Fast adjustments of ongoing movements in hemiparetic cerebral palsy

The present study focuses on the ability of participants with spastic hemiparesis caused by cerebral palsy to adjust an ongoing movement. Typical symptoms associated with the disorder would lead one to expect that people with spastic hemiparesis would be unable to adjust their movements quickly and proportionally to a sudden change in the environment with their spastic arm. The results of the present experiment, however, prove otherwise. Eight hemiparetic adolescents with cerebral palsy and eight healthy control participants were asked to quickly hit a target projected onto a fronto-parallel screen. The target either remained stationary or started to move immediately after hand movement onset. Participants needed to adapt the ongoing movement to hit moving targets. The task was performed with the spastic and non-spastic arm by the hemiparetic participants and with the dominant arm by the healthy participants. Kinematic analyses showed that although the spastic arm of the hemiparetic participants displayed a significant increase in spatial variability which led to more errors, they were capable of successfully adapting their movement in a qualitative manner. The latency of the response to the change in target position was longer for the hemiparetic participants compared to the healthy control participants, but only 25 ms. Surprisingly, no between arm latency difference was found in the hemiparetic participants. Given the commonly observed movement deficits of the spastic arm, these results show that participants with spastic hemiparesis displayed a remarkable ability in adjusting movements quickly.     

Familial type IV hypertriglyceridemia presenting as hemiparesis with cerebellar signs

Stroke in pediatric patients is distinctive as compare to adults. The authors report a rare case of familial hypertriglyceridemia type IV who had left hemiparesis with cerebellar signs. There was no history of oral trauma, head injury, convulsions, acute gastroenteritis, meningitis or otitis media     

A detailed analysis of the planning and execution of prehension movements by three adolescents with spastic hemiparesis due to cerebral palsy

Assuming that primary symptoms of motor disorders can best be distinguished from signs of adaptation through behavioral analyses on an individual basis, the present study provides a detailed analysis of the prehension movements of three adolescents with mild spastic hemiparesis of different etiology. We investigated the extent to which the hemiparetic participants took their movement limitations into account when planning and performing sequences of prehension movements. We examined three indices of flexibility in grip planning in conjunction with an analysis of arm-joint coordination patterns as the movements unfolded. Participants were asked to repeatedly grasp a square object of which the position was gradually changed leftwards or rightwards. In half the trials the goal of the task was to lift the object, in the other half it had to be rotated back-and-forth. Trunk, arm, and hand movements were recorded with two synchronized 3-D motion-tracking systems. The movements of the hemiparetic participants were compared with the average performance of 11 control participants of which the collective data were taken to represent a typical control participant. Whereas one hemiparetic participant (GV) maintained a single grasping pattern throughout the experiment, the other two (CV and LC) only partially persevered in previously adopted grasping patterns. The shoulder contributed more and the wrist contributed less to this perseverance. No effects of task goal were found on grip selection. However, two hemiparetic participants (CV and LC) did tune their hand displacement to the task that followed the grasps. Taken collectively, the results show that the hemiparetic participants took their limitations into account when performing movements, but not when planning movements.     

Extent of altered white matter in unilateral and bilateral periventricular white matter lesions in children with unilateral cerebral palsy

AimsTo investigate the extent of white matter damage in children with unilateral cerebral palsy (UCP) caused by periventricular white matter lesions comparing between unilateral and bilateral lesions; and to investigate a relationship between white matter microstructure and hand function.Methods and proceduresDiffusion MRI images from 46 children with UCP and 18 children with typical development (CTD) were included. Subjects were grouped by side of hemiparesis and unilateral or bilateral lesions. A voxel-wise white matter analysis was performed to identify regions where fractional anisotropy (FA) was significantly different between UCP groups and CTD; and where FA correlated with either dominant or impaired hand function (using Jebsen Taylor Hand Function Test).Outcomes and resultsChildren with unilateral lesions had reduced FA in the corticospinal tract of the affected hemisphere. Children with bilateral lesions had widespread reduced FA extending into all lobes. In children with left hemiparesis, impaired hand function correlated with FA in the contralateral corticospinal tract. Dominant hand function correlated with FA in the posterior thalamic radiations as well as multiple other regions in both left and right hemiparesis groups.Conclusions and implicationsPeriventricular white matter lesions consist of focal and diffuse components. Focal lesions may cause direct motor fibre insult resulting in motor impairment. Diffuse white matter injury is heterogeneous, and may contribute to more global dysfunction.What this paper adds

• ⿢Focal white matter alterations are observed in the corticospinal tract in UCP with unilateral white matter lesions
• ⿢Diffuse white matter alterations throughout all cerebral lobes are observed in UCP with bilateral white matter lesions
• ⿢Fractional anisotropy in the posterior thalamic radiations correlates with dominant hand function

     

Robot-assisted arm trainer for the passive and active practice of bilateral forearm and wrist movements in hemiparetic subjects

