Neurophysiological mechanisms and functional impact of mirror movements in children with unilateral spastic cerebral palsy

Kuo, Hsing‐Ching; Friel, Kathleen M.; Gordon, Andrew M.

doi:10.1111/dmcn.13524

Cited by 25 publications

(31 citation statements)

References 30 publications

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“…Mirror movement scores of the affected hand (task performed by the unaffected hand) Poor motor outcome supported by our findings. 27 The persistence of ipsilateral corticospinal pathways connecting the unlesioned motor cortex to the affected hand is well established by previous TMS studies, 6,15,16,28 several of which concluded that stimulation of the unlesioned hemisphere may only elicit bilateral motor evoked potentials in those with 'intense' mirror movements. More recently, this same pattern was well characterized in children with perinatal stroke, 25,29 including evidence of common control mechanisms in the contralesional hemisphere of children with ipsilateral projections.…”

Section: Discussionmentioning

confidence: 90%

“…Despite this data supporting the relationship between mirror movements and motor outcomes, it is important to consider that many other factors may contribute to function. As Kuo et al point out in a recent review, lesion type, size, location, possibly timing, and probably other factors may be implicated in motor function. It therefore becomes challenging to determine to what extent mirror movements alone impact this outcome and future studies may attempt to better tease apart these factors.…”

Section: Discussionmentioning

confidence: 99%

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Mirror movements in children with unilateral cerebral palsy due to perinatal stroke: clinical correlates of plasticity reorganization

Riddell

Kuo

Zewdie

et al. 2019

Develop Med Child Neuro

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Aim We aimed to determine if the mirror movements that often result in children with unilateral cerebral palsy (CP) after perinatal stroke represent a clinical biomarker of developmental plasticity. Method This was a prospective, controlled cohort study. Mirror movements in children with unilateral CP from a population‐based cohort were compared to those of typically developing controls. The population with stroke was assessed further via electromyography (EMG), motor function, and corticospinal organization investigations. Mirror movements were quantified (0–5) bidirectionally. EMG mirror movements were quantified during voluntary contraction. Motor function was quantified by validated measures including the Assisting Hand Assessment (AHA). Corticospinal organization was categorized as ipsilateral or contralateral using transcranial magnetic stimulation (TMS). The relationships between mirror movements, function, and corticospinal organization were assessed (t‐tests, Pearson rank correlation coefficients). Results Ninety‐two participants were scored (55 males, 37 females, mean [SD] 12y [5y 6mo], range 4–17y), 63 with complete motor outcomes and 39 with TMS data. EMG ratios correlated with clinical mirror movements (r=0.562, p=0.008). Mild mirror activity in controls declined with age (r=−0.459, p<0.001). Mirroring was stronger with tasks performed by the affected hand (p<0.001). Mirror movements correlated with AHA scores (r=−0.255, p=0.04) and poor motor outcome (p<0.001). Unaffected hand mirror activity was higher in children with ipsilateral corticospinal tract arrangements (p<0.001). Interpretation Clinical mirror movements correlate with disability and corticospinal organization in children with unilateral CP with perinatal stroke. This simple bedside biomarker could facilitate patient selection for personalized rehabilitation. What this paper adds Mirror movements are a clinical indicator of corticospinal organization in children with unilateral cerebral palsy with perinatal stroke. Mirroring is strongest in children with ipsilateral corticospinal tract reorganization. The concept of a ‘directionality factor’ to mirror movements highlights additional, clinically relevant functional correlations.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Mirror movements in children with unilateral cerebral palsy due to perinatal stroke: clinical correlates of plasticity reorganization

Riddell

Kuo

Zewdie

et al. 2019

Develop Med Child Neuro

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“…Whilst the presence of an ipsilateral projection (for both CSTbilat and CSTipsi) could explain the presence of MM, as proposed by various studies [11][12][13] , the high MM-similarity found in the CSTcontra group with a CSC lesion is obviously not due to the presence of an ipsilateral CST. In this case, a lack of interhemispheric inhibition could be the pathophysiological mechanism underlying MM in the less-affected hand 7 . Future studies should include neurophysiological techniques of interhemispheric inhibition to confirm this hypothesis in children with CSTcontra and CSC lesions.…”

Section: The Multifactorial Interaction Explaining the Variability Inmentioning

confidence: 76%

The impact of brain lesion characteristics and the corticospinal tract wiring pattern on mirror movement characteristics in unilateral cerebral palsy

