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- Weinstein, Maya, et al.
(author)
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Understanding the relationship between brain and upper limb function in children with unilateral motor impairments : A multimodal approach
- 2018
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In: European journal of paediatric neurology. - : Elsevier. - 1090-3798 .- 1532-2130. ; 22:1, s. 143-154
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Journal article (peer-reviewed)abstract
- Atypical brain development and early brain injury have profound and long lasting impact on the development, skill acquisition, and subsequent independence of a child. Heterogeneity is present at the brain level and at the motor level; particularly with respect to phenomena of bilateral activation and mirrored movements (MMs). In this multiple case study we consider the feasibility of using several modalities to explore the relationship between brain structure and/or activity and hand function: Electroencephalography (EEG), both structural and functional Magnetic Resonance Imaging (sMRI, fMRI), diffusion tensor imaging (DTI), transcranial magnetic stimulation (TMS), Electromyography (EMG) and hand function assessments.Methods: 15 children with unilateral CP (ages: 9.4 ± 2.5 years) undertook hand function assessments and at least two additional neuroimaging and/or neurophysiological procedures: MRI/DTI/fMRI (n = 13), TMS (n = 11), and/or EEG/EMG (n = 8). During the fMRI scans and EEG measurements, a motor task was performed to study cortical motor control activity during simple hand movements. DTI tractography analysis was used to study the corpus-callosum (CC) and cortico-spinal tracts (CST). TMS was used to study cortico-spinal connectivity pattern.Results: Type and range of severity of brain injury was evident across all levels of manual ability with the highest radiological scores corresponded to children poorer manual ability. Evidence of MMs was found in 7 children, mostly detected when moving the affected hand, and not necessarily corresponding to bilateral brain activation. When moving the affected hand, bilateral brain activation was seen in 6/11 children while 3/11 demonstrated unilateral activation in the contralateral hemisphere, and one child demonstrated motor activation predominantly in the supplementary motor area (SMA). TMS revealed three types of connectivity patterns from the cortex to the affected hand: a contralateral (n = 3), an ipsilateral (n = 4) and a mixed (n = 1) connectivity pattern; again without clear association with MMs. No differences were found between children with and without MMs in lesion scores, motor fMRI laterality indices, CST diffusivity values, and upper limb function. In the genu, midbody, and splenium of the CC, higher fractional anisotropy values were found in children with MMs compared to children without MMs. The EEG data indicated a stronger mu-restoration above the contralateral hemisphere in 6/8 children and above the ipsilateral hemisphere in 2/8 children.Conclusion: The current results demonstrate benefits from the use of different modalities when studying upper-limb function in children with CP; not least to accommodate to the variations in tolerance and feasibility of implementation of the differing methods. These exposed multiple individual brain-reorganization patterns corresponding to different functional motor abilities. Additional research is warranted to understand the transactional influences of early brain injury, neuroplasticity and developmental and environmental factors on hand function in order to develop targeted interventions.
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| 2. |
- Zielinski, Ingar M., et al.
(author)
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The relation between mirror movements and non-use of the affected hand in children with unilateral cerebral palsy
- 2017
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In: Developmental Medicine & Child Neurology. - : John Wiley & Sons. - 0012-1622 .- 1469-8749. ; 59:2, s. 152-159
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Journal article (peer-reviewed)abstract
- Aim:In children with unilateral cerebral palsy (CP), it is widely believed that mirror movements contribute to non-use of the affected hand despite preserved capacity, a phenomenon referred to as developmental disregard. We aimed to test whether mirror movements are related to developmental disregard, and to clarify the relation between mirror movements and bimanual function.Method:A repetitive squeezing task simultaneously measuring both hands' grip-forces was developed to assess mirror movements by using maximum cross-correlation coefficient (CCCmax) as well as strength measures (MMstrength). Developmental disregard, bimanual performance, and capacity were assessed using a validated video-observation method. Twenty-one children with unilateral CP participated (Median age 10y 7mo, interquartile range [IQR] 10y 1mo–12y 9mo). Outcome measures of mirror movements were correlated to developmental disregard, bimanual performance, and capacity scores using Spearman's correlations (significance level: α<0.05).Results:Mirror movements were not related to developmental disregard. However, enhanced mirror movements in the less-affected hand were related to reduced performance (CCCmax: ρ=−0.526, p=0.007; MMstrength: ρ=−0.750, p<0.001) and capacity (CCCmax: ρ=−0.410, p=0.033; MMstrength: ρ=−0.679, p<0.001). These relations were only moderate (performance:MMstrength: ρ=−0.504, p=0.010), low (capacity: MMstrength: ρ=−0.470, p=0.016) or absent for mirror movements in the affected hand. Additionally, seven children showed stronger movements in their less-affected hands when actually being asked to move their affected hand.Interpretation:These findings show no relation between mirror movements and developmental disregard, but support an association between mirror movements and bimanual function.
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