Visual information for action planning in left and right congenital hemiparesis

Motor planning is not restricted to only one hemisphere: evidence from ERPs in individuals with hemiplegic cerebral palsy

The evidence for the hemispheric specialization of motor planning reveals several inconsistencies between the left-lateralized hypothesis and a distributed system across the hemispheres. We compared participants with left hemiplegic cerebral palsy (HCP) to right-handed control subjects in this study's first experiment by inviting them to perform a motor planning task. Participants were required to release the start button, grasp a hexagon, and rotate it according to the instructions. In the second experiment, we compared left-HCP subjects with right-HCP subjects inviting them to perform the same task (we used the data for left-HCP subjects from the first experiment). P2 amplitude, as well as planning time, grasping time, releasing time, and initial grip selection planning patterns, were used as outcome measures in both experiments. The first experiment revealed that controls acted more quickly and chose more effective planning patterns. Also, the P2 amplitude was smaller in left-HCP subjects than in control subjects. No significant group effect was observed in the second experiment for any movement-related measure or P2. At the neural level, however, there was an interaction between 'region' and 'group,' indicating the distinction between the two groups in the right region. The results are discussed in terms of motor planning's hemispheric distribution and individual differences in the HCP group.

From Hemispheric Asymmetry through Sensorimotor Experiences to Cognitive Outcomes in Children with Cerebral Palsy

Recent neuroimaging studies allowed us to explore abnormal brain structures and interhemispheric connectivity in children with cerebral palsy (CP). Behavioral researchers have long reported that children with CP exhibit suboptimal performance in different cognitive domains (e.g., receptive and expressive language skills, reading, mental imagery, spatial processing, subitizing, math, and executive functions). However, there has been very limited cross-domain research involving these two areas of scientific inquiry. To stimulate such research, this perspective paper proposes some possible neurological mechanisms involved in the cognitive delays and impairments in children with CP. Additionally, the paper examines the ways motor and sensorimotor experience during the development of these neural substrates could enable more optimal development for children with CP. Understanding these developmental mechanisms could guide more effective interventions to promote the development of both sensorimotor and cognitive skills in children with CP.

Anticipatory Motor Planning and Control of Grasp in Children with Unilateral Spastic Cerebral Palsy

Children with unilateral spastic cerebral palsy (USCP) have impairments in motor planning, impacting their ability to grasp objects. We examined the planning of digit position and force and the flexibility of the motor system in covarying these during object manipulation. Eleven children with a left hemisphere lesion (LHL), nine children with a right hemisphere lesion (RHL) and nine typically developing children (controls) participated in the study. Participants were instructed to use a precision grip with their dominant/less affected hand to lift and keep an object level, with either a left, centered or right center of mass (COM) location. Digit positions, forces, compensatory torque and object roll where measured. Although children with USCP generated a compensatory torque and modulated digit placement by lift-off, their index finger was either collinear or higher than the thumb, regardless of COM location, leading to larger rolls after lift-off especially for the RHL group. The findings suggest that while the kinetics of grasp control is intact, the kinematics of grasp control is impaired. This study adds to the understanding of the underlying mechanisms of anticipatory planning and control of grasp in children with USCP and may provide insights on how to improve hand function in children with USCP.

Upper Limb Motor Planning in Individuals with Cerebral Palsy Aged between 3 and 21 Years Old: A Systematic Review

Individuals with cerebral palsy have difficulties performing activities of daily living. Beyond motor execution impairments, they exhibit motor planning deficits contributing to their difficulties. The objective of this review is to synthesize the behavioral evidence of motor planning deficits during an upper limb motor task in children, adolescents and young adults with cerebral palsy aged between 3 and 21 years. Methods: The inclusion criteria were: (1) including individuals with cerebral palsy from 3 to 21 years old; (2) assessing upper limb motor planning. Six databases were screened. The quality assessment of the studies was performed. Results: Forty-six studies and 686 participants were included. Five articles have been identified as very high quality, 12 as high, 20 as moderate, six as low, three as very low. Force planning studies reported a deficit for the more affected hand but adequate performances for the less affected hand. Object-manipulation studies reported hand posture planning deficits irrespectively of the hand assessed. Conclusions: Motor planning deficits has been shown in the more affected hand for force scaling, while the results for other variables showed overall deficits. Hence, variables affected by motor planning deficits in both hands should be considered in children with cerebral palsy to optimize intervention.

