Control of prehension in hemiparetic cerebral palsy: similarities and differences between the ipsi‐ and contra‐lesional sides of the body

Abstract

This study aimed at broadening our insight into ipsi-and contra-lesional control of prehension after unilateral brain damage. Six male adults with hemiparetic cerebral palsy (mean age 17 years 3 months, SD 15 months) performed unrestricted grasping of discs that differed in size (40, 60, and 80mm in diameter) and which were placed at different distances from the participants (150mm and 30mm). A precalibrated Optotrak 3020 system was used for recording motion. Kinematics of the transport and grasp component, and hand orientation at the moment of grasping, were determined. A marker on the wrist was used to calculate the kinematics of the transport component. The distance between the markers on the index finger and thumb was used for the calculation of the grasp component. Kinematic variables of the transport and grasp component were remarkably similar between both sides of the body. However, with the contralesional side, more time was spent in contact with the object before it was lifted, and movements were performed less fluently compared with the ipsi-lesional side. Maximum grasp aperture was attained very late during reaching. For final hand orientation, results showed a large standard deviation both within and between participants. These findings show that, despite the ostensible awkward prehension movements of the contra-lesional side (slowness and decreased fluency), similarities in the kinematics between both sides of the body are present, which may be indicative of intact central control of the movement. The results of variant final hand orientation, combined with the relative late occurrence of peak aperture, suggest that these participants encounter difficulties with forward planning and may use a step-by-step control strategy.

Differentiation of hand posture to object shape in children with unilateral spastic cerebral palsy

“…In one study, the less affected hand showed delayed aperture formation during reach and the more affected hand demonstrated no anticipatory shaping at all (Ronnqvist & Rosblad, 2007), while another cohort of children achieved peak aperture at 90% of reach in both hands, compared to 50% in TD children (Steenberger & van der Kamp, 2004). There are two possible explanations for this discrepancy.…”

“…Second, although aperture is correlated with object size, the relationship between shape and hand posture is complex. In prior studies of aperture modulation, the size of similarly shaped cylinders was varied (Jeannerod, 1986;Ronnqvist & Rosblad, 2007;Steenberger & van der Kamp, 2004), whereas our objects were similar in size, but varied in shape. Thus, prior studies reflect aperture control for size accommodation rather than shape.…”

“…Ultimately, 10 children with USCP, aged 6-13, and 10 aged matched children, with a full set of data were included. This range was selected based on evidence that by age 6 grasp patterns (Steenberger & van der Kamp, 2004) and visual size information cues used to estimate required grasping forces approximate that of adults (Gordon, Johanssen, Forssberg, Eliasson, & Westing, 1992). All subjects were ambulatory, mainstreamed in school, and classified with a Manual ability classification (MACS) level I and II.…”

“…Children with unilateral spastic cerebral palsy (USCP) display deficits in motor planning and execution that impact the timing and coordination of joint movements, orientation of the hand to object size and use, and calibration of fingertip forces (Coluccini, Maini, Martelloni, Sgandurra, & Cioni, 2007;Gordon et al, 2013;Mutsaarts, Steenberger, & Bekkering, 2006;Steenbergen, Verrel, & Gordon, 2007;Steenberger & van der Kamp, 2004). Bilateral impaired modulation of aperture (distance between thumb and index finger) to object size, an indicator of hand-shaping, was described in children with USCP (Steenberger & van der Kamp, 2004;Ronnqvist & Rosblad, 2007). Decreased bilateral ability to orient the hand prior to object contact based on forthcoming actions with the object was also reported (Craje, Aaers, van der Sanden, & Steenberger, 2010. Contoured objects require complex configurations of multiple digits for accurate grasp.…”

Development of hand‐arm bimanual intensive training (HABIT) for improving bimanual coordination in children with hemiplegic cerebral palsy

“…Furthermore, bimanual tasks require complex spatial-temporal coordination that has been shown to be impaired in children with hemiplegia. 30,32,43 Transcallosal transmission between hemispheres, which appears to be implicated in spatial coupling between the limbs, 44 may be altered in individuals with hemiplegia. 45 This means that in addition to specific lesions affecting their involved upper extremity, there may be functional brain damage that limits bimanual coordination.…”