Unilateral Cerebral Palsy Research Articles

Does accelerometry reflect hand function in infants at risk of unilateral cerebral palsy? A secondary analysis of BB-Bim results

BackgroundInfants at high-risk of unilateral Cerebral Palsy (UCP) may have asymmetry in upper extremity movement and function, which should be identified as soon as possible for management. AimsTo explore the feasibility of using two AX3 Axivity monitors in wrist-worn bracelets to quantify movements, and to identify whether accelerometry parameters are consistent with hand function. Methods and procedures6 infants at high risk of UCP (aged 3 to −12 months) were included in a Single-Case Experimental Design to explore the impact of an 8-week bimanual stimulation home program. OutcomesEach week of the baseline (randomized duration 4–7 weeks) and 8-week program, the Hand Assessment for Infants (HAI) was performed and accelerometry parameters were collected during HAI and also during spontaneous activity, several times a week. ResultsActimetry was analyzed during HAI and 238 spontaneous activity sessions (mean 42 ± 21 min). Actimetry ratios distribution and evolution show a high variability, especially for spontaneous activity. No strong correlation was found between HAI scores and accelerometry parameters, either collected during HAI, or during spontaneous activity times. Conclusion and implicationsDespite its feasibility, using accelerometry bracelets looks unreliable for detecting and monitoring hand function in infants under one year.

Hand use development in children with unilateral cerebral palsy.

Linked Article: https://onlinelibrary.wiley.com/doi/10.1111/dmcn.14957

Combining Unimanual and Bimanual Therapies for Children with Hemiparesis: Is There an Optimal Delivery Schedule?

Constraint-induced movement therapy (CIMT) and bimanual therapy (BT) are among the most effective hand therapies for children with unilateral cerebral palsy (uCP). Since they train different aspects of hand use, they likely have synergistic effects. The aim of this study was to examine the efficacy of different combinations of mCIMT and BT in an intensive occupational therapy program for children with uCP. Children (n = 35) participated in intensive modified CIMT (mCIMT) and BT, 6 weeks, 5 days/week, 6 h/day. During the first 2 weeks, children wore a mitt over the less-affected hand and engaged in functional and play activities with the affected hand. Starting in week 3, bimanual play and functional activities were added progressively, 1 hour/week. This intervention was compared to two different schedules of block interventions: (1) 3 weeks of mCIMT followed by 3 weeks of BT, and (2) 3 weeks of BT followed by 3 weeks of mCIMT. Hand function was tested before, after, and two months after therapy with the Assisting Hand Assessment (AHA), Pediatric Evaluation of Disability Inventory (PEDI), and Canadian Occupational Performance Measure (COPM). All three groups of children improved in functional independence (PEDI; p < 0.031), goal performance (COPM Performance; p < 0.0001) and satisfaction (COPM Satisfaction; p < 0.0001), which persisted two months post-intervention. All groups showed similar amounts of improvement, indicating that the delivery schedule for mCIMT and BT does not significantly impact the outcomes.

Utilization of shear wave elastography to quantify and predict response to upper extremity botulinum toxin injections in patients with cerebral palsy: A pilot study

