Unilateral Cerebral Palsy Research Articles

Perceived Experiences of Families of Children with Unilateral Cerebral Palsy in the Implementation of a Task-Specific Intervention in the Home Environment with an Upper Limb Splint: A Qualitative Study.

Specific home tasks and the use of splints seem to positively affect altered structures and functions, as well as the activities and participation, of children with unilateral cerebral palsy (UCP). However, how did families experience the implementation of these therapies? To describe the experiences as they were perceived by the families of children with UCP before, during, and after a specific task intervention in the home environment, either with or without upper limb splinting. A qualitative, descriptive, phenomenological study was conducted in a natural environment. Fourteen families caring for children with UCP who participated in a previous randomized controlled trial were included. Data from unstructured and semi-structured interviews were analyzed through a thematic analysis. Fourteen families (17 parents, age 37-47 years) caring for children with UCP (14 children, ages 6-10 years, 64% female) were interviewed. The following three themes emerged: "The project itself", in which families explained that they enrolled because of their trust in therapists; "Results obtained", where the main improvement was the integration of the assisting hand in the body schema; and "Lights and shadows", where families showed what they learned as positive points and some negative aspects related to the assessments and splints. The perceptions of the parents after the specific task intervention in the home environment showed a greater integration of the most affected side. Nevertheless, although the support of a splint on the hand can have beneficial results in terms of performance, other drawbacks leading to the disuse of the splint were highlighted.

Cerebral palsy characteristics in term-born children with and without detectable perinatal risk factors: A cross-sectional study.

To compare, in term-born children with cerebral palsy (CP), the characteristics of those who exhibit detectable risk factors for CP at birth with those who do not. This was a cross-sectional study of term-born children using the Canadian Cerebral Palsy Registry comparing those with and without perinatal risk factors and/or neonatal symptoms for pregnancy, birth and neonatal characteristics, magnetic resonance imaging (MRI) findings, CP subtype, and impairment severity. Risk factors were quantified with a CP risk calculator. Multivariable and multinomial regressions were expressed as odds ratios (OR) and relative risk ratios. Of 1333 term-born children, 781 (58.6%) had complete variables for the CP risk calculator, of whom 195 (25%) had 'undetectable' newborn infant CP risk, and they did not have greater postneonatal brain injury. Focal injury on MRI was more common (OR 2.0, 95% confidence interval [CI] 1.3-3.1) than in the 'detectable' group. The 'undetectable' group had more unilateral CP (OR 1.8, 95% CI 1.3-2.6), less severe motor impairment (OR 0.76, 95% CI 0.67-0.86), and were more verbal (OR 2.3, 95% CI 1.5-3.6). In the Canadian CP Registry, one-quarter of term-born children lacked neonatal encephalopathy, seizures, or perinatal risk factors. They were more likely to have unilateral CP, focal MRI findings, and communicate with words than children with risk factors or neonatal symptoms.

Changes in diffusion MRI and clinical motor function after physical/occupational therapies in toddler-aged children with spastic unilateral cerebral palsy.

Diffusion-weighted magnetic resonance imaging (DMRI) is a potential tool to assess changes in brain connectivity and microstructure resulting from physical and occupational therapy in young children with cerebral palsy. This works was carried out to assess whether DMRI can detect changes after 36 weeks of physical and occupational therapy in the microstructure and connectivity of the brains of children with cerebral palsy and determine whether imaging findings correlate with changes in clinical measures of motor function. Five children underwent anatomical MRI and DMRI and evaluations of motor function skills at baseline and after 36 weeks of intensive or once-weekly physical and occupational Perception-Action Approach therapies. Diffusion tensor imaging and constrained spherical deconvolution methods were used to calculate fractional anisotropy (FA) and fiber orientation distribution functions (fODFs), respectively. The fODFs were used to generate tractograms of the cerebrospinal tract (CST). After 36 weeks of physical and occupational therapy, all children showed increases in motor function. No changes were observed in anatomical MRI before and after therapy but CST tractography did show small differences indicating possible altered microstructure and connectivity in the brain. FA values along the CSTs, however, showed no significant changes. Reliable longitudinal DMRI can be employed in toddler-aged children with CP and DMRI has the potential to monitor neuroplastic changes in white matter microstructure. However, there is a high variability between subjects and clinical improvements were not always correlated with measures of FA along the CST.

