait in cerebral palsy: a systematic review and meta-analysis. Neuropsychiatr Dis Treat 2018; 14:43-59. [PMID: 29339922 PMCID: PMC5746070 DOI: 10.2147/ndt.s148053] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Auditory entrainment can influence gait performance in movement disorders. The entrainment can incite neurophysiological and musculoskeletal changes to enhance motor execution. However, a consensus as to its effects based on gait in people with cerebral palsy is still warranted. A systematic review and meta-analysis were carried out to analyze the effects of rhythmic auditory cueing on spatiotemporal and kinematic parameters of gait in people with cerebral palsy. Systematic identification of published literature was performed adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses and American Academy for Cerebral Palsy and Developmental Medicine guidelines, from inception until July 2017, on online databases: Web of Science, PEDro, EBSCO, Medline, Cochrane, Embase and ProQuest. Kinematic and spatiotemporal gait parameters were evaluated in a meta-analysis across studies. Of 547 records, nine studies involving 227 participants (108 children/119 adults) met our inclusion criteria. The qualitative review suggested beneficial effects of rhythmic auditory cueing on gait performance among all included studies. The meta-analysis revealed beneficial effects of rhythmic auditory cueing on gait dynamic index (Hedge's g=0.9), gait velocity (1.1), cadence (0.3), and stride length (0.5). This review for the first time suggests a converging evidence toward application of rhythmic auditory cueing to enhance gait performance and stability in people with cerebral palsy. This article details underlying neurophysiological mechanisms and use of cueing as an efficient home-based intervention. It bridges gaps in the literature, and suggests translational approaches on how rhythmic auditory cueing can be incorporated in rehabilitation approaches to enhance gait performance in people with cerebral palsy.
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Affiliation(s)
- Shashank Ghai
- Institute for Sports Science, Leibniz University Hannover, Hannover, Germany
| | - Ishan Ghai
- School of Life Sciences, Jacobs University, Bremen, Germany
| | - Alfred O Effenberg
- Institute for Sports Science, Leibniz University Hannover, Hannover, Germany
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Taylor S, McLean B, Blair E, Carey LM, Valentine J, Girdler S, Elliott C. Clinical acceptability of the sense_assess© kids
: Children and youth perspectives. Aust Occup Ther J 2017; 65:79-88. [DOI: 10.1111/1440-1630.12429] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Susan Taylor
- School of Occupational Therapy and Social Work; Curtin University; Perth WA Australia
- Department of Paediatric Rehabilitation; Princess Margaret Hospital for Children; Perth WA Australia
| | - Belinda McLean
- Department of Paediatric Rehabilitation; Princess Margaret Hospital for Children; Perth WA Australia
- School of Paediatrics and Child Health; University of Western Australia; Perth WA Australia
| | - Eve Blair
- Population Sciences; Telethon Kids Institute; Perth WA Australia
| | - Leeanne Mary Carey
- Neurorehabilitation and Recovery; The Florey Institute of Neuroscience and Mental Health; Melbourne VIC Australia
- Occupational Therapy; School of Allied Health; La Trobe University; Melbourne VIC Australia
| | - Jane Valentine
- Department of Paediatric Rehabilitation; Princess Margaret Hospital for Children; Perth WA Australia
- School of Paediatrics and Child Health; University of Western Australia; Perth WA Australia
| | - Sonya Girdler
- School of Occupational Therapy and Social Work; Curtin University; Perth WA Australia
- Population Sciences; Telethon Kids Institute; Perth WA Australia
| | - Catherine Elliott
- School of Occupational Therapy and Social Work; Curtin University; Perth WA Australia
- Department of Paediatric Rehabilitation; Princess Margaret Hospital for Children; Perth WA Australia
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Walmsley C, Taylor S, Parkins T, Carey L, Girdler S, Elliott C. What is the current practice of therapists in the measurement of somatosensation in children with cerebral palsy and other neurological disorders? Aust Occup Ther J 2017; 65:89-97. [DOI: 10.1111/1440-1630.12431] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Corrin Walmsley
- School of Occupational Therapy and Social Work; Curtin University; Perth Australia
| | - Susan Taylor
- School of Occupational Therapy and Social Work; Curtin University; Perth Australia
- Department of Paediatric Rehabilitation; Princess Margaret Hospital for Children; Perth Australia
| | - Timothy Parkins
- School of Occupational Therapy and Social Work; Curtin University; Perth Australia
| | - Leeanne Carey
- Neurorehabilitation and Recovery; The Florey Institute of Neuroscience and Mental Health; Melbourne Australia
- Occupational Therapy; School of Allied Health; La Trobe University; Melbourne Australia
| | - Sonya Girdler
- School of Occupational Therapy and Social Work; Curtin University; Perth Australia
| | - Catherine Elliott
- School of Occupational Therapy and Social Work; Curtin University; Perth Australia
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