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Understanding bimanual motor control in children with unilateral cerebral palsy
No full textIn daily life, we perform a lot of activities without consciously thinking about it, like buttoning a shirt or using cutlery. During childhood, these activities are still challenging, but due to practice and experience typically developing children (TDC) learn how to use both hands in a controlled manner. These activities all require bimanual motor control, a complex interplay of neurological processes and motor output mechanisms, which results in the ability to perform fast and accurate movements (bimanual dexterity) as well as synchronizing the spatial and temporal components of both hands in order to achieve the same goal (bimanual coordination). Nevertheless, this process can be hampered in case of a brain lesion occurring in developmental stages of the brain which is the case in children with unilateral cerebral palsy (uCP). Children with uCP exhibit sensorimotor impairments on one side of the body, primarily in the upper limb which significantly affects their daily activities. Up till now, research mainly focuses on the functional hand use which investigates the efficacy of the non-dominant hand, or more-impaired hand, during bimanual tasks. Although these clinical assessments provide valuable information, they do not assess the precise control between both hands during a bimanual task. In contrast, objective, innovative methods like 3D motion analysis and robotics, have been brought forward as possible assessment methods to quantify bimanual motor control. However, research using this state-of-the-art technology in children with uCP is still very limited. Consequently, also the understanding of the underlying neural mechanisms of bimanual motor control is still very much unexplored. Bimanual motor control depends on two white matter pathways: the corpus callosum (CC), connecting the brain hemispheres, and the corticospinal tract (CST), linking the cortex to the spinal cord. However, the structural properties of these neural pathways can be diminished in children with uCP, potentially impacting their bimanual motor control. Therefore, the main scope of this doctoral manuscript is to enhance our understanding of bimanual motor control in children with uCP and identify its neural correlates, with the use of state-of-the-art technology. These new insights, can ultimately contribute to optimizing the treatment of bimanual motor control in children with uCP, aiming to enhance their independence during daily life activities
Understanding bimanual motor control in children with unilateral cerebral palsy
No full textIn daily life, we perform a lot of activities without consciously thinking about it, like buttoning a shirt or using cutlery. During childhood, these activities are still challenging, but due to practice and experience typically developing children (TDC) learn how to use both hands in a controlled manner. These activities all require bimanual motor control, a complex interplay of neurological processes and motor output mechanisms, which results in the ability to perform fast and accurate movements (bimanual dexterity) as well as synchronizing the spatial and temporal components of both hands in order to achieve the same goal (bimanual coordination). Nevertheless, this process can be hampered in case of a brain lesion occurring in developmental stages of the brain which is the case in children with unilateral cerebral palsy (uCP). Children with uCP exhibit sensorimotor impairments on one side of the body, primarily in the upper limb which significantly affects their daily activities. Up till now, research mainly focuses on the functional hand use which investigates the efficacy of the non-dominant hand, or more-impaired hand, during bimanual tasks. Although these clinical assessments provide valuable information, they do not assess the precise control between both hands during a bimanual task. In contrast, objective, innovative methods like 3D motion analysis and robotics, have been brought forward as possible assessment methods to quantify bimanual motor control. However, research using this state-of-the-art technology in children with uCP is still very limited. Consequently, also the understanding of the underlying neural mechanisms of bimanual motor control is still very much unexplored. Bimanual motor control depends on two white matter pathways: the corpus callosum (CC), connecting the brain hemispheres, and the corticospinal tract (CST), linking the cortex to the spinal cord. However, the structural properties of these neural pathways can be diminished in children with uCP, potentially impacting their bimanual motor control. Therefore, the main scope of this doctoral manuscript is to enhance our understanding of bimanual motor control in children with uCP and identify its neural correlates, with the use of state-of-the-art technology. These new insights, can ultimately contribute to optimizing the treatment of bimanual motor control in children with uCP, aiming to enhance their independence during daily life activities