An exploratory study of functional brain activity associated with gross motor function improvement in children with unilateral cerebral palsy

ABSTRACT Purpose Identify relations of gross motor function and primary motor cortex (M1) functional activity pre and post gross motor interventions for children with unilateral cerebral palsy (UCP). Methods Thirteen children with UCP completed a gross motor intervention. Pre/post-intervention functional MRI outcomes included the laterality index (LI), activation volume, and spatial overlap of M1 activation during active ankle dorsiflexion. Advanced gross motor function (Challenge) was assessed pre/post-intervention, and 2–6 months later. Bivariate correlations and linear regression assessed relations between neuroimaging and motor function. Results Mean pre-intervention M1 activity was contralateral during dominant (LI = +0.85, SD 0.21) but variable during the affected (LI = +0.43, SD 0.57) ankle dorsiflexion. Changes in motor function and neuroimaging outcomes were not significantly associated. However, smaller affected ankle activation and less spatial overlap between ankle activations pre-intervention predicted Challenge improvements post-intervention (adjusted R2 = 0.74, p = .001.) Conclusions This exploratory study identified pre-intervention neuroimaging predictors of post-intervention improvements in advanced gross motor function.

Spatiotemporal coordination in children with unilateral cerebral palsy: Insights from a bimanual goal-directed task

BackgroundIn children with unilateral cerebral palsy (uCP), bimanual assessments mostly focus on qualitative assessments of the impaired upper limb during bimanual tasks, which do not capture the spatiotemporal coordination between both hands. Hence, we aimed to advance our understandings in spatiotemporal coordination in children with uCP compared to typically developing children (TDC) using a bimanual, asymmetrical, goal-directed task. Participants and methodologyIn this observational study, thirty-seven children with uCP (11y8m±2y10m, 20 males, 16 right-sided uCP, Manual Ability Classification System level I = 23, II = 11, III = 3) and 37 age and sex-matched TDC opened a box with one hand and pressed a button inside using the opposite hand. Spatiotemporal bimanual (movement time, temporal coupling, movement overlap, goal synchronisation) and unimanual (movement time, path length and smoothness) parameters were extracted. Between groups comparisons were investigated using a two-way mixed ANCOVA with age as covariate (α < 0.05). Additionally, correlation coefficients between unimanual and bimanual parameters were calculated. ResultsCompared to TDC, children with uCP were slower (p = 0.01, ηp2 = 0.13) and presented unimanual spatiotemporal deficits in both upper limbs (p < 0.03, ηp2>0.10), which worsened in children with lower manual abilities (p < 0.04, ηp2>0.19). However, they did not differ in bimanual coupling (p > 0.31, ηp2<0.03). Furthermore, slower movement time was related with increased unimanual spatiotemporal deficits bilaterally (r = 0.34–0.80, p = 0.001–0.04), suggesting that reduced performance at both upper limbs contributes to bimanual difficulties in children with uCP. ConclusionsThe bilateral reduced spatiotemporal performance, related to longer bimanual movement time, stresses the importance to assess and treat both upper limbs in children with uCP.

Effectiveness of intensive motor learning approaches from working on a vertical surface on hemiplegic children’s upper limb motor skills, a randomized controlled trial

Purpose This study compares the effect of intensive motor learning approaches on improving the quality of upper extremity skills in children with unilateral cerebral palsy (UCP) by working on vertical surfaces versus horizontal surfaces during rehabilitation sessions. Materials and methods Forty UCP children of both sexes were randomized into two equal groups. All participants received 60 min of intensive motor learning approaches three days/week for three successive months. These approaches included constraint-induced movement therapy (CIMT), in which children wore a splint or sling on the unaffected upper limb, as well as hand-arm bimanual intensive training (HABIT) that requires the use of both hands during specific play-based activities. The control group received training on a horizontal surface while the child sat in front of an elbow-height table while the study group (vertical surface training) sat or stood in front of a wall/mirror/board. The task requirements were graded to ensure success. Results Statistically significant differences were detected between the mean values of post-treatment of all scorers, with a greater percentage of improvement in favor of the study group. Conclusions This study revealed that working on a vertical surface improved upper limb motor skills more significantly than working on a horizontal surface.