ObjectiveShear wave elastography (SWE) was used to quantify change in upper extremity muscle stiffness in patients with unilateral spastic cerebral palsy (USCP) following botulinum toxin A (BTX-A) therapy. We hypothesized that SWE measures would decrease following ultrasound-guided BTX-A injection, and correlate with functional improvement. MethodsSWE measures of BTX-A treated muscles were recorded immediately pre-injection, and at 1-, 3- and 6-months post-injection. At the same timepoints, functional assessment was performed using the Modified Ashworth Scale (MAS), and passive and active range of motion (PROM and AROM) measures. Correlation of SWE with MAS, PROM and AROM, as well as the relationship between change in SWE and change in MAS, PROM and AROM was determined using Spearman’s rank correlation coefficient and generalized estimating equation modeling. Results16 muscles were injected and longitudinally assessed. SWE and MAS scores decreased following BTX-A injection (p = 0.030 and 0.004, respectively), reflecting decreased quantitative and qualitative muscle stiffness. Decreased SWE reached statistical significance at 1- and 3-months, and 1-, 3- and 6-months for MAS. When comparing relative change in SWE to relative change in AROM, larger change in SWE strongly correlated with positive change in AROM (p-value range:<0.001–0.057). BTX-A responders also demonstrated lower baseline SWE (1.4 m/s) vs. non-responders (1.9 m/s), p = 0.035. ConclusionUltrasound-guided BTX-A injections in patients with USCP resulted in decreased quantitative and qualitative muscle stiffness. Strong correlation between change in SWE and AROM, as well as the significant difference in baseline SWE for BTX-A responders and non-responders, suggests SWE may provide a useful tool to predict and monitor BTX-A response.

Assessing engagement in rehabilitation: development, validity, reliability, and responsiveness to change of the Rehabilitation Observation Measure of Engagement (ROME)

Purpose We describe the development of an observational video coding tool, the Rehabilitation Observation Measure of Engagement (ROME), to quantify engagement in rehabilitative settings at the person (internal state of an individual) and between-system (interaction between individuals) level. Methods Forty-nine children with unilateral spastic cerebral palsy (29 males; Age: M = 9.28 yrs, SD = 3.08 yrs) and their interventionists were videotaped during different activities. Construct validity was examined by correlating the ROME with the Engagement vs. Disaffection with Learning Survey and the Pediatric Rehabilitation Intervention Measure of Engagement – Observation questionnaire. Inter- and intra-rater reliability were examined using two independent raters. The ROME’s responsiveness to change was examined by comparing scores across activities. Results For construct validity, results showed a positive correlation for person-level engagement (r = 0.444, p = 0.003). No relationship was found between-system-level engagement. High intrarater (91.8%) and interrater (96.1%) reliability was found. The ROME’s responsiveness to change was supported by children exhibiting lower engagement scores during repetitive shaping activities. Conclusion These findings provide evidence that the ROME is a reliable tool to objectively examine the construct of engagement within rehabilitation and is valid for quantifying person-level engagement. It provides information that cannot be extracted from questionnaires and can help guide intervention decisions.

Investigation of brain mechanisms underlying upper limb function in bilateral cerebral palsy using EEG

ObjectiveFew studies focus on upper limbs in bilateral cerebral palsy (CP) despite potential bimanual deficits. Electroencephalography (EEG) was utilized to investigate brain mechanisms underlying upper limb tasks in bilateral CP and typical development (TD) and relationships to function. Methods26 (14 CP; 12 TD) completed the Box and Blocks Test and transport task with paper, sponge or mixed blocks, while recording EEG and motion data. ResultsGroup effects for path time, path length and Box and Blocks Test revealed bimanual deficits. Four sensorimotor-related EEG clusters were identified. Group effects were found in premotor and dominant motor clusters with greater beta event-related desynchronization (ERD) in CP. Hand and hand by group effects were found in the dominant motor cluster, showing greater ERD with the more affected hand in CP. Condition effects were prominent in the posterior parietal cluster with higher ERD reflecting greater difficulty in force modulation. ConclusionsHigher brain activation associated with greater bimanual deficits is similar to our lower limb findings but contrasts studies in TD or unilateral CP linking higher ERD to greater proficiency. SignificanceBilateral CP shows overreliance on the dominant hemisphere with the less functional hand and higher brain activity presumably related to excessive intracortical connectivity.

A protocol for a single-arm interventional study assessing the effects of a home-based joystick-operated ride-on-toy navigation training programme to improve affected upper extremity function and spontaneous use in children with unilateral cerebral palsy (UCP)

IntroductionChildren with unilateral cerebral palsy (UCP) face significant limitations in upper extremity (UE) function and require effective interventions that promote intensive goal-directed practice while maximising motivation and adherence with therapy....