Impact of Sensory Deficits on Upper Limb Motor Performance in Individuals with Cerebral Palsy: A Systematic Review

People living with cerebral palsy (CP) exhibit motor and sensory impairments that affect unimanual and bimanual functions. The importance of sensory functions for motor control is well known, but the association between motor and sensory functions remains unclear in people living with CP. The objective of this systematic review was to characterize the relationship between sensory deficits and upper limb motor function in individuals living with CP.

METHODS

Five databases were screened. The inclusion criteria were: (1) including people living with CP, (2) reporting measurements of upper limb motor and sensory functions. A qualitative analysis of the studies' level of evidence was done.

RESULTS

Thirty-three articles were included. Twenty-five articles evaluated tactile functions, 10 proprioceptive functions and 7 visual functions; 31 of the articles reported on unimanual functions and 17 of them reported on bimanual functions. Tactile functions showed a moderate to high association; it was not possible to reach definitive conclusions for proprioceptive and visual functions.

CONCLUSIONS

The heterogeneity of the results limits the ability to draw definitive conclusions. Further studies should aim to perform more comprehensive assessments of motor and sensory functions, to determine the relative contribution of various sensory modalities to simple and more complex motor functions.

Motor control times and strategies in left- and right-handed participants: Behavioral evidence for the hemispheric distribution of motor planning

Background: There is conflicting evidence in favor of the hemispheric distribution of motor planning. Some studies supported the left-hemisphere-dominance hypothesis for motor planning and claimed that the left-hemisphere has a crucial function in motor control even in left-handers. The present study aimed to compare the right- and left-handed participants on motor planning ability and to investigate the performance of their dominant hands in a specific action selection task. Also, the effect of task complexity was assessed. Methods: Twenty right-handers and 20 left-handers performed an action selection task. The participants had to grasp a hexagonal knob with their dominant hand and consequently rotated it 60° or 180 ° clockwise or counterclockwise. Depending on our objects, we used mixed factorial ANOVA and the groups were examined in terms of the planning time, grasping time, releasing time and planning pattern for initial grip selection. The SPSS 19 was used for analyzing the data and p≤0.05 was considered as the significant level. Results: No significant differences were observed between the two groups. The movement-related measures revealed a main effect of rotation (p˂0.001). However, a significant interaction between direction × planning pattern × group (p˂0.001) indicated a preferential bias for rotatory movements in the medial direction which is consistent with the "medial over lateral advantage". Conclusion: Both left- and right-handed participants had a similar motor planning ability while performing a planning task with their dominant hands. Because our study was behavioral, it only provided a test of the left-hemisphere hypothesis of motor planning.

The influence of time constraints on posture choices during an end-state comfort task

People adopt comfortable postures for the end states of motor actions (end-state comfort; Rosenbaum & Jorgensen, 1992). The choice to end comfortably often elicits adoption of uncomfortable beginning states, demonstrating that a sequence of movement is planned in advance of movement onset. Many factors influence the choice of comfortable end-state postures including the greater precision and speed afforded by postures at joint angle mid-ranges (Short & Cauraugh, 1999). To date, there has been little evaluation of the hypothesis that postures are chosen based on minimizing the time spent in uncomfortable postures. The aim of this experiment was to examine how the relative time required to hold beginning and end-state postures influenced the choice of posture. Participants moved a two-toned wooden dowel from one location to another with the requirement to grasp the object and place a specified color down. Participants completed four conditions where no postures were held, only one posture was held, or both postures were held. We predicted more thumb-up postures for positions held longer regardless of whether these postures were at the end or beginning state. Results verified that the constraint of holding the initial posture led to decreased end-state comfort supporting the hypothesis that estimation of time spent in postures is an important constraint in planning. We also note marked individual differences in posture choices, particularly when the object was moved to the left.

Joint-Position Sense Accuracy Is Equally Affected by Vision among Children with and without Cerebral Palsy

We compared the effect of visual information on the dominant upper limb position sense of children with diplegic cerebral palsy (n = 10) and normally developing children (n = 10). An isokinetic dynamometer passively moved the dominant forearm in 120° of elbow flexion/extension until the volunteers stopped the machine to indicate that the elbow joint was positioned in the predetermined target angle. Participants performed this task five times in sequence with and without visual feedback of the elbow angle. We calculated the absolute and the relative position errors related to the final elbow position and the target angle. In both groups, absolute error was significantly higher when vision was occluded. Relative error was not affected by cerebral palsy or visual feedback. When vision was occluded, accuracy on this task was similarly impaired in both groups and precision was not disturbed.