Long-term effects of different number of botulinum toxin injections into the gastrocnemius muscle on function and muscle morphology in children with cerebral palsy

BackgroundBotulinum toxin (BoNT) injections are used to reduce spasticity, and sometimes repeated injections of the toxin are required. The aim of this study is to investigate the effects of the number of injections of BoNT into the gastrocnemius muscle on function, muscle morphology, muscle stiffness and muscle vascularization in children with cerebral palsy (CP). MethodsThe study included 22 children with unilateral or bilateral spastic type CP aged 5-13 years who had previously received one, two, or three BoNT injections into the gastrocnemius muscle. A total of 29 gastrocnemius muscles were evaluated. Gastrocnemius muscle morphology (muscle cross-sectional area, thickness, fascicle length and pennation angle) was examined by ultrasonography, muscle stiffness by shear wave ultrasound elastography and muscle vascularization by Superb Microvascular Imaging. The functional status of the children was evaluated by the Gross Motor Function Measurement, the Timed-Up-and-Go Test, the Squat Test, the Vertical Jumping Test and the Sit-and-Reach Test. ResultsIn the motor functions and muscle morphology values were similar in all three groups (p>0.05). Muscle stiffness values were higher (p=0.035) and vascularization values were lower (p=0.03) in the group that received three injections compared to the groups that received one injection. There was a moderate positive correlation of the number of BoNTs with muscle stiffness (p<0.05, r=0.454) and a moderate negative correlation with muscle vascularization (p<0.05, r=-0.497). ConclusionsRepeated BoNT applications have no effect on motor functions and muscle morphology in children with CP, whereas BoNT injections administered three times increase muscle stiffness and decrease vascularization.

Infant Modified Constraint-Induced Movement Therapy Paired With Neuromuscular Electrical Stimulation: A Feasibility Study.

To determine the feasibility of modified constraint-induced movement therapy (mCIMT) paired with neuromuscular electrical stimulation (NMES) for infants with asymmetrical hand function (AHF). Five infants received an experimental ABA design: (A1) 3weeks of our Standard AHF Care, (B) 3weeks mCIMT-NMES, and (A2) 3weeks of our Standard AHF Care. Parents tracked key data in a daily log, and infants were assessed 4 times using the Hand Assessment for Infants and Peabody Developmental Motor Scale-2. There was a high level of participant enrollment, visit frequency adherence, and compliance with the treatment protocol. No adverse events were reported. Mean Hand Assessment for Infants Both Hands measure scores changed more after mCIMT-NMES than after our Standard AHF Care. mCIMT-NMES is a feasible early intervention for infants with AHF at risk for unilateral cerebral palsy. A future study in a larger sample should examine the efficacy of mCIMT-NMES in this population.

Group-based progressive functional, high-intensity training in adolescents and young adults with unilateral cerebral palsy – a tool to improve gross motor function, endurance and gait? – a pilot study

ABSTRACT Purpose This pilot study assessed the safety and effects of progressive functional high-intensity training in a group setting for adolescents with unilateral cerebral palsy (CP) on daily function indicators. Methods Nine adolescents (mean age 16.9 years, GMFCS levels I–II) participated in 12 weeks of training (2x/week). Evaluations included 3D gait analysis, the 6-min walking test (6MWT), clinical exams, and the Gross Motor Function Measure-66 (GMFM-66). Results No adverse events occurred, and GMFM-66 scores significantly improved (p = .031, Δ = 2.19%). Although increases in 6MWT (p = .09, Δ = 29.8 m) performance and propulsion ratio (p = .067, Δ = 5.4%) for the affected leg were observed, they were not statistically significant. Discussion The study suggests that this training is safe and may enhance gross motor function, endurance, and gait asymmetry in unilateral CP. Future research should include upper limb evaluations and out-of-clinic motion analysis with wearable inertial measurement units (IMUs) to provide a more comprehensive assessment of functional movements.

Impact of virtual reality and mirror therapy on balance, muscle strength and quality of life in children with unilateral cerebral palsy: a double blinded randomized comparative study

Background and Purpose This study aimed to compare between the impact of virtual reality and mirror therapy on balance, muscle strength and quality of life in unilateral cerebral palsy children. Materials and methods This study involved 36 children of both sexes with unilateral cerebral palsy. Their ages ranged between 6 to 10 years and their motor function ability fell between levels I and II on Growth Motor Functional Classification System (GMFCS). Their grade of spasticity on Modified Ashworth scale was from 1+ to 2. They were allocated to one of two study groups (A and B). A designated physical rehabilitation program was given to both groups. furthermore, group A received a wii fit virtual reality-based program while, group B received mirror therapy. Children in both groups received treatment for three consecutive months, three days per week, 60 minutes per day. Balance, muscle strength and quality of life were assessed using biodex balance system, lafayette hand-held dynamometer and pediatric quality of life inventory cerebral palsy Module respectively for each child in two groups pre and post treatment program. Results Children in the two groups demonstrated a noticeable improvement in the post-treatment average scores of all evaluated outcomes (p 0.001) when compared to pre-treatment average scores. By comparing posttreatment values of both groups, group A showed a noticeably greater improvement than group B (p 0.05). Conclusions Both virtual reality and mirror therapy may be recommended to enhance balance, muscle strength and quality of life in children with unilateral cerebral palsy. Virtual reality is more beneficial in enhancing balance, muscular strength and quality of life among those children.