Corticomuscular Coherence in Children with Unilateral Cerebral Palsy: A Feasibility and Preliminary Protocol Study.

Objective This study assessed the feasibility of corticomuscular coherence measurement during a goal-directed task in children with unilateral cerebral palsy while establishing optimal experimental parameters. Methods Participants (Manual Ability Classification System levels I-III) completed a submaximal isometric goal-directed grip task during simultaneous electroencephalography and electromyography (EMG) acquisition. Results All participants (n = 11, 6 females, mean age 11.3 ±2.4 years) completed corticomuscular coherence procedures. Of the 40 trials obtained per extremity, an average of 29 (n = 9) and 27 (n = 10) trials were retained from the more- and less-affected extremities, respectively. Obtaining measurement stability required an average of 28 trials per extremity. Conclusion Findings from this work support the feasibility of corticomuscular coherence measurement in children with unilateral cerebral palsy. Acquiring 28 to 40 corticomuscular coherence trials per extremity is ideal. The experimental parameters established in this work will inform future corticomuscular coherence application in pediatric unilateral cerebral palsy.

Brain Stimulation and Constraint Induced Movement Therapy in Children With Unilateral Cerebral Palsy: A Randomized Controlled Trial

Background There is a crucial need to devise optimum rehabilitation programs for children with cerebral palsy (CP). Objective This study aimed to assess the feasibility, safety, and efficacy of combining 6-Hz primed, low-frequency, repetitive transcranial magnetic stimulation (rTMS) with modified constraint-induced movement therapy (mCIMT) in improving upper limb function in children with unilateral CP. Methods Children aged 5 to 18 years with unilateral CP were randomized (23 in each arm) to receive 10 sessions of mCIMT with real rTMS (intervention arm) or mCIMT with sham rTMS (control arm), on alternate weekdays over 4 weeks. The primary outcome was the difference in mean change in Quality of Upper Extremity Skills Test (QUEST) scores. Secondary outcomes were changes in QUEST domain scores, speed and strength measures, CP quality of life (CP-QOL) scale scores, and safety of rTMS. Results All 46 children completed the trial except one. At 4 weeks, the mean change in total QUEST scores was significantly higher in the intervention arm as compared to the control arm (11.66 ± 6.97 vs 6.56 ± 4.3, d = 5.1, 95% CI 1.7-8.5, P = .004). Change in “weight bearing” and “protective extension” domain score was significantly higher for children in the intervention arm. These improvements were sustained at 12 weeks (P = .028). CP-QOL scores improved at 12 weeks. No serious adverse events were seen. Conclusion A 6-Hz primed rTMS combined with mCIMT is safe, feasible, and superior to mCIMT alone in improving the upper limb function of children with unilateral CP. Trial Registration: ClinicalTrials.gov Identifier: NCT03792789.

Detecting Movement Changes in Children with Hemiparesis after Upper Limb Therapies: A Responsiveness Analysis of a 3D Bimanual Protocol.

The "Be an Airplane Pilot" (BE API) protocol was developed to evaluate upper limb (UL) kinematics in children with unilateral cerebral palsy (uCP) during bimanual tasks. The aim of this study was to investigate the responsiveness of this protocol to changes in kinematics and movement quality after UL therapies, using individual and group analyses, and to analyse the relationships between kinematic and functional changes in these children. Twenty children with uCP (5-15 years old) either participated in bimanual intensive therapy or received UL botulinum toxin injections. All the children performed the BE API protocol and functional assessments (Assisting Hand Assessment [AHA]) before and after the interventions. The individual analyses found kinematic changes in 100% of the children after therapy. The group analysis found significantly higher trunk and shoulder deviations after the intensive therapy. No significant changes were found for smoothness or trajectory straightness. The changes in the kinematic deviations were moderately correlated with the changes in the AHA scores. This study confirmed the responsiveness of the BE API protocol to change after therapy; therefore, the protocol is now fully validated and can be implemented in clinical practice. Its use should help in the accurate identification of impairments so that individualized treatments can be proposed.

