The role of corticospinal tract wiring in determining upper limb function in children with unilateral cerebral palsy

IntroductionChildren with unilateral cerebral palsy (uCP) show a variety of sensorimotor problems in their affected upper limb (UL) due to a brain injury. Brain lesion characteristics (timing, location and extent) have been proposed as predictors of UL function, albeit with large variability in results. Recently, corticospinal tract (CST) reorganization has also been put forward as an important determinant, although its impact has not yet been systematically explored. Here, we investigated differences in unimanual and bimanual UL function between children with uCP with different CST wiring patterns.Patients and methodsCST wiring patterns were defined using single-pulse Transcranial Magnetic Stimulation. Unimanual capacity was assessed with grip strength, the Melbourne Assessment 2 (MA2, subscales: range of motion, accuracy, dexterity and fluency) and Jebsen-Taylor Hand Function (JTHF) test. Bimanual performance was measured with the Assisting Hand Assessment (AHA) and ABILHAND-Kids. ResultsFifty-six children were included (mean age (SD): 11y1m (3y6m); 28 girls).Twenty showed contralateral wiring, 17bilateraland 19ipsilateral. Compared to the ipsilateral wiring group, children with a contralateral wiring showed better unimanual capacity (grip strength, all MA2-subscales, JTHF; p<0.005) and bimanual performance (ABILHAND-Kids, AHA; p<0.001). Compared to those with bilateral wiring, children with contralateral wiring also showed preserved unimanual (grip strength, MA2-range-of-motion, MA2-dexterity, MA2-fluency, and JTHF; p<0.001) and bimanual function (ABILHAND-Kids, AHA; p<0.007). Interestingly, children with bilateral and ipsilateral CST wiring did not differ in UL function.ConclusionA preserved contralateral CST wiring favors the development of UL function in children with uCP.

Jaar van publicatie:2018