Pilot evaluation of changes in motor control after a CrossFit® intervention in adolescents with unilateral cerebral palsy

Pilot evaluation of changes in motor control after a CrossFit® intervention in adolescents with unilateral cerebral palsy

Test-retest reliability and level of agreement in kinematic variables during a standardized drinking task in adults with unilateral CP

Test-retest reliability and level of agreement in kinematic variables during a standardized drinking task in adults with unilateral CP

WITHDRAWN: Innovative Combination of focal vibration therapy and botulinum toxin to treat equinus in a child with unilateral spastic cerebral palsy

WITHDRAWN: Innovative Combination of focal vibration therapy and botulinum toxin to treat equinus in a child with unilateral spastic cerebral palsy

Serious Game in Children with Unilateral Spastic Cerebral Palsy and Equinus Gait: Muscle shortening prevalence on the spasticity

Serious Game in Children with Unilateral Spastic Cerebral Palsy and Equinus Gait: Muscle shortening prevalence on the spasticity

UPPER EXTREMITY SELECTIVE VOLUNTARY MOTOR CONTROL IN CHILDREN WITH UNILATERAL CEREBRAL PALSY AND ITS ASSOCIATION WITH UPPER EXTREMITY FUNCTIONS

Purpose: The study aimed to define the upper extremity selective voluntary motor control (SVMC) in children with unilateral Cerebral Palsy (CP). It was also aimed to investigate the relationship between upper extremity SVMC and upper extremity functions. Methods: Twenty-four children diagnosed with unilateral CP, aged between 6 and 18, were included in the study. The Quality of Upper Extremity Skills Test (QUEST) assessed the upper extremity functions. Manual dexterity was measured using the Jebsen-Taylor Hand Function Test (JTT) timed tasks. The SVMC of the upper extremity was measured using the Selective Control of Upper Extremity Scale (SCUES) using the videotape recording method. Results: Statistically significant decreases in SCUES scores from shoulder to fingers were recorded using the Page statistical test for trend (p

Robotic assessment of bilateral and unilateral upper limb functions in adults with cerebral palsy

BackgroundChildren with unilateral cerebral palsy (CP) exhibit motor impairments predominantly on one side of the body, while also having ipsilesional and bilateral impairments. These impairments are known to persist through adulthood, but their extent have not been described in adults with CP. This study’s aim is to characterize bilateral and unilateral upper limbs impairments in adults with CP.MethodsNineteen adults with CP (34.3 years old ± 11.5) performed three robotic assessments in the Kinarm Exoskeleton Lab, including two bilateral tasks (Object Hit [asymmetric independent goals task] and Ball on Bar [symmetric common goal task]) and one unilateral task (Visually Guided Reaching, performed with the more affected arm [MA] and less affected arm [LA]). Individual results were compared to sex, age and handedness matched normative data, describing the proportion of participants exhibiting impairments in each task-specific variable (e.g., Hand speed), each performance category (e.g., Feedforward control) and in global task performance. Associations were assessed using Spearman correlation coefficients between: 1: the results of the MA and LA of each limb in the unilateral task; and 2: the results of each limb in the unilateral vs. the bilateral tasks.ResultsThe majority of participants exhibited impairments in bilateral tasks (84%). The bilateral performance categories (i.e., Bimanual) identifying bilateral coordination impairments were impaired in the majority of participants (Object Hit: 57.8%; Ball on Bar: 31.6%). Most of the participants were impaired when performing a unilateral task with their MA arm (63%) and a smaller proportion with their LA arm (31%). The Feedforward control was the unilateral performance category showing the highest proportion of impaired participants while displaying the strongest relationship between the MA and LA arms impairments (rs = 0.93). Feedback control was the unilateral performance category most often associated with impairments in bilateral tasks (6 out of 8 performance categories).ConclusionsAdults with CP experienced more impairment in bilateral tasks while still having substantial impairments in unilateral tasks. They frequently display Feedforward control impairments combined with a higher reliance on Feedback control during both bilateral and unilateral tasks, leading to poorer motor performance.

Parents in the Driver's Seat-Experiences of Parent-Delivered Baby-mCIMT Coached Remotely.

