Abstract
Little is known about the action observation network (AON) in children with unilateral cerebral palsy (UCP). Using fMRI, we aimed to explore AON and sensory-motor network (SMN) in UCP children and compare them to typically developed (TD) children and analyse the relationship between AON (re-)organization and several neurophysiological and clinical measures. Twelve UCP children were assessed with clinical scales and transcranial magnetic stimulation (TMS). For the fMRI study, they underwent a paradigm based on observation of complex and simple object-manipulation tasks executed by dominant and nondominant hand. Moreover, UCP and TD children carried out a further fMRI session to explore SMN in both an active motor and passive sensory task. AON in the UCP group showed higher lateralization, negatively related to performances on clinical scales, and had greater activation of unaffected hemisphere as compared to the bilateral representation in the TD group. In addition, a good congruence was found between bilateral or contralateral activation of AON and activation of SMN and TMS data. These findings indicate that our paradigm might be useful in exploring AON and the response to therapy in UCP subjects.
Highlights
Functional representation of actions, either observed or performed or even imagined, relies on the human action observation network (AON), constituted by the premotor, inferior frontal, parietal, and temporal regions
It has been extensively demonstrated that the type of lesion and reorganization, studied through functional magnetic resonance imaging and transcranial magnetic stimulation (TMS), of the central nervous system have an impact on severity of upper limb deficits [6, 7]
Neural Plasticity underlying unilateral cerebral palsy (UCP), are often categorized into three groups, according to location and timing of insult: type I: malformations or 1st and 2nd trimester patterns, presumed to occur in utero such as lissencephaly, focal cortical dysplasia, unilateral schizencephaly; type II: periventricular white matter lesions mainly occurring in the early 3rd trimester and often in preterm born infants such as periventricular leukomalacia (PVL); type III: cortical or deep grey matter lesions that occur towards the end of gestation, that is, around term age, such as infarcts in the territory of the middle cerebral artery (MCA) [7,8,9]
Summary
Functional representation of actions, either observed or performed or even imagined, relies on the human action observation network (AON), constituted by the premotor, inferior frontal, parietal, and temporal regions. Some neurophysiological studies exploring the presence and functionality of AON networks in children have suggested that maturation of AON has an age-related course from a more bilateral to a more lateralized representation, indicating physiological plasticity [3,4,5]. These properties are very meaningful, and it would be important to know if similar mechanisms could be observed in pathological conditions such as unilateral or asymmetrical early brain injuries in children with unilateral cerebral palsy (UCP). Neural Plasticity underlying UCP, are often categorized into three groups, according to location and timing of insult: type I (prenatal): malformations or 1st and 2nd trimester patterns, presumed to occur in utero such as lissencephaly, focal cortical dysplasia, unilateral schizencephaly; type II (perinatal): periventricular white matter lesions mainly occurring in the early 3rd trimester and often in preterm born infants such as periventricular leukomalacia (PVL); type III (connatal): cortical or deep grey matter lesions that occur towards the end of gestation, that is, around term age, such as infarcts in the territory of the middle cerebral artery (MCA) [7,8,9]
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