Simon-Martinez

Zielinski

Hoare

et al. 2020

Preprint

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Herestraat 49, box 1510 cristina.simon@kuleuven.be Phone number: +32 16 37 61 95 Word count: 4121 words. ABSTRACT Background. Mirror movements (MM) influence bimanual performance in children with unilateral cerebral palsy (uCP). Whilst MM are related to brain lesion characteristics and the corticospinal tract (CST) wiring pattern, the combined impact of these neurological factors remains unknown. Objective. To investigate the combined impact of neurological factors on MM.Methods. Forty-nine children with uCP (mean age 10y6mo) performed a repetitive squeezing task to quantify similarity between MM activity (MM-similarity) and strength of the MM activity (MMintensity). We used MRI to evaluate lesion type (periventricular white matter, N=30) corticosubcortical, N=19), the extent of ipsilesional damage and damage to basal ganglia, thalamus and corpus callosum. The CST wiring pattern (17 CSTcontralateral, 16 CSTipsilateral, 16 CSTbilateral) was assessed with Transcranial Magnetic Stimulation. Data was analyzed with simple and multiple regression analyses.Results. MM-similarity in the more-affected hand was higher with more damage to the corpus callosum. MM-intensity was higher in children with CSTcontralateral with damage to the basal ganglia and thalamus. In the less-affected hand, MM-similarity was explained by the interaction between lesion type and CST wiring pattern, with higher MM-similarity in children with corticosubcortical lesions in the CSTcontralateral group. MM-intensity was higher with larger damage to the corpus callosum and unilateral lesions. Conclusions. A complex combination of neurological factors influences MM characteristics andthe mechanisms differ between hands.

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“…Second, cyclic passive movements in one joint could evoke repetitive motor responses in “remote” muscles of both ipsilateral (Figure 6) and contralateral (Figure 7) limbs, possibly also related to the so-called “irradiation” of responses to mechanical stimulation to distant muscles in infants (Myklebust and Gottlieb, 1993; Teulier et al, 2011). The contralateral effects can also be observed in adults in some conditions or pathologies (for instance, the phenomenon of “cross education” (Lee and Carroll, 2007) and “mirror movements” Carson, 2005; Kuo et al, 2018), although such effects generally take place during voluntary rather than passive movements.…”

Section: Discussionmentioning

confidence: 99%

Muscle Responses to Passive Joint Movements in Infants During the First Year of Life

et al. 2019

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Muscle tone represents one of the important concepts for characterizing changes in the state of the developing nervous system. It can be manifested in the level of activity of flexors and extensors and in muscle reactions to its passive stretching (StR) or shortening (ShR). Here we investigated such reactions in a cohort of healthy infants aged from 2 weeks to 12 months. We examined the presence and the characteristics of StR and ShR during slow passive cyclic flexion/extension movements (T~3 s) in the hip, knee, ankle, and elbow joints while awake infants were in the supine position. The results showed that most infants demonstrated prominent ShRs in response to passive joint rotations, although the StR was observed more frequently, suggesting that the ShR is an important component of adaptive motor behavior already at an early developmental stage. Interestingly, the occurrence of both StR and ShR in most muscles significantly decreased throughout the first year of life. Passive cyclic flexion/extension movements could also evoke rhythmic muscle responses in other joints or in the contralateral limb, however, such responses were predominantly observed in younger infants (<6 months). A noticeable manifestation of muscle reactions at an early developmental stage, along with spontaneous motor activity in this period of life, may reflect the processes underlying a formation of appropriate muscle tone and the self-organization of neural circuits. A substantial reduction of ipsilateral and contralateral muscle responses to passive movements with age is consistent with the idea of a functional reorganization of the motor circuitry during early development.

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Neurophysiological mechanisms and functional impact of mirror movements in children with unilateral spastic cerebral palsy

Cited by 25 publications

References 30 publications

Mirror movements in children with unilateral cerebral palsy due to perinatal stroke: clinical correlates of plasticity reorganization

Mirror movements in children with unilateral cerebral palsy due to perinatal stroke: clinical correlates of plasticity reorganization

The impact of brain lesion characteristics and the corticospinal tract wiring pattern on mirror movement characteristics in unilateral cerebral palsy

Muscle Responses to Passive Joint Movements in Infants During the First Year of Life

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