Exploring Temporospatial Gait Asymmetry, Dynamic Balance, and Locomotor Capacity After a 12-Week Split-Belt Treadmill Training in Adolescents with Unilateral Cerebral Palsy: A Randomized Clinical Study

Aim To investigate the effects of a 12-week split-belt treadmill walking (Sb-TW) practice using an error augmentation strategy on temporospatial gait asymmetries, dynamic balance, and locomotor capacity in adolescents with unilateral cerebral palsy (ULCP). Methods Fifty-two adolescents with ULCP (age: 10–16 years) were randomized into either the Sb-TW group (n = 26; underwent repeated Sb-TW practice, with exaggeration of the initial step-length asymmetry, three times/week, for 12 sequential weeks) or control group (n = 26; received equivalent dosages of traditional single-belt treadmill training). Step-length and swing-time asymmetries, directional (LoSdirectional) and overall (LoSoverall) limits of stability, and locomotor capacity [6-minute walk test (6-MWT), Timed Up and Down Stair test (TUDS), and 10-m Shuttle Run Test (10mSRT)] were assessed pre- and post-intervention. Results The Sb-TW group demonstrated more favorable changes in step-length asymmetry (p < .001, η 2 partial = 0.27), LoSdirectional [affected side direction (p = .033, η 2 partial = 0.09), forward direction (p = .004, η 2 partial = 0.16), and backward direction (p = .01, η 2 partial = 0.12)], and LoSoverall (p < .001, η 2 partial = 0.31) than the control group. Also, the Sb-TW group showed significantly higher locomotor capacity [6-MWT (p < .001, η 2 partial = 0.38), TUDS (p = .032, η 2 partial = 0.09), 10mSRT (p = .021, η 2 partial = 0.10)] as compared to the control group. Conclusion The Sb-TW-induced adaptations can be capitalized on for remediating spatial gait asymmetry, dynamic balance deficits, and impaired locomotor performance in adolescents with ULCP.

Modulation of the angle of rigid ankle-foot orthosis to control knee hyperextension in children with unilateral cerebral palsy

The aim of this study was to compare the effects of a modified 5° dorsiflexion ankle-foot orthosis (AFO) to the traditional right angle rigid AFO on controlling knee hyperextension and improving spatiotemporal gait parameters in children with unilateral cerebral palsy (CP). We used a pretest-posttest experimental design in which forty children (2-6 years) of both genders with unilateral CP were randomly assigned into two equal groups (A and B). Group A used a traditional right angle rigid AFO and received a selective exercise program to enhance walking pattern while group B used a modified 5° dorsiflexion rigid AFO and received the same exercise program as group A. Assessments for the knee angle during mid-stance and spatiotemporal gait parameters were done pre and post-intervention programs for both groups. All statistical analyses were conducted using the Statistical Package for Social Studies (SPSS) version 25 for windows (IBM SPSS, Chicago, IL, USA). There was a significant decrease in the knee angle in mid-stance post-treatment in groups A and B compared to pre-treatment (p &lt; 0.001) but a significant increase in spatiotemporal gait parameters post-treatment in groups A and B compared to pre-treatment (p &lt; 0.001). There was a significant decrease in the knee angle in mid-stance of group B compared to group A in post-treatment (p &gt; 0.001). However, there was no significant difference in spatiotemporal gait parameters between groups post treatment (p &gt; 0.05). In conclusion, using a rigid AFO improves the spatiotemporal gait parameters and decreases knee hyperextension for children with unilateral CP. Furthermore, a modified 5° dorsiflexion rigid AFO is recommended for better control of knee hyperextension than a traditional right angle rigid AFO for such cases.

Prevalence, birth, and clinical characteristics of dyskinetic cerebral palsy compared with spastic cerebral palsy subtypes: A Norwegian register-based study.