Hemispheric lateralization does not affect the cognitive and mechanical cost of a sequential motor task

In sequential, repetitive tasks, we often partially reuse former motor plans. This causes a persistence of an earlier adopted posture (termed motor hysteresis). The cost-optimization hypothesis states that a partial reuse reduces the cognitive cost of a movement, while the persistence in a former posture increases its mechanical cost. An optimal fraction of reuse, which depends on the relative cognitive and mechanical cost, minimizes the total movement cost. Several studies postulate differences in mechanical or cognitive cost as a result of hemispheric lateralization. In the current study, we asked whether these differences would result in different fractions of motor plan reuse. To this end, left- and right-handed dominant participants executed a sequential motor task (opening a column of drawers) with their dominant and non-dominant hand. The size of the motor hysteresis effect was measured as a proxy for the fraction of plan reuse. Participants used similar postures and exhibited a similar hysteresis effect, irrespective of hand and handedness. This finding indicates that either the cognitive and mechanical costs of a motor task are unaffected by hemispheric differences or that their effect on motor planning is negligible.

The development of anticipatory action planning in children with unilateral cerebral palsy

Background Previous studies suggest that compromised bimanual performance experienced by children with unilateral cerebral palsy (CP) is not only due to difficulties in action execution but may also be a result of impaired anticipatory action planning. Aims The effect of age and side of hemiplegia were examined and the relationship between anticipatory action planning, unimanual capacity and bimanual performance was explored. Methods and procedures Using a multi-centre, prospective, cross-sectional observational design, anticipatory action planning was analyzed in 104 children with unilateral cerebral palsy, aged 6-12 years, using the sword task. Outcomes and results Anticipatory action planning did not improve with age in children with unilateral CP, aged between 6-12 years. No differences were found between children with left or right hemiplegia. Finally, anticipatory action planning was not related to unimanual capacity or bimanual performance. Conclusion and implications This study demonstrates anticipatory action planning, measured using the sword task, does not improve with age in children with unilateral CP and is not related to bimanual performance or laterality. Future studies of anticipatory action planning in children with unilateral CP should consider using measures that require effective anticipatory action planning for successful task completion rather than end state comfort.

Perceptuo-motor planning during functional reaching after stroke

In healthy young adults, reaching movements are planned such that the initial grasp position on the object is modulated based on the final task goal. This perceptuo-motor coupling has been described as the end-state comfort effect. This study aimed to determine the extent to which visuo-perceptual and motor deficits, but not neglect, due to stroke impact end-state comfort measured as the grasp-height effect. Thirty-four older adults (17 controls, 17 chronic stroke) performed a functional goal-directed two-sequence task with each arm, consisting of reaching and moving a cylindrical object (drain plunger) from an initial to four target platform heights, standardized to body height, in a block randomized sequence. Arm motor impairment (Fugl-Meyer Assessment) and visual–perceptual deficits (Motor-Free Visual Perception Test) were assessed in stroke subjects, and arm and trunk kinematics were assessed in all subjects. The primary outcome measure of the grasp-height effect was the relationship between the grasp heights used at the home position and the final target platform heights. Mixed model analysis was used for data analysis. The grasp-height effect was present in all participants, but decreased in stroke subjects with visuo-perceptual impairments compared to controls. In stroke subjects with sensorimotor impairments alone, indicated by altered kinematics, the grasp-height effect was comparable to controls. This first study examining the grasp-height effect in individuals with stroke provides new knowledge of the impact of visuo-perceptual deficits on movement planning and execution, which may assist clinicians in selecting more effective treatment strategies to improve perceptuo-motor skills and enhance motor recovery.

Relationships between activities of daily living, upper limb function, and visual perception in children and adolescents with unilateral cerebral palsy

AIM

This study examined relationships between activities of daily living (ADL) motor and process skills, unimanual capacity, bimanual performance, and visual perception in children with unilateral cerebral palsy (CP).