Visual, perceptual functions, and functional vision in children with unilateral cerebral palsy compared to children with neurotypical development
No full textAim To investigate visual (perceptual) function and functional vision in children with unilateral cerebral palsy (CP) and children with neurotypical development (NTD). Method Fifty children with unilateral CP (mean age 11 years 11 months, SD 2 years 10 months, range 7-15 years; 27 males; 26 left-sided unilateral CP; Manual Ability Classification System [MACS] levels: I, 27; II, 16; III, 7) and 50 age- and sex-matched children with NTD participated in a cross-sectional study. Visual acuity, stereoacuity, and visual-perceptual functions were measured with standardized clinical tests. Functional vision was assessed in children with unilateral CP with the Flemish cerebral visual impairment questionnaire (FCVIQ). Group differences were investigated with Mann-Whitney U tests, Kruskal-Wallis tests, and the relative effect sizes r, eta(2) respectively. Correlations between visual assessments and the FCVIQ were investigated with Spearman's rank correlations. Results The total group of children with unilateral CP showed reduced visual acuity compared with children with NTD (p = 0.02, r = 0.23). Only children with left-sided unilateral CP scored lower than those with NTD on stereoacuity (p < 0.01, r = 0.36). Children with right/left-sided unilateral CP scored significantly lower than those with NTD on visual-perceptual functions (p = 0.001-0.02), with large effect sizes on visuomotor integration and visual closure (both r = 0.57). Children with unilateral CP classified in MACS level III showed significantly lower scores on visual-perceptual assessments than children classified in MACS level I. Stereoacuity and visual-perceptual functions negatively correlated with the FCVIQ, with the highest association with visual (dis)interest and anxiety-related behaviours. Interpretation Multi-level visual profiling is warranted in the clinical intake of children with unilateral CP to detect visual impairments that further compromise their level of functioning.FUNDING INFORMATION
The Flemish Research Foundation (FWO project, G0C4919N). The project ‘PARENT’ funded by the European Union's Horizon 2020 Project MSCA-ITN-2020 – Innovative Training Networks Grant No. 956394
ACKNOWLEDGEMENTS
We thank all the participating families and children. We also thank the master's students who assisted with data collection
Unimanual and bimanual dexterity and its association with sensorimotor impairments in children with unilateral cerebral palsy
No full textChildren with unilateral cerebral palsy (uCP) experience sensorimotor impairments, compromising thedevelopment of manual dexterity which is crucial for performing everyday activities. Recently, the TynesidePegboard Test1 (TPT) was developed, to assess unimanual and bimanual dexterity specifically in childrenwith CP.
This study aimed
– to examine the psychometric properties of the TPT.
– to investigate the impact of sensorimotor impairments on unimanual and bimanual dexterity assessedwith the TP
Sensory function influences unimanual and bimanual dexterity in unilateral cerebral palsy
No full textThe recently developed Tyneside Pegboard Test (TPT) assesses both unimanual and bimanual dexterity in children with unilateral cerebral palsy (uCP). Our aim was to explore the TPT psychometric properties and the impact of sensorimotor impairments on unimanual and bimanual dexterity. Forty-nine children with uCP (mean age 9y8m, SD 1y11m, 30 males, 23 right-sided uCP) performed the unimanual and bimanual TPT providing task duration. For the psychometric properties, known-group validity was evaluated using ANCOVA (between MACS levels) and concurrent and construct validity with Spearman's correlations (r) with known and valid tests (Jebsen-Taylor Hand Function test (JTHFT), Assisting Hand Assessment (AHA), ABILHAND-Kids and Children's Hand Use Experience Questionnaire (CHEQ). The impact of sensorimotor impairments (spasticity, grip force, stereognosis and mirror movements) was investigated using multiple linear regression (α<0.05, R 2). Unimanual and bimanual dexterity differed between MACS levels (known-group validity) (p<0.001). The TPT tasks correlated to the JTHFT (concurrent validity, r=0.86-0.88), the AHA, ABILHAND-Kids and CHEQ (construct validity, r=-0.38-(-0.78)). Stereognosis was the main factor influencing all tasks (p<0.001, R²=37%-50%). Unimanual dexterity was further explained by grip strength (p<0.05, R 2 =8%-9%) and mirror movements in the more-impaired hand (p<0.05, R 2 =4%-8%), while bimanual dexterity was additionally explained by mirror movements in the more-impaired hand (p<0.01, R 2 =10%-16%) and spasticity (p=0.04, R 2 =5%). The TPT is a valid assessment to measure unimanual and bimanual dexterity. This study further highlights that stereognosis is the main determinant for unimanual and bimanual dexterity in children with uCP