To study the prevalence, birth, and clinical characteristics of children with dyskinetic cerebral palsy (CP) in Norway compared with spastic quadriplegic CP and other spastic CP subtypes. Data on children born from 1996 to 2015 were collected from the Norwegian Quality and Surveillance Registry for Cerebral Palsy and the Medical Birth Registry of Norway. One hundred and seventy (6.8%) children had dyskinetic CP. The birth prevalence decreased during 1996 to 2015 from 0.21 to 0.07 per 1000 livebirths (p < 0.001). Dyskinetic CP was more often associated with term/post-term birth, and motor and associated impairments were more severe compared with spastic bilateral and unilateral CP, but less severe than spastic quadriplegic CP. On neuroimaging, grey matter injuries were most prevalent in dyskinetic CP (mainly basal ganglia/thalamus) and spastic quadriplegic CP (mainly cortico-subcortical), white matter injuries in spastic bilateral, and white and grey matter injuries were equally common in spastic unilateral CP. Normal neuroimaging and brain maldevelopment were present in 25% of children with dyskinetic CP. The decrease in birth prevalence of dyskinetic CP was probably due to improved antenatal and perinatal care. Potential sentinel events at term were more common in dyskinetic CP than other spastic CP subtypes. However, probable antenatal aetiologies were most prevalent. Motor and associated impairments were less severe in children with dyskinetic CP compared with spastic quadriplegic CP. Birth prevalence of those with dyskinetic and spastic bilateral cerebral palsy (CP) in Norway decreased between 1996 and 2015. Potential sentinel events at term were more common in dyskinetic CP. Nonetheless, probable antenatal aetiologies were most prevalent in dyskinetic CP. Basal ganglia/thalamus lesions were more common in dyskinetic than spastic quadriplegic CP. Motor and associated impairments were milder in dyskinetic than spastic quadriplegic CP.

Action Observation Training to Improve Upper Limb Function in Infants with Unilateral Brain Lesion – a Feasibility Study

ABSTRACT In this study, the feasibility of Action Observation Training (AOT) in combination with sensor-based measurements in infants at high risk of Unilateral Spastic Cerebral Palsy (UCP) were evaluated. Over a four-week period, eight infants at high risk of UCP performed AOT at home while wearing sensors with assistance of caregivers. Sensor data were compared to clinical assessments of upper limb function, the Hand Assessment for Infants (HAI) and the Mini-Assisting Hand Assessment (Mini-AHA). AOT training time and acceptance by the caregivers were considered as indicators for feasibility. The excellent training adherence and positive feedback of the caregivers showed that the AOT was feasible in this patient group and setting. Sensor measurements were accepted and displayed significant correlations with hand function. These preliminary results indicate the potential of wearable sensors to record upper limb function over the course of AOT for infants at high risk of UCP. Thus, AOT in combination with sensor measurements are proposed as a feasible training tool to complement usual care.

Development of Hand Use with and Without Intensive Training Among Children with Unilateral Cerebral Palsy in Scandinavia

ABSTRACT Aim To describe hand use development in children with unilateral cerebral palsy who did/did not participate in constraint-induced movement therapy (CIMT) before 7 years of age. Method The study included 334 participants (18 months–12 years) who were assessed with 1,565 Assisting Hand Assessments (AHAs) and categorized into no intensive training (NIT), CIMT (18 months–7 years), and Baby-CIMT (<18 months) groups. Results AHA performance at 18 months (AHA-18) was positively associated with development regardless of training. The CIMT group had lower AHA-18 performance than the NIT group (p = .028), but higher stable limit (p = .076). The age when 90% of development was reached was highest in the CIMT group (p = .014). Although non-significant, the Baby-CIMT group had higher mean curve than NIT and CIMT combined (AHA-18 p = .459, limit p = .477). Conclusion The CIMT group improved more over time than the NIT group. Intensive training extended the window of development, and Baby-CIMT might promote early development.

Safety and adherence of pressure garment therapy in children with upper limb unilateral cerebral palsy. Results from a randomized clinical trial ancillary analysis.