METHOD

Participants were 101 children with unilateral CP (51 males, 50 females; mean age 11y 9mo [SD 2y 5mo; range 8-17y]; Manual Ability Classification System [MACS] level I=24; level II=76; level III=1). Measures were (1) Assessment of Motor and Process Skills (AMPS), (2) Jebsen-Taylor Test of Hand Function (JTTHF), (3) Assisting Hand Assessment (AHA), and (4) Test of Visual Perceptual Skills, 3rd edition (TVPS-3). Regression models were constructed with the AMPS motor scale and AMPS process as the dependent variables.

RESULTS

The AHA and JTTHF dominant upper limb score together explained 57% of the variance in AMPS motor scale scores. TVPS-3 Visual Sequential Memory, TVPS-3 Visual Closure, and JTTHF dominant upper limb score together explained 35% of the variance in AMPS process scale scores.

INTERPRETATION

Bimanual performance and unimanual capacity of the dominant upper limb are significantly associated with ADL motor skills in children with unilateral CP. Process skills of ADL are related to visual perceptual ability and dominant upper limb unimanual capacity, which may reflect motor planning required to perform daily tasks.

Manual (a)symmetries in grasp posture planning: a short review

Many activities of daily living require that we physically interact with one or more objects. Object manipulation provides an intriguing domain in which the presence and extent of manual asymmetries can be studied on a motor planning and a motor execution level. In this literature review we present a state of the art for manual asymmetries at the level of motor planning during object manipulation. First, we introduce pioneering work on grasp posture planning. We then sketch the studies investigating the impact of future task demands during unimanual and bimanual object manipulation tasks in healthy adult populations. In sum, in contrast to motor execution, there is little evidence for hand-based performance differences in grasp posture planning. We discuss potential reasons for the lack of manual asymmetries in motor planning and outline potential avenues of future research.

Mild impairments of motor imagery skills in children with DCD

It has been hypothesized that the underlying mechanism of clumsy motor behaviour in children with Developmental Coordination Disorder (DCD) is caused by a deficit in the internal modelling for motor control. An internal modelling deficit can be shown on a behavioural level by a task that requires motor imagery. Motor imagery skills are suggested to be related to anticipatory action planning, but motor imagery and action planning have not been tested within the same child. In the present study, action planning and motor imagery skills were assessed in 82 children between 7 and 12 years of age. Twenty-one of these children met the criteria for DCD, which was assessed by the McCarron Assessment of Neuromuscular Development and 56 of these children were used in the control group. Motor imagery was tested by a mental rotation task of hands that were shown from a back and palm point of view. The results show that motor imagery is affected in children with DCD but only in conditions with complex task constraints (i.e., rotation of hand stimuli presented in palm view). These results provide partial support for the internal modelling deficit hypothesis. We were not able to elicit motor planning deficits in this group, however, and argue that more complex planning tasks may be needed to identify such deficits.

Effect of motor imagery in children with unilateral cerebral palsy: fMRI study

Background

Motor imagery is considered as a promising therapeutic tool for rehabilitation of motor planning problems in patients with cerebral palsy. However motor planning problems may lead to poor motor imagery ability.

Aim

The aim of this functional magnetic resonance imaging study was to examine and compare brain activation following motor imagery tasks in patients with hemiplegic cerebral palsy with left or right early brain lesions. We tested also the influence of the side of imagined hand movement.

Method

Twenty patients with clinical hemiplegic cerebral palsy (sixteen males, mean age 12 years and 10 months, aged 6 years 10 months to 20 years 10 months) participated in this study. Using block design, brain activations following motor imagery of a simple opening-closing hand movement performed by either the paretic or nonparetic hand was examined.

Results

During motor imagery tasks, patients with early right brain damages activated bilateral fronto-parietal network that comprise most of the nodes of the network well described in healthy subjects. Inversely, in patients with left early brain lesion brain activation following motor imagery tasks was reduced, compared to patients with right brain lesions. We found also a weak influence of the side of imagined hand movement.

Conclusion

Decreased activations following motor imagery in patients with right unilateral cerebral palsy highlight the dominance of the left hemisphere during motor imagery tasks. This study gives neuronal substrate to propose motor imagery tasks in unilateral cerebral palsy rehabilitation at least for patients with right brain lesions.

