Impaired Voluntary Movement Control and Its Rehabilitation in Cerebral Palsy

Abstract

Cerebral palsy is caused by early damage to the developing brain, as the most common pediatric neurological disorder. Hemiplegia (unilateral spastic cerebral palsy) is the most common subtype, and the resulting impairments, lateralized to one body side, especially affect the upper extremity, limiting daily function. This chapter first describes the pathophysiology and mechanisms underlying impaired upper extremity control of cerebral palsy. It will be shown that the severity of impaired hand function closely relates to the integrity of the corticospinal tract innervating the affected hand. It will also shown that the developing corticospinal tract can reorganize its connectivity depending on the timing and location of CNS injury, which also has implications for the severity of hand impairments and rehabilitation. The mechanisms underlying impaired motor function will be highlighted, including deficits in movement execution and planning and sensorimotor integration. It will be shown that despite having unimanual hand impairments, bimanual movement control deficits and mirror movements also impact function. Evidence for motor learning-based therapies including Constraint-Induced Movement Therapy and Bimanual Training, and the possible pathophysiological predictors of treatment outcome and plasticity will be described. Finally, future directions for rehabilitations will be presented.

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

“…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).…”

The Relationship Between Hand Function and Overlapping Motor Representations of the Hands in the Contralesional Hemisphere in Unilateral Spastic Cerebral Palsy

“…5,6 The presence of samesided (ipsilateral) CST connections to the affected hand is associated with poorer hand function than preserved crossed CST connections to the affected hand. 2,[7][8][9][10] However, even among children with this ipsilateral CST pattern, there is high variability in hand function. 9 The source of this variability remains unknown.…”

“…Many factors potentially contribute to impaired hand function in children with USCP. The type of corticospinal tract (CST) pattern and the timing, location, and size of brain lesions predict upper-limb function in USCP (see reviews 1,2 ). In many children with USCP, the CST to the affected hand does not originate in the hemisphere contralateral to the affected hand, as it does in typically developing children.…”

Constraint-induced movement therapy in a patient with ataxia after cerebellar tumor resection

“…Many studies have shown the benefits of applying CIMT in patients with cerebral palsy to improve the affected limb's function, but it is also significantly efficient when compared to other rehabilitation methods [6,[30][31][32]. The study by Sparrow et al [5] performed with children with brain tumor sequelae, showed beneficial results both qualitatively and quantitatively in the movement of the trained upper limb; in addition, the gains were maintained in the follow-up evaluations for three months.…”