Abstract
BackgroundDetailed kinematics of motor impairment of the contralesional (“affected”) and ipsilesional (“unaffected”) limbs in children with hemiparetic cerebral palsy are not well understood. We aimed to 1) quantify the kinematics of reaching in both arms of hemiparetic children with perinatal stroke using a robotic exoskeleton, and 2) assess the correlation of kinematic reaching parameters with clinical motor assessments.MethodsThis prospective, case-control study involved the Alberta Perinatal Stroke Project, a population-based research cohort, and the Foothills Medical Center Stroke Robotics Laboratory in Calgary, Alberta over a four year period. Prospective cases were collected through the Calgary Stroke Program and included term-born children with magnetic resonance imaging confirmed perinatal ischemic stroke and upper extremity deficits. Control participants were recruited from the community. Participants completed a visually guided reaching task in the KINARM robot with each arm separately, with 10 parameters quantifying motor function. Kinematic measures were compared to clinical assessments and stroke type.ResultsFifty children with perinatal ischemic stroke (28 arterial, mean age: 12.5 ± 3.9 years; 22 venous, mean age: 11.5 ± 3.8 years) and upper extremity deficits were compared to healthy controls (n = 147, mean age: 12.7 ± 3.9 years). Perinatal stroke groups demonstrated contralesional motor impairments compared to controls when reaching out (arterial = 10/10, venous = 8/10), and back (arterial = 10/10, venous = 6/10) with largest errors in reaction time, initial direction error, movement length and time. Ipsilesional impairments were also found when reaching out (arterial = 7/10, venous = 1/10) and back (arterial = 6/10). The arterial group performed worse than venous on both contralesional and ipsilesional parameters. Contralesional reaching parameters showed modest correlations with clinical measures in the arterial group.ConclusionsRobotic assessment of reaching behavior can quantify complex, upper limb dysfunction in children with perinatal ischemic stroke. The ipsilesional, “unaffected” limb is often abnormal and may be a target for therapeutic interventions in stroke-induced hemiparetic cerebral palsy.
Highlights
Detailed kinematics of motor impairment of the contralesional (“affected”) and ipsilesional (“unaffected”) limbs in children with hemiparetic cerebral palsy are not well understood
Differences in timing of the injury may influence motor development, as periventricular venous infarction (PVI) lesions are incurred before 32–34 weeks gestation and most arterial lesions are acquired near term
While motor impairments of the contralesional upper limb have been the primary focus in rehabilitation, studies have suggested that the “unaffected” ipsilesional limb shows deficits in coordination, dexterity, strength, and movement speed [4,5,6,7,8,9]
Summary
Detailed kinematics of motor impairment of the contralesional (“affected”) and ipsilesional (“unaffected”) limbs in children with hemiparetic cerebral palsy are not well understood. The most common perinatal stroke types are large arterial ischemic strokes (AIS) in the middle cerebral artery territory and smaller fetal periventricular venous infarctions (PVI) of the subcortical white matter [2]. While both types of lesions can damage the sensory-motor system, children with PVI typically show milder impairments. These differences may be attributed to the purely subcortical nature of the venous infarctions compared to the cortical and subcortical injuries sustained within the middle cerebral artery in children with arterial stroke [3]. Many activities of daily living depend on the input and coordination of both arms, developing a better understanding of upper limb impairments may advance therapies and improve outcomes
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