Improvements in Upper Extremity Function Following Intensive Training Are Independent of Corticospinal Tract Organization in Children With Unilateral Spastic Cerebral Palsy: A Clinical Randomized Trial

Background/Objectives: Intensive training of the more affected upper extremity (UE) has been shown to be effective for children with unilateral spastic cerebral palsy (USCP). Two types of UE training have been particularly successful: Constraint-Induced Movement Therapy (CIMT) and Bimanual training. Reorganization of the corticospinal tract (CST) early during development often occurs in USCP. Prior studies have suggested that children with an ipsilateral CST controlling the affected UE may improve less following CIMT than children with a contralateral CST. We tested the hypothesis that improvements in UE function after intensive training depend on CST laterality.Study Participants and Setting: Eighty-two children with USCP, age 5 years 10 months to 17 years, University laboratory setting.Materials/Methods: Single-pulse transcranial magnetic stimulation (TMS) was used to determine each child's CST connectivity pattern. Children were stratified by age, sex, baseline hand function and CST connectivity pattern, and randomized to receive either CIMT or Bimanual training, each of which were provided in a day-camp setting (90 h). Hand function was tested before, immediately and 6 months after the intervention with the Jebsen-Taylor Test of Hand Function, the Assisting Hand Assessment, the Box and Block Test, and ABILHAND-Kids. The Canadian Occupational Performance Measure was used to track goal achievement and the Pediatric Evaluation of Disability Inventory was used to assess functioning in daily living activities at home.Results: In contrast to our hypothesis, participants had statistically similar improvements for both CIMT and Bimanual training for all measures independent of their CST connectivity pattern (contralateral, ipsilateral, or bilateral) (p < 0.05 in all cases).Conclusions/Significance: The efficacy of CIMT and Bimanual training is independent of CST connectivity pattern. Children with an ipsilateral CST, previously thought to be maladaptive, have the capacity to improve as well as children with a contralateral or bilateral CST following intensive CIMT or Bimanual training.Clinical Trial Registration:www.ClinicalTrials.gov, identifier NCT02918890.

Download Full-text

Improvement in upper extremity function in children with unilateral spastic cerebral palsy after intensive training correlates with interhemispheric connectivity

Developmental Medicine & Child Neurology ◽

10.1111/dmcn.103_14017 ◽

2018 ◽

Vol 60 ◽

pp. 66-66

Keyword(s):

Cerebral Palsy ◽

Upper Extremity ◽

Spastic Cerebral Palsy ◽

Intensive Training ◽

Extremity Function ◽

Interhemispheric Connectivity ◽

Upper Extremity Function

Download Full-text

Improvements in hand function after intensive bimanual training are not associated with corticospinal tract dysgenesis in children with unilateral cerebral palsy

Experimental Brain Research ◽

10.1007/s00221-014-3889-x ◽

2014 ◽

Vol 232 (6) ◽

pp. 2001-2009 ◽

Cited By ~ 20

Author(s):

Kathleen M. Friel ◽

Hsing-Ching Kuo ◽

Jason B. Carmel ◽

Stefan B. Rowny ◽

Andrew M. Gordon

Keyword(s):

Cerebral Palsy ◽

Corticospinal Tract ◽

Hand Function ◽

Bimanual Training ◽

Unilateral Cerebral Palsy

Download Full-text

Improvements in upper extremity function in children with unilateral spastic cerebral palsy after intensive training correlates with interhemispheric connectivity

10.1101/609313 ◽

2019 ◽

Author(s):

Maxime T. Robert ◽

Jennifer Gutterman ◽

Claudio L. Ferre ◽

Karen Chin ◽

Marina B. Brandao ◽

...

