The face, scalp, and temporal region

The face conveys our conscious and subconscious emotions and projects vulnerability in disfigurement. Functionally, the face encompasses the muscles that surround our eyes, nose and mouth, contributing to the sphincters and dilators that allow the fine motor control of our eyelids, nostrils and lips, respectively. The face forms the anterior part of the head medial to the ears and between the hairline superiorly and the chin inferiorly. It comprises everything that lies between what is visible anteriorly and laterally. The face consists of four recognisable tissue planes – skin, a subcutaneous layer of fibroadipose tissue (held responsible for some of the changes of the ageing face), the superficial muscular aponeurotic system and the parotidomasseteric fascia. The scalp forms the soft tissue envelope of the cranial vault. The triad it forms with the forehead anteriorly and the temporal regions laterally should be considered as a continuum rather than three separate entities.

Assessing the Development of Fine Motor Control in Elementary School Children Using Drawing and Tracing Tasks

Adequately quantifying fine motor control is imperative for understanding individual motor behavior development and mastery. We recently showed that using different tasks to evaluate fine motor control may produce different results, suggesting that multiple measures for fine motor control may be evaluating different skills and/or underlying processes. Specifically, drawing behavior may depend on internal cueing, whereas tracing depends more on external cueing. To better understand how an individual develops a certain preference for cueing, we evaluated fine motor control in 265 typically developing children (aged 6–11) by measuring their accuracy for both drawing and tracing a circle. Our results first confirmed that there was no significant correlation between tracing and drawing task performances during this phase of development and, secondly, showed a significant developmental improvement in tracing, especially between 2nd and 3rd graders, whereas drawing ability improved only moderately. We discuss the potential roles of attentional focus and cognitive development as possible influencing factors for these developmental patterns. We conclude that using both a drawing and tracing task to evaluate fine motor control is rapid, economic and valuable for monitoring motor development among elementary school children.

The role of the inferior parietal lobule in writer’s cramp

Humans have a distinguishing ability for fine motor control that is subserved by a highly evolved cortico-motor neuronal network. The acquisition of a particular motor skill involves a long series of practice movements, trial and error, adjustment and refinement. At the cortical level, this acquisition begins in the parieto-temporal sensory regions and is subsequently consolidated and stratified in the premotor-motor cortex. Task-specific dystonia can be viewed as a corruption or loss of motor control confined to a single motor skill. Using a multimodal experimental approach combining neuroimaging and non-invasive brain stimulation, we explored interactions between the principal nodes of the fine motor control network in patients with writer’s cramp and healthy matched controls. Patients and healthy volunteers underwent clinical assessment, diffusion-weighted MRI for tractography, and functional MRI during a finger tapping task. Activation maps from the task-functional MRI scans were used for target selection and neuro-navigation of the transcranial magnetic stimulation. Single- and double-pulse TMS evaluation included measurement of the input-output recruitment curve, cortical silent period, and amplitude of the motor evoked potentials conditioned by cortico-cortical interactions between premotor ventral (PMv)-motor cortex (M1), anterior inferior parietal lobule (aIPL)-M1, and dorsal inferior parietal lobule (dIPL)-M1 before and after inducing a long term depression-like plastic change to dIPL node with continuous theta-burst transcranial magnetic stimulation in a randomized, sham-controlled design. Baseline dIPL-M1 and aIPL-M1 cortico-cortical interactions were facilitatory and inhibitory, respectively, in healthy volunteers, whereas the interactions were converse and significantly different in writer’s cramp. Baseline PMv-M1 interactions were inhibitory and similar between the groups. The dIPL-PMv resting state functional connectivity was increased in patients compared to controls, but no differences in structural connectivity between the nodes were observed. Cortical silent period was significantly prolonged in writer’s cramp. Making a long term depression-like plastic change to dIPL node transformed the aIPL-M1 interaction to inhibitory (similar to healthy volunteers) and cancelled the PMv-M1 inhibition only in the writer’s cramp group. These findings suggest that the parietal multimodal sensory association region could have an aberrant downstream influence on the fine motor control network in writer’s cramp, which could be artificially restored to its normal function.

Neuropsychological functioning following surgery for pediatric low-grade glioma: a prospective longitudinal study

OBJECTIVEHigh survival rates have led to an increased emphasis on the functional outcomes of children diagnosed with low-grade glioma. Most outcomes research has focused on risks associated with radiotherapy, but less is known about neuropsychological risks for patients treated with surgery alone. Here, the authors sought to examine the neuropsychological trajectories of children diagnosed with a low-grade glioma and monitored up to 6 years postsurgery. Secondarily, they explored demographic and clinical predictors of neuropsychological performance.METHODSThe neuropsychological functioning of 32 patients (median age at diagnosis 10.0 years) was prospectively assessed annually for up to 6 years after surgery (median days from surgery at baseline = 72). Tumor location was predominately supratentorial (65.6%). A combination of performance-based and parent-reported measures was used to assess intelligence, memory, executive functioning, and fine motor control in all patients.RESULTSBinomial tests at the postoperative baseline revealed that the proportion of children falling below the average range (< 16th percentile) was significantly higher than the rate expected among healthy peers on measures of verbal memory, processing speed, executive functioning, and fine motor control (p < 0.05). Even so, linear mixed models indicated that neuropsychological functioning at the postoperative baseline did not significantly change over time for up to 6 years after surgery across all domains. A larger tumor size was associated with a slower reaction time (p < 0.01). A supratentorial tumor location and history of seizures were associated with more parent-reported executive difficulties (p < 0.01).CONCLUSIONSWhile radiotherapy is a known risk factor for neuropsychological deficits in pediatric brain tumor patients, findings in this study indicate that children treated for low-grade glioma with surgery alone (without radiotherapy or chemotherapy) remain susceptible to difficulties with memory, executive functioning, and motor functioning that persist over time. Over half of the children in the study sample required school support services to address neuropsychological weaknesses. Although low-grade glioma is often conceptualized as a benign tumor, children treated for this lesion require ongoing monitoring and intervention to address neuropsychological weaknesses resulting from the tumor itself as well as the surgery.