Mirror movements in unilateral spastic cerebral palsy: Specific negative impact on bimanual activities of daily living

Adler, Caroline; Berweck, Steffen; Lidzba, Karen; Becher, T.; Staudt, Martin

doi:10.1016/j.ejpn.2015.03.007

Cited by 48 publications

(77 citation statements)

References 24 publications

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“…With this assumption, it becomes most remarkable that no signs for hemiparesis were evident on clinical examination and motor testing. The patient was not, however, tested on more demanding assessments of bimanual function, and it could well be that, owing to the presence of mirror movements, the scores on such assessments would have been suboptimal . Movement Assessment Battery for Children scores were in the borderline range, with more difficulties reported in bimanual coordination skills.…”

Section: Discussionmentioning

confidence: 99%

Is one motor cortex enough for two hands?

Fiori

Staudt

Pannek

et al. 2015

Develop Med Child Neuro

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ADMAbductor digiti minimiWe report on a patient with mirror movements sustained by a mono-hemispheric fast control of bilateral hand muscles and normal hand function. Transcranial magnetic stimulation of the right motor cortex evoked contractions of muscles in both hands while no responses were observed from the left hemisphere. Somatosensory-evoked potentials, functional magnetic resonance, and diffusion tractography showed evidence of sensorimotor dissociation and asymmetry of corticospinal projections, suggestive of reorganization after early unilateral left brain lesion. This is the first evidence that, in certain rare conditions, good hand function is possible with ipsilateral corticospinal reorganization, supporting the role of unexplored mechanisms of motor recovery.In normal conditions, each primary motor cortex (M1) is required to control voluntarily the contralateral hand. Indeed, the axons of most M1 motoneurons controlling hand muscles, cross the midline to reach the alpha motoneurons in the contralateral anterior horn of the spinal cord. ). Either way, both hemispheres are required to control the two hands.A specific condition has been described in the case of unilateral damage to the corticospinal tract in early phases of development, typically around birth or before, when the physiological withdrawal of ipsilateral corticomotoneuronal connections has not yet occurred.3 Increased corticospinal projections from the contralesional hemisphere competitively displace surviving projections from the damaged cortex, leading to a pattern of reorganization in which both hands are controlled by the contralesional motor cortex. This pattern of reorganization, however, has so far always been reported as incomplete, i.e. in association with marked impairment of the ipsilateral hand. 4,5 Here, we present the exceptional case of a mono-hemispheric fast control of bilateral hand muscles and normal hand function bilaterally-except for the presence of mirror movements. CASE REPORT PatientA male presented at 14 years with grade 3 mirror movements 6 affecting either hand (see Video S1, online supporting information). Family history was negative for any mirror-movement-related disorder. Perinatal and postnatal histories were uneventful. Neurological examination was normal except for left-handedness. An extensive battery of motor tests was performed and video-recorded, including the Melbourne Assessment of Unilateral Upper Limb Function, 7 Movement Assessment Battery for Children, 8 and Assisting Hand Assessment, 9 with scores within the normal range and no asymmetries (Melbourne Assessment of Unilateral Upper Limb Function score 100% on both right and left hands, Movement Assessment Battery for Children score 10°centile, Assisting Hand Assessment score 95%). On clinical examination, the inspection of the cervical region was normal, and mobility of head and neck was also normal. Conventional brain magnetic resonance imaging (MRI) showed a mild irregular enlargement of the left lateral ventricle, most pronounced in the fr...

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Section: Discussionmentioning

confidence: 99%

Is one motor cortex enough for two hands?

Fiori

Staudt

Pannek

et al. 2015

Develop Med Child Neuro

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“…Adler et al [22] concluded in his study that the bimanual movements of the mirrors result in a certain negative impact on the bimanual performance of cerebral palsy children. Probably the reason behind the rejection of the hypothesis was not taking the entry and exit criteria and the type of task or inappropriate intervention into account.…”

Section: (Mt) Versus 1443 (Nmt) After Testmentioning

confidence: 99%

The Effect of Motor Training in Mirror Therapy on Gross Motor Skills of the Affected Hand in Children With Hemiplegia

Farzamfar

Heirani

Sedighi

2017

IRJ

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Objectives: Spastic hemiplegia cerebral palsy is the second type of cerebral palsy among premature infants, which affects the mobility of one side of the body by impairing the brain's ability to send nerve impulse to the muscles. The present research aims to examine the effect of motor training in mirror therapy on the gross motor skills in Spastic Hemiplegia Cerebral Palsy (SHCP) children. Methods:This experimental study, 14 children with SHCP were selected using convenience sampling and randomly divided into two groups, i.e. mirror therapy or therapy group (7 children) and the control group or without mirror therapy (7 children). The gross motor skills for both groups was measured using Box and Block Test in the first session as pre-test. Later, the first group participated in motor training such as wheeling shoulder, adduction and abduction arm, throwing tennis balls into the basket, pushing a cylinder, rolling a tennis ball, rowing with elastic bands, etc. Both groups participated in 16 sessions of 30 minutes each. The control group completed the above program without a mirror. The post-test was conducted using the same procedure as the pre-test. Results:Results showed that the gross manual dexterity significantly promoted from pre-to post-test in both groups (P<0.05), but comparisons showed that the therapy group outperformed the control group in gross motor skills of their affected hand (P<0.05). Discussion:The finding of this study suggests that though motor training were beneficial for gross manual dexterity, mirror therapy had higher efficiency and efficacy. Therefore occupational therapists can benefit from this program in their remedial sessions for SHCP children.

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“…Adler et al 21 was the first to compare children with and without mirror movements using a timed functional outcome measure. They developed a new assessment, Bimanual Activities Negatively Influenced by Mirror Movements (BANIMM), which evaluates the time to complete five bimanual activities (opening a chocolate bar, poking a straw into a drinking package, unwrapping a piece of candy, opening a bag of chips, and twisting off a cap of a full plastic bottle).…”

Section: Functional Impact Of Mirror Movements In Children With Unilamentioning

confidence: 99%

“…[10][11][12] Recent studies sought to investigate the impact of mirror movements on hand function. 15,21 Future studies should systematically evaluate mirror movements using comprehensive measures to understand the anatomical (e.g. 15,22,23 It was shown by Kuhtz-Buschbeck et al 15 that children can suppress mirror movements (suppressed to 35%-50% of baseline level) when they paid attention to the involuntary force output (displayed visually), although force output was compromised in the voluntary hand.…”

Section: Conclusion and Future Considerationsmentioning

confidence: 99%