This study was conducted to assess the safety and adherence of the use of a PGT (Pressure Garment Therapy) Lycra® sleeve to treat upper limb unilateral cerebral palsy (UCP) in children. This study was conducted as a prospective, placebo-controlled, double-blinded, randomized monocenter study. Included in the study were 58 UCP children, 49 of whom were analyzed. 25 children (mean age 6.6 ± 1.6 years; 12 girls) were allocated to the active group vs. 24 (mean age 6.7 ± 1.6 years; 10 girls) in the placebo group. The intervention consisted of an active PGT Lycra® arm sleeve manufactured to generate a homogeneous pressure ranging from 15 to 25 mmHg. The placebo PGT Lycra® sleeve was manufactured to generate a homogeneous pressure under 7 mmHg. The time of wearing period was set at 3 h/day at minimum and 6 h/day at maximum, over the course of 6 months. The main outcome measures were safety outcomes including the number and intensity of Adverse Events of Special Interest (AESIs). AESIs were defined as adverse events imputable to compressive therapy and Lycra® wearing. Level of adherence was expressed in percentage of number of days when the sleeve was worn for at least 3 h per day compared to length of duration in days (start and end date of wearing period). Frequency of AESIs were very low and no different between groups (4.12 ± 11.32% vs. 1.83 ± 3.38%; p = 0.504). There were no differences in adherence (91.86 ± 13.86% vs. 94.30 ± 9.95%; p = 0.425). The use of PGT Lycra® arm sleeve in children with UCP is safe and well-tolerated with a very good adherence. The low rate of AESIs is promising for further randomized clinical trials on efficacy.

Lower extremity proprioception and its association with activity and participation in children with unilateral spastic cerebral palsy

ObjectiveThis cross-sectional study aimed to assess lower extremity proprioception and investigate its relationship to activity and participation levels in children with unilateral spastic cerebral palsy (USCP). MethodsA total of 22 children with USCP between the ages of 5 and 16 years participated in this study. Lower extremity proprioception was evaluated with a protocol that consisted of verbal and location identification, unilateral and contralateral limb matching, and static and dynamic balance tests performed with the impaired and less impaired lower extremities under eyes-open and eyes-closed conditions. Furthermore, the Functional Independence Measure (WeeFIM) and Pediatric Outcomes Data Collection Instrument (PODCI) were used to evaluate the independence levels in daily living activities and participation levels. ResultsChildren demonstrated proprioceptive loss, as evidenced by an increase in matching errors under the eyes-closed condition compared to the eyes-open condition (p<0.05). Also, the impaired extremity had greater proprioceptive loss than the less impaired extremity (p<0.05). The 5–6-year age group experienced greater proprioceptive deficits than did the 7–11 and 12–16 age groups (p<0.05). Children's lower extremity proprioceptive deficit was moderately associated with their activity and participation levels (p<0.05). ConclusionsOur findings suggest that treatment programs based on comprehensive assessments, including proprioception, may be more effective in these children.

A 10.5-year follow-up of walking with unilateral spastic cerebral palsy.

The purpose of this study was to describe gait evolution in patients with unilateral spastic cerebral palsy (USCP) using modified Gait Profile Score (mGPS without hip rotation), Gait Variable Score (GVS), walking speed, and the observed effects of single-level surgery (SLS) after 10 years. Fifty-two patients with USCP (Gross Motor Function Classification System I) and data from two Clinical Gait Analyses (CGAs) were included. The evolution of patients' mGPS, GVS, and walking speed were calculated. Two "no surgery" and "single-level surgery" patient categories were analyzed. Paired t-tests were used to compare the data between CGAs and as a function of treatment category. Pearson's correlations were used to examine relationships between baseline values and evolutions in mGPS and walking speed. Mean ages (SD) at first and last CGAs were 9.3 (3.2) and 19.7 (6.0) years old, respectively, with an average follow-up of 10.5 (5.6) years. Mean mGPS for the patients' affected side was significantly lower at the last CGA for the full cohort: baseline = 8.5° (2.1) versus follow-up = 7.2° (1.6), effect size = 0.73, p < 0.001. Significant improvements in mGPS and GVS for ankle and foot progression were found for the SLS group. The mGPS change and mGPS at baseline (r = -0.79, p < 0.001) were negatively correlated. SLS patients demonstrated a positive long-term change in gait pattern over time. The group that had undergone surgery had worse gait scores at baseline than the group that had not, but the SLS group's last CGA scores were relatively closer to those of the "no surgery" group. This was a retrospective comparative therapeutic study (level III).

