Abstract
BackgroundThe purpose of the current study was to determine the influence of upper-limb prostheses on brain activity and gross dexterity in children with congenital unilateral upper-limb reduction deficiencies (ULD) compared to typically developing children (TD).MethodsFive children with ULD (3 boys, 2 girls, 8.76 ± 3.37 years of age) and five age- and sex-matched TD children (3 boys, 2 girls, 8.96 ± 3.23 years of age) performed a gross manual dexterity task (Box and Block Test) while measuring brain activity (functional near-infrared spectroscopy; fNIRS).ResultsThere were no significant differences (p = 0.948) in gross dexterity performance between the ULD group with prosthesis (7.23 ± 3.37 blocks per minute) and TD group with the prosthetic simulator (7.63 ± 5.61 blocks per minute). However, there was a significant (p = 0.001) difference in Laterality Index (LI) between the ULD group with prosthesis (LI = − 0.2888 ± 0.0205) and TD group with simulator (LI = 0.0504 ± 0.0296) showing in a significant ipsilateral control for the ULD group. Thus, the major finding of the present investigation was that children with ULD, unlike the control group, showed significant activation in the ipsilateral motor cortex on the non-preferred side using a prosthesis during a gross manual dexterity task.ConclusionsThis ipsilateral response may be a compensation strategy in which the existing cortical representations of the non-affected (preferred) side are been used by the affected (non-preferred) side to operate the prosthesis. This study is the first to report altered lateralization in children with ULD while using a prosthesis.Trial registration The clinical trial (ClinicalTrial.gov ID: NCT04110730 and unique protocol ID: IRB # 614-16-FB) was registered on October 1, 2019 (https://clinicaltrials.gov/ct2/show/NCT04110730) and posted on October 1, 2019. The study start date was January 10, 2020. The first participant was enrolled on January 14, 2020, and the trial is scheduled to be completed by August 23, 2023. The trial was updated January 18, 2020 and is currently recruiting
Highlights
The Centers for Disease Control and Prevention (CDC) estimates that about 4 out of every 10,000 babies are born with upper-limb reductions every year in the U.S [1, 2]
Recent technological advances in computer-aided design (CAD) programs and additive manufacturing (i.e., Three dimensional (3D) printing) [7], made it possible to design and manufacture child-friendly 3D printed prostheses that can be customized as the child growths with low-cost, lightweight, and desirable visual appearance [5,6,7,8,9,10,11]
Pediatric population The CDC indicated that children with upper-limb reduction deficiency (ULD) will face potential problems including, difficulties with normal development such as motor skills, needing assistance with daily activities such as self-care, limitations with certain movements, sports, or activities, as well as potential emotional and social issues because of physical appearance [1]
Summary
The Centers for Disease Control and Prevention (CDC) estimates that about 4 out of every 10,000 babies are born with upper-limb reductions every year in the U.S [1, 2]. Pediatric population The CDC indicated that children with upper-limb reduction deficiency (ULD) will face potential problems including, difficulties with normal development such as motor skills, needing assistance with daily activities such as self-care, limitations with certain movements, sports, or activities, as well as potential emotional and social issues because of physical appearance [1]. The reasons for pediatric rejecting rates include excessive weight, low visual appeal, low comfort, and lack of function [14,15,16] While these factors are exclusive to the design of the prosthesis, previous literature suggest the involvement of specific neural control mechanisms that limit the functional use of these devices [12, 13, 15]. The purpose of the current study was to determine the influence of upper-limb prostheses on brain activity and gross dexterity in children with congenital unilateral upper-limb reduction deficiencies (ULD) compared to typically developing children (TD)
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