Hand-Arm Bimanual Intensive Therapy Improves Prefrontal Cortex Activation in Children With Hemiplegic Cerebral Palsy

Surkar, Swati M.; Hoffman, Rashelle M.; Willett, Sandra L.; Flegle, J. H.; Harbourne, Regina T.; Kurz, Max J.

doi:10.1097/pep.0000000000000486

Cited by 25 publications

(25 citation statements)

References 28 publications

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“…Higher activation in unilateral CP can therefore be related to the greater effort needed to produce a coordinated asymmetric movement against the tendency to produce more symmetric movements . Finally, asymmetric tasks may increase attentional demands, as suggested by an earlier study on complex action planning in children with unilateral CP that demonstrated greater prefrontal cortical activation compared with controls . Our findings in the sensorimotor cortex may therefore indicate increased need for sensorimotor resources to perform complex motor tasks.…”

Section: Discussionsupporting

confidence: 53%

Brain activation patterns underlying upper limb bilateral motor coordination in unilateral cerebral palsy: an fNIRS study

Campos

Sukal-Moulton

Huppert

et al. 2020

Develop Med Child Neuro

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Aim To explore cortical activation during bimanual tasks and functional correlates in unilateral cerebral palsy (CP). Method This cross‐sectional study included eight participants with unilateral CP (six females, two males; mean age [SD] 20y 10mo [5y 10mo], 13y 8mo–31y 6mo) in Manual Ability Classification System levels II to III and nine age‐matched participants with typical development (seven females, two males; mean age [SD] 17y 8mo [5y 7mo], 9y 4mo–24y 2mo). They performed bimanual symmetric squeezing (BSS) and bimanual asymmetric squeezing (BAS) tasks at 1Hz, and a pouring task with dominant hand (DPour) and a pouring task with non‐dominant hand (NDPour) at 0.67Hz, all while a custom array of functional near‐infrared spectroscopy (fNIRS) optodes were placed over their sensorimotor area. Mixed‐effects were used to contrast groups, tasks, and hemispheres (corrected p‐values [q] reported). Analysis of variance and t‐tests compared performance measures across groups and tasks. Results Participants with unilateral CP showed greater activation in both hemispheres during BAS (non‐lesioned: q<0.001; lesioned: q<0.001), and in the lesioned hemisphere during BSS (q<0.001), DPour (q=0.02), and NDPour (q=0.02) than those with typical development. The lesioned hemisphere in unilateral CP showed more activity than the non‐lesioned one (BSS: q=0.01; BAS: q=0.009; NDPour: q=0.04). During BAS, higher cortical activity correlated with more synchronous arm activation (r=0.79; p=0.02); activity lateralized towards the non‐lesioned hemisphere correlated with better Pediatric Evaluation of Disability Inventory computer adaptive test scores (r=0.81; p=0.03). Interpretation Results suggest abnormally increased sensorimotor cortical activity in unilateral CP, with implications to be investigated. What this paper adds Cortical activity in manual tasks is described with functional near‐infrared spectroscopy in typical and atypical cohorts. Activation levels in unilateral cerebral palsy appear to escalate with task difficulty. Increased brain activity may be associated with poorer selective manual control. Specific patterns of brain activity may be related to impaired bimanual function.

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Section: Discussionsupporting

confidence: 53%

Brain activation patterns underlying upper limb bilateral motor coordination in unilateral cerebral palsy: an fNIRS study

Campos

Sukal-Moulton

Huppert

et al. 2020

Develop Med Child Neuro

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“…Rather the motor decisions seen in these children are also partly dependent upon how they process and perceive visual information. This view fuels the emerging perspective that the abnormal motor actions seen in children with CP are fundamentally influenced by top-down processing (Gordon, 2016; Kurz et al, 2017a; Lust et al, 2018; Surkar et al, 2018).…”

Section: Discussionmentioning

confidence: 61%

Children with cerebral palsy display altered neural oscillations within the visual MT/V5 cortices