Keyword(s):

Corpus Callosum ◽

Upper Limb ◽

Diffusion Tensor ◽

Hand Function ◽

Intensive Therapy ◽

Performance Measure ◽

Spastic Cerebral Palsy ◽

Post Intervention ◽

Intensive Training ◽

Hand Functions

AbstractAIMSThe corpus callosum (CC) regulates signalling between the two hemispheres and plays an important role in upper limb functions. There is limited evidence on the relationships between the integrity of the CC and upper limb functions in children with USCP. Furthermore, the extent of how much the CC can be used as a biomarker to predict hand functions following intensive interventions remains unknown. We examined 1) the relationship between hand function and tractography of the CC, and 2) the associations between the integrity of the CC and changes in hand function following intensive intervention.METHODSForty-four participants received 90 hours of intensive therapy and were randomly allocated in one of two training groups: Hand-arm Bimanual Intensive Therapy (HABIT) or Constraint-Induced Movement Therapy (CIMT). Hand functions were assessed pre-and post-intervention by a blinded clinician using the Jebsen-Taylor of Hand Function (JTTHF), Assisting Hand Assessment (AHA), and Box and Blocks test (BBT). Functional goals and daily functioning were measured using the Canadian Occupational Performance Measure and the Abilhand-Kids. CC tractography was reconstructed using diffusion tensor imaging (DTI). Corpus callosum was segmented into three regions of interest (genu, midbody and splenium). Linear regression and pearson correlations were used to assess the relationships between bimanual outcomes and DTI parameters.RESULTSBoth groups demonstrated improvement of hand function (p<0.05). JTTHF, AHA and BBT significant correlated with DTI variables for all ROIs (p<0.05). Bimanual and perceived manual ability of children changes following CIMT were negatively correlated with number of streamlines and number of voxel for the whole CC (r=-.442, p=0.05), midbody (r=-.458, p=0.042) and spelnium (r=-.512, p=0.021). No significant correlation was observed for the HABIT group.INTERPRETATIONTractography of the CC was found to be associated with unimanual and bimanual functions at baseline. Children with reduced integrity of the CC and with greater bimanual impairments improve more from CIMT. On the contrary, all children in the HABIT group had similar improvements independent of the CC integrity.

Download Full-text

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

Neurorehabilitation and Neural Repair ◽

10.1177/1545968317745991 ◽

2018 ◽

Vol 32 (1) ◽

pp. 62-72 ◽

Cited By ~ 8

Author(s):

Michelle Marneweck ◽

Hsing-Ching Kuo ◽

Ana R. P. Smorenburg ◽

Claudio L. Ferre ◽

Veronique H. Flamand ◽

...

Keyword(s):

Cerebral Palsy ◽

Corticospinal Tract ◽

Hand Function ◽

Single Pulse ◽

Spastic Cerebral Palsy ◽

Bimanual Performance ◽

Mirror Movement ◽

Motor Representations ◽

The Relationship ◽

Shared Site

Background. In many children with unilateral spastic cerebral palsy (USCP), the corticospinal tract to the affected hand atypically originates in the hemisphere ipsilateral to the affected hand. Such ipsilateral connectivity is on average a predictor of poor hand function. However, there is high variability in hand function in these children, which might be explained by the complexity of motor representations of both hands in the contralesional hemisphere. Objective. To measure the link between hand function and the size and excitability of motor representations of both hands, and their overlap, in the contralesional hemisphere of children with USCP. Methods. We used single-pulse transcranial magnetic stimulation to measure the size and excitability of motor representations of both hands, and their overlap, in the contralesional hemisphere of 50 children with USCP. We correlated these measures with manual dexterity of the affected hand, bimanual performance, and mirror movement strength. Results. The main and novel findings were (1) the large overlap in contralesional motor representations of the 2 hands and (2) the moderate positive associations of the size and excitability of such shared-site representations with hand function. Such functional associations were not present for overall size and excitability of representations of the affected hand. Conclusions. Greater relative overlap of the affected hand representation with the less-affected hand representation within the contralesional hemisphere was associated with better hand function. This association suggests that overlapping representations might be adaptively “yoked,” such that cortical control of the child’s less-affected hand supports that of the affected hand.

Download Full-text

Corpus Callosum Integrity Relates to Improvement of Upper-Extremity Function Following Intensive Rehabilitation in Children With Unilateral Spastic Cerebral Palsy

Neurorehabilitation and Neural Repair ◽

10.1177/15459683211011220 ◽

2021 ◽

pp. 154596832110112

Author(s):

Maxime T. Robert ◽

Jennifer Gutterman ◽

Claudio L. Ferre ◽

Karen Chin ◽

Marina B. Brandao ◽

...