Differences in somatosensory processing due to dominant hemispheric motor impairment in cerebral palsy

Background

Although cerebral palsy (CP) is usually defined as a group of permanent motor disorders due to non-progressive disturbances in the developing fetal or infant brain, recent research has shown that CP individuals are also characterized by altered somatosensory perception, increased pain and abnormal activation of cortical somatosensory areas. The present study was aimed to examine hemispheric differences on somatosensory brain processing in individuals with bilateral CP and lateralized motor impairments compared with healthy controls. Nine CP individuals with left-dominant motor impairments (LMI) (age range 5–28 yrs), nine CP individuals with right-dominant motor impairments (RMI) (age range 7–29 yrs), and 12 healthy controls (age range 5–30 yrs) participated in the study. Proprioception, touch and pain thresholds, as well as somatosensory evoked potentials (SEP) elicited by tactile stimulation of right and left lips and thumbs were compared.

Results

Pain sensitivity was higher, and lip stimulation elicited greater beta power and more symmetrical SEP amplitudes in individuals with CP than in healthy controls. In addition, although there was no significant differences between individuals with RMI and LMI on pain or touch sensitivity, lip and thumb stimulation elicited smaller beta power and more symmetrical SEP amplitudes in individuals with LMI than with RMI.

Conclusions

Our data revealed that brain processing of somatosensory stimulation was abnormal in CP individuals. Moreover, this processing was different depending if they presented right- or left-dominant motor impairments, suggesting that different mechanisms of sensorimotor reorganization should be involved in CP depending on dominant side of motor impairment.

Manual asymmetries in the kinematics of a reach-to-grasp action

In the present study, we manipulated the perceived demand of an ecologically valid task to investigate the possible presence of manual asymmetries in a reach-to-grasp action. Participants reached, grasped and sipped from a water glass under low (nearly empty) and high (nearly full) demand conditions. Participants reached to grasp in closed-loop, open-loop and delay visual conditions. Manual asymmetries were found in movement time, peak velocity and maximum grip aperture variability. Consistent with reach-to-point literature: (1) right-handed actions were completed in less time than left-handed actions in visually and memory-guided conditions; (2) right-handed movements were more accurate (i.e., produced more consistent maximum grip apertures) than left-handed movements in visually guided conditions. The results support a theory of left-hemisphere specialization for visual control of action.

Motor planning ability is not related to lesion side or functional manual ability in children with hemiplegic cerebral palsy

Optimal task performance requires anticipatory planning to select the most appropriate movement strategy. There is conflicting evidence for hemispheric specialisation of motor planning, with some suggesting left hemisphere dominance, claiming that children with right hemiplegic cerebral palsy (HCP) are therefore disproportionally affected. An alternative view is that there is a positive relationship between functional ability (rather than side of lesion) and motor planning skill. We aimed to compare children with right and left HCP on motor planning ability and to explore its relationship with functional manual ability. Participants were 76 children with HCP (40 left HCP; 30 female), aged 4-15 years (Mean 9.09, SD 2.94). Motor planning was assessed using a measure of end-state comfort, which involved turning a hexagonal handle 180° without readjusting grasp. This is difficult, or in some cases impossible, to achieve unless an appropriate initial grasp is adopted. Children completed 24 turns (12 clockwise), which were video recorded for offline scoring. Functional manual ability was assessed with the ABILHAND-Kids questionnaire, completed by parents. Contrary to the existing literature, no differences were observed between right and left HCP. However, a significant interaction between direction of turn and side of hemiplegia indicated a preferential bias for turns in the medial direction, consistent with the "medial over lateral advantage". There was no relationship between functional ability and motor planning. Therefore, motor planning may not be a priority for therapeutic intervention to improve functional ability in HCP.

Choosing actions

Actions that are chosen have properties that distinguish them from actions that are not. Of the nearly infinite possible actions that can achieve any given task, many of the unchosen actions are irrelevant, incorrect, or inappropriate. Others are relevant, correct, or appropriate but are disfavored for other reasons. Our research focuses on the question of what distinguishes actions that are chosen from actions that are possible but are not. We review studies that use simple preference methods to identify factors that contribute to action choices, especially for object-manipulation tasks. We can determine which factors are especially important through simple behavioral experiments.