OBJECTIVE: To determine whether use of a robotic arm trainer for bilateral exercise in daily repetitive training for a 3-week period reduced spasticity and improved motor control in the arm of severely affected, chronic hemiparetic subjects. DESIGN: Before-after trial. SETTING: Community rehabilitation center in Germany. PARTICIPANTS: Consecutive sample of 12 chronic hemiparetic patients; minimum stroke interval 6 months; patients could maximally protract the affected shoulder, hold the extended arm, or slightly flex and extend the elbow. INTERVENTIONS: Additional daily therapy of 15 minutes with the arm trainer for 3 weeks; the 1 degree of freedom trainer enabled the bilateral passive and active practice of a forearm pronation and supination and wrist dorsiflexion and volarflexion; impedance control guaranteed a smooth movement. MAIN OUTCOME MEASURES: Patients' impressions, the Modified Ashworth Scale (MAS) score (range, 0-5) to assess spasticity, and the arm section of the Rivermead Motor Assessment (RMA) score (range, 0-15) to assess motor control were rated before therapy, after each 3-week interval, and at follow-up 3 months later. RESULTS: All patients had favorable impressions: the extremity felt more vivid, and 8 subjects noticed a reduction in spasticity, an ease of hand hygiene, and pain relief. The MAS score of the wrist and fingers joints decreased significantly (P<.0125) from a median of 3 (2-3) and 3 (3-4) to 2 (1-2) and 2.5 (2-3). The RMA score minimally increased in 5 cases without improvement in functional tasks. The median RMA score before therapy was 2.0 (1-2) and 2.0 (1-3.75) after therapy. There were no side effects. At follow-up, the effects had waned. CONCLUSIONS: The arm trainer made possible intensive bilateral elbow and wrist training of severely affected stroke patients. Future studies should address the treatment effect in subacute stroke patients and determine the optimum treatment intensity.     

Cyst of the septum pellucidum presenting as hemiparesis

An 11-year-old boy with Down syndrome is presented who suffered progressive hemiparesis on the left side for a period of 5 years. Computed tomography demonstrated a large cyst of the septum pellucidum and a calcified spot in the head of caudate nucleus on the right side. By penetrating the cyst wall to create a communication into the lateral ventricle, shrinkage of the cyst and improvement of the hemiparesis were obtained. The pathogenesis of the hemiparesis was presumed to be attributed to circulatory compromise in the deep cerebral veins, secondary to the cyst.     

Reliability of isokinetic normalized peak torque assessments for knee muscles in post-stroke hemiparesis

The purpose of this study was to establish test–retest reliability of measurement procedures for quantifying isokinetic concentric peak torque (PT) at the knee using normalization methods post-stroke. A second aim was to estimate the change required to show clinically significant improvements in knee muscles strength. The isokinetic normalized PT (NPT) values for the knee extensors and flexors were measured in each participant at two different angular velocities during two sessions 1 day apart. Thirty participants with mild to moderate hemiparesis after stroke who were able to walk were tested. The normalized PT measures for the knee muscles of the affected lower extremity were highly reliable (intraclass correlation coefficients ranged from 0.85 to 0.98; p < 0.05). Size of relative changes (the percent smallest real difference, SRD%) for extensors NPT (ranged from 22.35% to 25.68%) were lower than flexors NPT (ranged from 74.01% to 76.31%), indicating that the affected isokinetic knee flexors had more random variation than the knee extensors. This study supports the use of isokinetic dynamometers for the assessment of knee muscle strength in participants with chronic mild to moderate post-stroke hemiparesis and to measure clinical improvements. Established measurement error and smallest real differences in normalized PT will aid interpretation of real changes in muscle strength in this clinical population.     

Impaired interlimb coordination is related to asymmetries during pedaling after stroke

ObjectiveTo understand whether lower limb asymmetry in chronic stroke is related to paretic motor impairment or impaired interlimb coordination.MethodsStroke and control participants performed conventional, unilateral, and bilateral uncoupled pedaling. During uncoupled pedaling, the pedals were mechanically disconnected. Paretic mechanical work was measured during conventional pedaling. Pedaling velocity and muscle activity were compared across conditions and groups. Relative limb phasing was examined during uncoupled pedaling.ResultsDuring conventional pedaling, EMG and mechanical work were lower in the paretic than the non-paretic limb (asymmetry). During unilateral pedaling with the paretic limb, muscle activity was larger, but velocity was slower and more variable than during conventional pedaling (evidence of paretic motor impairment). During uncoupled pedaling, muscle activity increased further, but velocity was slower and more variable than in other conditions (evidence of impaired interlimb coordination). Relative limb phasing was impaired in stroke participants. Regression analysis suggested that interlimb coordination may be a stronger predictor of asymmetry than paretic motor impairment.ConclusionsParetic motor impairment and impaired interlimb coordination may contribute to asymmetry during pedaling after stroke.SignificanceRehabilitation that addresses paretic motor impairment and impaired interlimb coordination may improve symmetry and maximize improvement.     

Travail bimanuel versus travail unimanuel chez les enfants (0–18 ans) atteints de paralysie cérébrale spastique unilatérale

ObjectiveThe objective of this work is to research, from the literature, whether there is an interest of bimanual training compared unimanual training in improving the upper limb function in children with unilateral spastic cerebral palsy.MethodPubMed and Science Direct databases have been consulted to find articles since 2000 discussing the intensive bimanual therapy and the constraint induced movement therapy in these patients.ResultsFive articles were selected between 2011 and 2017, including two systematic reviews, a multisite clinical trial, a secondary analysis of a randomized controlled trial and a literature review.ConclusionThe literature shows a strong but nonspecific recommendation for one or the other approach in improving the hemiparetic upper limb function. However, constraint induced movement therapy appears to be more effective in improving grip in the injured hand and there is a weak recommendation for intensive bimanual therapy in improving coordination between limbs and for bimanual activities. The conclusion would be to approach these two therapies by making them complementary and to link unimanual training and bimanual training in the rehabilitation of children with unilateral spastic cerebral palsy.