Sensory function influences unimanual and bimanual dexterity in unilateral cerebral palsy
No full textThe recently developed Tyneside Pegboard Test (TPT) assesses both unimanual and bimanual dexterity in children with unilateral cerebral palsy (uCP). Our aim was to explore the TPT psychometric properties and the impact of sensorimotor impairments on unimanual and bimanual dexterity. Forty-nine children with uCP (mean age 9y8m, SD 1y11m, 30 males, 23 right-sided uCP) performed the unimanual and bimanual TPT providing task duration. For the psychometric properties, known-group validity was evaluated using ANCOVA (between MACS levels) and concurrent and construct validity with Spearman's correlations (r) with known and valid tests (Jebsen-Taylor Hand Function test (JTHFT), Assisting Hand Assessment (AHA), ABILHAND-Kids and Children's Hand Use Experience Questionnaire (CHEQ). The impact of sensorimotor impairments (spasticity, grip force, stereognosis and mirror movements) was investigated using multiple linear regression (α<0.05, R 2). Unimanual and bimanual dexterity differed between MACS levels (known-group validity) (p<0.001). The TPT tasks correlated to the JTHFT (concurrent validity, r=0.86-0.88), the AHA, ABILHAND-Kids and CHEQ (construct validity, r=-0.38-(-0.78)). Stereognosis was the main factor influencing all tasks (p<0.001, R²=37%-50%). Unimanual dexterity was further explained by grip strength (p<0.05, R 2 =8%-9%) and mirror movements in the more-impaired hand (p<0.05, R 2 =4%-8%), while bimanual dexterity was additionally explained by mirror movements in the more-impaired hand (p<0.01, R 2 =10%-16%) and spasticity (p=0.04, R 2 =5%). The TPT is a valid assessment to measure unimanual and bimanual dexterity. This study further highlights that stereognosis is the main determinant for unimanual and bimanual dexterity in children with uCP
Identifying bimanual motor control impairments in children with unilateral cerebrals palsy using the Kinarm End-point robot
No full textIdentifying bimanual motor control impairments in children with unilateral cerebrals palsy using the Kinarm End-point robot
No full textUnimanual and bimanual dexterity and its association with sensorimotor impairments in children with unilateral cerebral palsy
No full textChildren with unilateral cerebral palsy (uCP) experience sensorimotor impairments, compromising thedevelopment of manual dexterity which is crucial for performing everyday activities. Recently, the TynesidePegboard Test1 (TPT) was developed, to assess unimanual and bimanual dexterity specifically in childrenwith CP.
This study aimed
– to examine the psychometric properties of the TPT.
– to investigate the impact of sensorimotor impairments on unimanual and bimanual dexterity assessedwith the TP
The impact of brain lesion characteristics and the corticospinal tract wiring on mirror movements in unilateral cerebral palsy.
Full text linkMirror 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. Forty-nine children with uCP (mean age 10y6mo) performed a repetitive squeezing task to quantify similarity (MM-similarity) and strength (MM-intensity) of the MM activity. We used MRI data to evaluate lesion type (periventricular white matter, N = 30; cortico-subcortical, N = 19), extent of ipsilesional damage, presence of bilateral lesions, and damage to basal ganglia, thalamus and corpus callosum. The CST wiring was assessed with Transcranial Magnetic Stimulation (17 CSTcontralateral, 16 CSTipsilateral, 16 CSTbilateral). Data was analyzed with regression analyses. In the more-affected hand, MM-similarity and intensity were higher with CSTbilateral/ipsilateral. In the less-affected hand, MM-similarity was higher in children with (1) CSTcontra with CSC lesions, (2) CSTbilat/ipsi with PVL lesions and (3) CSTbilat/ipsi with unilateralized lesions. MM-intensity was higher with larger damage to the corpus callosum and unilateral lesions. A complex combination of neurological factors influences MM characteristics, and the mechanisms differ between hands
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