Abstract
Unilateral cerebral palsy (CP) results from damage to the developing brain that occurs within the first 2 years of life. Previous studies found associations between asymmetry in the size of the corticospinal tract (CST) from the two hemispheres and severity of hand impairments in children with unilateral CP. The extent to which CST damage affects the capacity for hand function improvement is unknown. This study examines the association between an estimate of CST dysgenesis and (1) hand function and (2) the efficacy of intensive bimanual training in improving hand function. Children with unilateral CP, age 3.6–14.9 years, n = 35, received intensive bimanual training. Children engaged in bimanual functional/play activities (6 h/day, 15 days). Peduncle asymmetry, an estimate of CST dysgenesis, was measured on T1-weighted magnetic resonance imaging scans. Hand function was measured pre- and post-treatment using the assisting hand assessment (AHA) and Jebsen–Taylor test of hand function (JTTHF). AHA and JTTHF improved post-treatment (p < 0.001). Peduncle asymmetry was correlated with baseline AHA and JTTHF (p < 0.001) but not with AHA or JTTHF improvement post-training (R 2 < 0.1, p > 0.2). An estimate of CST dysgenesis is correlated with baseline hand function but is a poor predictor of training efficacy, possibly indicating a flexibility of developing motor systems to mediate recovery.
Highlights
Poor function in the affected hand is among the greatest functional impairments for children with unilateral cerebralExp Brain Res (2014) 232:2001–2009 palsy (CP) (Gordon and Friel 2009)
All children had a diagnosis of unilateral cerebral palsy (CP), bilateral damage was found on the magnetic resonance imaging (MRI) of five children
We examined the contribution of the following covariates to the linear relationship between peduncle asymmetry and baseline assisting hand assessment (AHA) and Jebsen–Taylor test of hand function (JTTHF): age, gender, side of lesion, lesion type, and the lag time from when the MRI was done to the time of training
Summary
Poor function in the affected hand is among the greatest functional impairments for children with unilateral cerebralExp Brain Res (2014) 232:2001–2009 palsy (CP) (Gordon and Friel 2009). Previous studies have demonstrated a strong association between asymmetry in the size of the corticospinal tract (CST) or cerebral peduncles and various features of hand function in children with unilateral CP (Bleyenheuft et al 2007; Duque et al 2003) and adult stroke patients (Barnes et al 2008; Pineiro et al 2000). Asymmetry in the size of the CST, measured using diffusion tensor imaging (DTI) (Bleyenheuft et al 2007; Yoshida et al 2010) or by cross-sectional area of the cerebral peduncles (Bouza et al 1994; Duque et al 2003), is strongly correlated with stereognosis, and a measure of hand function in activities of daily living in children with unilateral CP. Another study found a correlation between peduncle asymmetry and stereognosis in children with unilateral CP (Bleyenheuft et al 2007)
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