Abstract
BackgroundWhile motor deficits are the hallmark of hemiparetic cerebral palsy, children may also experience impairments in visuospatial attention that interfere with participation in complex activities, including sports or driving. In this study, we used a robotic object hitting task to assess bilateral sensorimotor control and visuospatial skills in children with hemiparesis due to perinatal arterial ischemic stroke (AIS) or periventricular venous infarct (PVI). We hypothesized that performance would be impaired bilaterally and be related to motor behavior and clinical assessment of visuospatial attention.MethodsForty-nine children with perinatal stroke and hemiparetic cerebral palsy and 155 typically developing (TD) children participated in the study. Participants performed a bilateral object hitting task using the KINARM Exoskeleton Robot, in which they used virtual paddles at their fingertips to hit balls that fell from the top of the screen with increasing speed and frequency over 2.3 min. We quantified performance across 13 parameters including number of balls hit with each hand, movement speed and area, biases between hands, and spatial biases. We determined normative ranges of performance accounting for age by fitting 95% prediction bands to the TD children. We compared parameters between TD, AIS, and PVI groups using ANCOVAs accounting for age effects. Lastly, we performed regression analysis between robotic and clinical measures.ResultsThe majority of children with perinatal stroke hit fewer balls with their affected arm compared to their typically developing peers. We also found deficits with the ipsilesional (“unaffected”) arm. Children with AIS had greater impairments than PVI. Despite hitting fewer balls, we only identified 18% of children as impaired in hand speed or movement area. Performance on the Behavioral Inattention Test accounted for 21–32% of the variance in number of balls hit with the unaffected hand.ConclusionsChildren with perinatal stroke-induced hemiparetic cerebral palsy may have complex bilateral deficits reflecting a combination of impairments in motor skill and visuospatial attention. Clinical assessments and interventions should address the interplay between motor and visuospatial skills.
Highlights
While motor deficits are the hallmark of hemiparetic cerebral palsy, children may experience impairments in visuospatial attention that interfere with participation in complex activities, including sports or driving
Age effects on performance on robotic object hit task We found significant effects of age in typically developing (TD) children for total hits, median error, hits affected, hits unaffected, hand speed affected, hand speed unaffected, movement area affected, and movement area unaffected
Relationship between motor behavior and hits during the object hit task We performed regressions between motor performance parameters and number of hits with each hand to determine the extent to which the amount and speed of movement can explain successful task performance
Summary
While motor deficits are the hallmark of hemiparetic cerebral palsy, children may experience impairments in visuospatial attention that interfere with participation in complex activities, including sports or driving. We used a robotic object hitting task to assess bilateral sensorimotor control and visuospatial skills in children with hemiparesis due to perinatal arterial ischemic stroke (AIS) or periventricular venous infarct (PVI). We hypothesized that performance would be impaired bilaterally and be related to motor behavior and clinical assessment of visuospatial attention. While clinical assessments and research studies typically focus on reaching and grasping performance [17], real-world situations often require more complex actions. In contrast to the clinical assessment, this complex real-world activity requires preserved motor and sensory function bilaterally, and the ability to use visuospatial skills to make rapid motor decisions.
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