Background/Objectives: Recent guidelines on early intervention in children at high risk of cerebral palsy (CP) recommend parental involvement and family-centered home-based interventions with parents as primary trainers. Therapist coaching by home visitation is resource demanding, and telerehabilitation is a viable option for remote intervention and coaching. This study aims to describe parents' experiences of engaging in Baby-mCIMT coached remotely. Their infants are at high risk of unilateral cerebral palsy and the parents have been the primary trainers in regard to home-based intervention, optimizing the use of the affected hand. Methods: A qualitative approach involving semi-structured interviews with eight parents was employed. Data were analyzed using qualitative content analysis. Results: The overarching theme "Parents in the driver's seat-learning through remote coaching to create conditions to enhance the child's motor skills" describes parents' experiences as primary training providers. The following three underlying categories with subcategories were identified: (1) Baby-mCIMT coached remotely in an everyday context-practical and technical prerequisites; (2) the child's response and the therapists' coaching supports active parental learning; (3) capability and sense of control-strengthening and demanding aspects. Conclusions: Our findings revealed that Baby-mCIMT coached remotely empowered the parents as primary trainers, which provided them with opportunities for understanding and learning about their child and their development. The findings underscore the importance of responsive professional guidance and a strong therapist-parent relationship to succeed with the Baby-mCIMT program coached remotely and to manage the digital coaching format.

Magic-themed motor training on daily bimanual task performance in children with unilateral spastic cerebral palsy: A systematic review and meta-analysis.

Magic-themed motor training on daily bimanual task performance in children with unilateral spastic cerebral palsy: A systematic review and meta-analysis.

The real magic of magic therapy: Improving daily bimanual task performance in children with unilateral spastic cerebral palsy.

The real magic of magic therapy: Improving daily bimanual task performance in children with unilateral spastic cerebral palsy.

The Motor Optimality Score-Revised Improves Early Detection of Unilateral Cerebral Palsy in Infants with Perinatal Cerebral Stroke.

Neonatal cerebral stroke includes a range of focal and multifocal ischemic and hemorrhagic brain lesions, occurring in about one of 3000 live births. More than 50% of children with neonatal stroke develop adverse outcomes, mainly unilateral cerebral palsy. Asymmetries in segmental movements at three months have been proven to be an early sign of CP in infants with unilateral brain damage. Recognition of additional early signs could enhance prognostic assessment and enable an early and targeted intervention. The aim of the study was to assess early signs of CP in infants with arterial cerebral stroke through the General Movements Assessment and the Motor Optimality Score-Revised (MOS-R). Twenty-four infants born at term (12 females and 12 males) diagnosed with ACS, and 24 healthy infants (16 females and 8 males) were assessed. The GMs (fidgety movements) and MOS-R were assessed from videos recorded at 11-14 weeks of post-term age. Cognitive and motor outcomes were assessed at 24 months using the Griffiths III developmental quotient and Amiel-Tison neurological examination. The gross motor function classification system expanded and revised (GMFCS-E&R) was adopted to categorize CP. Among infants with ACS, 21 (87.5%) developed unilateral CP. Most of them showed non-disabling CP (14 had GMFCS-E&R grade 1 [66.6%], 6 grade 2 [28.6%], and 1 grade 5 [4.8%]). Fidgety movements (FMs) were absent in 17 (70.8%), sporadic in 4 (16.7%) infants, and normal in 3 (12.5%). Segmental movement asymmetry was found in 22/24 (91.7%). According to the MOS-R, motor items (kicking, mouth movements), postural patterns (midline centered head, finger posture variability), and movement character (monotonous and stiff) were statistically different among infants with ACS and healthy infants. The MOS-R median global score was lower in the group with ACS compared to the control group (6 vs 26; p < 0.01). FMs, segmental movement asymmetry, and MOS-R global score were significantly correlated with abnormal outcome. MOS-R global scores less than or equal to 13 had 100% specificity and sensitivity in predicting GMFCS-E&R grade ≥ 2 CP in infants with ACS. The rate of CP was high among infants with ACS, but in most cases it showed low GMFCS-E&R grades. The study highlighted a significant correlation between MOS-R, together with absent FMs and unilateral CP in infants with ACS. Moreover, the MOS-R showed high sensitivity and specificity in the prediction of CP. Combined assessment of FMs and MOS-R could help to better identify infants at high risk of developing UCP in a population of infants with ACS. Early identification of precocious signs of unilateral CP is fundamental to providing an early individualized intervention.