Keyword(s):

Cerebral Palsy ◽

Corpus Callosum ◽

Upper Extremity ◽

Diffusion Tensor ◽

Hand Function ◽

Intensive Therapy ◽

Spastic Cerebral Palsy ◽

Bimanual Performance ◽

Neuroimaging Data ◽

The Impact

Background The corpus callosum (CC) plays an important role in upper extremity (UE) function. The impact on UE function in children with unilateral spastic cerebral palsy (USCP) and improvements following intensive interventions remain unknown. Objectives To examine the (1) relationship between UE function and CC integrity and (2) relationship between CC integrity and changes in UE function following intensive interventions. Methods We retrospectively analyzed clinical and neuroimaging data from a sample of convenience of 44 participants (age 9.40 ± 3.10 years) from 2 larger trials. Participants received 90 hours of Hand-Arm Bimanual Intensive Therapy (HABIT) or Constraint-Induced Movement Therapy (CIMT). Unimanual dexterity (Jebsen-Taylor Test of Hand Function [JTTHF]) and bimanual performance (Assisting Hand Assessment [AHA]) were assessed preintervention and postintervention. CC tractography was reconstructed with diffusion tensor imaging (DTI) and segmented into 3 regions (genu, midbody, splenium). Pearson correlations and regression were used to assess the relationship between outcomes and DTI parameters (ie, fractional anisotropy [FA], number of streamlines, and mean, radial, and axial diffusivity). Results Both groups improved in bimanual performance ( P < .01). The CIMT group improved in unimanual dexterity ( P < .01). Baseline unimanual dexterity and bimanual performance correlated with FA and number of streamlines for most CC regions ( P < .05). Following CIMT, pre-post changes in JTTHF were negatively correlated with axial and radial diffusivity of the CC, and AHA with splenium and number of streamlines for the CC, midbody, and splenium (all P < .05). Following HABIT, midbody FA was positively correlated with pre-post AHA changes ( r = 0.417; P = .042). Conclusions CC integrity is important for UE function in children with USCP.

Download Full-text

A critical reappraisal of corticospinal tract somatotopy and its role in traumatic cervical spinal cord syndromes

Journal of Neurosurgery Spine ◽

10.3171/2021.7.spine21546 ◽

2021 ◽

pp. 1-7

Author(s):

Allan D. Levi ◽

Jan M. Schwab

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Upper Extremity ◽

Corticospinal Tract ◽

Cervical Spinal Cord ◽

Hand Function ◽

Cervical Spinal Cord Injury ◽

Pathophysiological Mechanism ◽

Cord Injury ◽

Central Cord Syndrome

The corticospinal tract (CST) is the preeminent voluntary motor pathway that controls human movements. Consequently, long-standing interest has focused on CST location and function in order to understand both loss and recovery of neurological function after incomplete cervical spinal cord injury, such as traumatic central cord syndrome. The hallmark clinical finding is paresis of the hands and upper-extremity function with retention of lower-extremity movements, which has been attributed to injury and the sparing of specific CST fibers. In contrast to historical concepts that proposed somatotopic (laminar) CST organization, the current narrative summarizes the accumulated evidence that 1) there is no somatotopic organization of the corticospinal tract within the spinal cord in humans and 2) the CST is critically important for hand function. The evidence includes data from 1) tract-tracing studies of the central nervous system and in vivo MRI studies of both humans and nonhuman primates, 2) selective ablative studies of the CST in primates, 3) evolutionary assessments of the CST in mammals, and 4) neuropathological examinations of patients after incomplete cervical spinal cord injury involving the CST and prominent arm and hand dysfunction. Acute traumatic central cord syndrome is characterized by prominent upper-extremity dysfunction, which has been falsely predicated on pinpoint injury to an assumed CST layer that specifically innervates the hand muscles. Given the evidence surveyed herein, the pathophysiological mechanism is most likely related to diffuse injury to the CST that plays a critically important role in hand function.

Download Full-text