Exploring structural connectomes in children with unilateral cerebral palsy using graph theory.

We explored structural brain connectomes in children with spastic unilateral cerebral palsy (uCP) and its relation to sensory-motor function using graph theory. In 46 children with uCP (meanage=10 years 7 months ± 2 years 9 months; Manual Ability Classification System I=15, II=16, III=15)we assessed upper limb somatosensory and motor function. We collected multi-shell diffusion-weighted, T1-weighted and T2-FLAIR MRI and identified the corticospinal tract (CST) wiring pattern using transcranial magnetic stimulation. Structural connectomes were constructed using Virtual Brain Grafting-modified FreeSurfer parcellations and multi-shell multi-tissue constrained spherical deconvolution-based anatomically-constrained tractography. Graph metrics (characteristic path length, global/local efficiency and clustering coefficient) of the whole brain, the ipsilesional/contralesional hemisphere, and the full/ipsilesional/contralesional sensory-motor network were compared between lesion types (periventricular white matter (PWM)=28, cortical and deep gray matter (CDGM)=18) and CST-wiring patterns (ipsilateral=14, bilateral=14, contralateral=12, unknown=6) using ANCOVA with age as covariate. Using elastic-net regularized regression we investigated how graph metrics, lesion volume, lesion type, CST-wiring pattern and age predicted sensory-motor function. In both the whole brain and subnetworks, we observed a hyperconnectivity pattern in children with CDGM-lesions compared with PWM-lesions, with higher clustering coefficient (p=[<.001-.047], =[0.09-0.27]), characteristic path length (p=.003, =0.19) and local efficiency (p=[.001-.02], =[0.11-0.21]), and a lower global efficiency with age (p=[.01-.04], =[0.09-0.15]). No differences were found between CST-wiring groups. Overall, good predictions of sensory-motor function were obtained with elastic-net regression (R2 =.40-.87). CST-wiring pattern was the strongest predictor for motor function. For somatosensory function, all independent variables contributed equally to the model. Inconclusion, we demonstrated the potential of structural connectomics in understanding disease severity and brain development in children with uCP.

The Effect of Bimanual Intensive Functional Training on Somatosensory Hand Function in Children with Unilateral Spastic Cerebral Palsy: An Observational Study.

(1) Background: Next to motor impairments, children with unilateral spastic cerebral palsy (CP) often experience sensory impairments. Intensive bimanual training is well known for improving motor abilities, though its effect on sensory impairments is less known. (2) Objective: To investigate whether bimanual intensive functional therapy without using enriched sensory materials improves somatosensory hand function. (3) Methods: A total of twenty-four participants with CP (12-17 years of age) received 80-90 h of intensive functional training aimed at improving bimanual performance in daily life. Somatosensory hand function was measured before training, directly after training, and at six months follow-up. Outcome measures were: proprioception, measured by thumb and wrist position tasks and thumb localization tasks; vibration sensation; tactile perception; and stereognosis. (4) Results: Next to improving on their individual treatment goals, after training, participants also showed significant improvements in the perception of thumb and wrist position, vibration sensation, tactile perception, and stereognosis of the more affected hand. Improvements were retained at six months follow-up. Conversely, proprioception measured by the thumb localization tasks did not improve after training. (5) Conclusions: Intensive functional bimanual training without environmental tactile enrichment may improve the somatosensory function of the more affected hand in children with unilateral spastic CP.