Abstract
BackgroundActivities of daily living frequently require children to make rapid decisions and execute desired motor actions while inhibiting unwanted actions. Children with hemiparetic cerebral palsy due to perinatal stroke may have deficits in executive functioning in addition to motor impairments. The objective of this study was to use a robotic object hit and avoid task to assess the ability of children with hemiparetic cerebral palsy to make rapid motor decisions.MethodsForty-five children with hemiparetic cerebral palsy due to perinatal stroke and 146 typically developing children (both groups ages 6–19 years) completed a robotic object hit and avoid task using the Kinarm Exoskeleton. Objects of different shapes fell from the top of the screen with increasing speed and frequency. Children were instructed to hit two specific target shapes with either hand, while avoiding six distractor shapes. The number of targets and distractors hit were compared between children with hemiparetic cerebral palsy and typically developing children, accounting for age effects. We also compared performance to a simpler object hit task where there were no distractors.ResultsWe found that children with hemiparetic cerebral palsy hit a greater proportion of total distractors compared to typically developing children, demonstrating impairments in inhibitory control. Performance for all children improved with age. Children with hemiparetic cerebral palsy hit a greater percentage of targets with each arm on the more complex object hit and avoid task compared to the simpler object hit task, which was not found in typically developing children.ConclusionsChildren with hemiparetic cerebral palsy due to perinatal stroke demonstrated impairments in rapid motor decision making including inhibitory control, which can impede their ability to perform real-world tasks. Therapies that address both motor performance and executive functions are necessary to maximize function in children with hemiparetic cerebral palsy.
Highlights
Activities of daily living frequently require children to make rapid decisions and execute desired motor actions while inhibiting unwanted actions
Executive functions are critical for children with hemiparetic cerebral palsy (HCP) to be able to compensate for motor impairments, incorporate the more affected arm in bilateral tasks, and achieve new motor skills through explicit learning [7, 8]
Of the clinical scores (BIT, Assisting Hand Assessment (AHA), and Melbourne), the arterial ischemic strokes (AIS) and periventricular venous infarcts (PVI) groups were only found to be significantly different for the Melbourne, in which the PVI group scored higher than the AIS group (t (27) = − 2.50, p = 0.0187)
Summary
Activities of daily living frequently require children to make rapid decisions and execute desired motor actions while inhibiting unwanted actions. Children with hemiparetic cerebral palsy due to perinatal stroke may have deficits in executive functioning in addition to motor impairments. The objective of this study was to use a robotic object hit and avoid task to assess the ability of children with hemiparetic cerebral palsy to make rapid motor decisions. Executive functions are critical for children with HCP to be able to compensate for motor impairments, incorporate the more affected arm in bilateral tasks, and achieve new motor skills through explicit learning [7, 8]. Executive function impairments can cause difficulty with academic performance [9], as well as general behavioral problems and hyperactivity [10]
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