VerMaas

Gehringer

Wilson

et al. 2019

NeuroImage: Clinical

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Cortical visual processing in visual MT/V5 is necessary for tracking movement and performing reliable visuomotor transformations. Although the role of this cortical area is well recognized, the activity of the visual MT/V5 cortical area in children with cerebral palsy (CP) has not been examined nor has its potential role in the atypical motor actions of these children been considered. This study used magnetoencephalography to image the neural activity in the motion-sensitive MT/V5 cortices of typically developing (TD) children ( n = 21; mean age 14 yrs. ± 2, 12 males) and children with CP (n = 21; mean age 16 yrs. ± 4, 13 males) as they viewed a horizontally moving stimulus. Behavioral measures of visual perception were additionally assessed by having the participants press a button when the visual stimulus changed to moving in vertical direction. Our results showed that the horizontal movement of the visual stimulus evoked changes in the strength of the theta-alpha (5–10 Hz) and alpha-beta (8–20 Hz) oscillations in the visual MT/V5 area of all participants. Compared with the TD children, the children with CP had weaker alpha-beta oscillations in the visual MT/V5 cortices. In addition, the children with CP took longer to perceive a directional change of the visual stimulus and made more errors in detecting the change. Lastly, weaker alpha-beta oscillations were correlated with slower detection of the change in motion direction and less accuracy in identifying the change. This study shows that the uncharacteristic neural oscillations in the visual MT/V5 cortical area may partially account for the abnormal perceptions and motor decisions seen in children with CP.

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“…8 However, the functional basis of these improvements remains poorly understood, as the neuroimaging literature has predominantly focused on identifying how structural aberrations (eg, fiber track integrity) modulate the clinically relevant improvements seen after these interventions, [9][10][11] with very few studies examining neural activity within the key networks that serve the production of the hand motor actions. [12][13][14][15] The outcomes from functional MRI (fMRI) have noted that children with CP have reduced sensorimotor cortical activity in the hemisphere contralateral to the more affected hand, and compensatory cortical activity in the ipsilateral hemisphere. 14,[16][17][18] Resting-state analyses have also shown less connectivity in the sensorimotor cortices of the more affected hemisphere.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Hand Motor Actions of Children With Cerebral Palsy Are Associated With Abnormal Sensorimotor Cortical Oscillations

Hoffman

Wilson

Kurz

2019

Neurorehabil Neural Repair

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Background. The neuroimaging literature on cerebral palsy (CP) has predominantly focused on identifying the structural aberrations (eg, fiber track integrity), with very few studies examining neural activity within the key networks that serve the production of hand movements. Objective. We aimed to start to fill this knowledge gap by using magnetoencephalographic brain imaging to quantify the temporal dynamics of the sensorimotor oscillations during a hand motor action. Methods: Children with CP (n = 12; MACS [Manual Abilities Classification System] levels I-III) and typically developing (TD) children (n = 26) performed an arrow-based version of the Eriksen flanker task where a button press was performed with either the second or third digit of the right hand depending on the arrow’s direction. Results: Overall, the children with CP were less accurate and had slower reaction times compared with the TD children. These behavioral differences were closely linked with aberrant sensorimotor cortical oscillations seen in the children with CP. Compared with the TD children, the children with CP had a weaker gamma (68-82 Hz) response during motor execution and a weaker post-movement beta rebound (PMBR; 14-26 Hz) response on movement termination. Moreover, we observed a significant correlation between the amplitude of the gamma and PMBR with reaction time, with weaker gamma and PMBR responses being linked with slower reaction times. Conclusions: Overall, these results suggest that aberrations in motor-related gamma and beta cortical oscillations are associated with the impaired hand motor actions seen in children with CP.

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Hand-Arm Bimanual Intensive Therapy Improves Prefrontal Cortex Activation in Children With Hemiplegic Cerebral Palsy

Abstract: HABIT potentially improves the PFC's involvement in the action planning of the upper extremity movements in children with HCP.

Cited by 25 publications

References 28 publications

Brain activation patterns underlying upper limb bilateral motor coordination in unilateral cerebral palsy: an fNIRS study

Brain activation patterns underlying upper limb bilateral motor coordination in unilateral cerebral palsy: an fNIRS study

Children with cerebral palsy display altered neural oscillations within the visual MT/V5 cortices

Hand Motor Actions of Children With Cerebral Palsy Are Associated With Abnormal Sensorimotor Cortical Oscillations

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