Cognition, action, and object manipulation

Although psychology is the science of mental life and behavior, little attention has been paid to the means by which mental life is translated into behavior. One domain in which links between cognition and action have been explored is the manipulation of objects. This article reviews psychological research on this topic, with special emphasis on the tendency to grasp objects differently depending on what one plans to do with the objects. Such differential grasping has been demonstrated in a wide range of object manipulation tasks, including grasping an object in a way that reveals anticipation of the object's future orientation, height, and required placement precision. Differential grasping has also been demonstrated in a wide range of behaviors, including 1-hand grasps, 2-hand grasps, walking, and transferring objects from place to place as well as from person to person. The populations in which the tendency has been shown are also diverse, including nonhuman primates as well as human adults, children, and babies. The tendency is compromised in a variety of clinical populations and in children of a surprisingly advanced age. Verbal working memory is compromised as well if words are memorized while object manipulation tasks are performed; the recency portion of the serial position curve is reduced in this circumstance. In general, the research reviewed here points to rich connections between cognition and action as revealed through the study of object manipulation. Other implications concern affordances, Donders' law, naturalistic observation, and the teaching of psychology.

Gaze behaviour during interception in children with spastic unilateral cerebral palsy

Anticipatory gaze behaviour during interceptive movements was investigated in children with Spastic Unilateral Cerebral Palsy (SUCP), and related to the side of the intracerebral lesion. Five children with lesions of the right hemisphere (RHL) and five children with lesions of the left hemisphere (LHL) had to walk towards and intercept a ball that moved perpendicular to the walking path. Interception accuracy and gaze patterns were measured in a no-occlusion and occlusion condition, in which the ball was occluded from view for half of its trajectory. There was a clear support for a relationship between gaze behaviour and success in interception performance, with some evidence for the presence of anticipatory gaze behaviour. There were also differences in gaze behaviour between children with RHL and children with LHL that might be related to planning, but these did not affect interception accuracy. It is concluded that gaze behaviour during interceptive movements is anticipatory, and at least partly dependent on the lesional side.

An investigation into manual asymmetries in grasp behavior and kinematics during an object manipulation task

Manual asymmetries in the control of movements have been investigated in a variety of experimental paradigms. Initial studies demonstrated that the dominant right hand has advantages over the non-dominant left hand in many aspects of motor control. However, more recent studies have shown that the presence and extent of these asymmetries depends on the task context and accuracy demands. Typically, manual asymmetries on a motor planning and motor execution level are examined separately. However, given that recent research has demonstrated that specific task constraints do not influence both levels equally, the purpose of the present experiment was to investigate manual asymmetries in motor planning and execution. To this end, initial grasp behavior (motor planning) and kinematics (motor execution) were examined in thirteen right-handed participants during a unimanual grasping and placing task. We specifically manipulated grasping hand, target location, object end orientation, and object grasp time at the start location. There were three main findings. First, motor planning or movement execution was similar regardless of grasping hand. Second, prospectively planned actions were influenced by target location and the required end orientation of the object. Third, the amount of time spent in an initial posture did not influence initial grasp postures. However, it did alter the movement kinematics during the grasping (approach phase) and placing (transport phase) portion of the task. We posit that grasping and placing movements are comprised of an initial grasp and a transport component, which are differentially influenced by task constraints.

Behavioral evidence for left-hemisphere specialization of motor planning

Recent studies suggest that the left hemisphere is dominant for the planning of motor actions. This left-hemisphere specialization hypothesis was proposed in various lines of research, including patient studies, motor imagery studies, and studies involving neurophysiological techniques. However, most of these studies are primarily based on experiments involving right-hand-dominant participants. Here, we present the results of a behavioral study with left-hand-dominant participants, which follows up previous work in right-hand-dominant participants. In our experiment, participants grasped CD casings and replaced them in a different, pre-cued orientation. Task performance was measured by the end-state comfort effect, i.e., the anticipated degree of physical comfort associated with the posture that is planned to be adopted at movement completion. Both left- and right-handed participants showed stronger end-state comfort effects for their right hand compared to their left hand. These results lend behavioral support to the left-hemisphere-dominance motion-planning hypothesis.

Neural evidence for compromised motor imagery in right hemiparetic cerebral palsy

In the present event-related potential (ERP) study we investigated the neural and temporal dynamics of motor imagery in participants with right-sided hemiparetic cerebral palsy (HCP; n = 10) and in left-handed control participants (n = 10). A mental rotation task was used in which participants were required to judge the laterality of hand pictures. At a behavioral level participants with HCP were slower in making hand laterality judgments compared to control subjects, especially when presented with pictures representing the affected hand. At a neural level, individuals with HCP were characterized by a reduced rotation-related negativity (RRN) over parietal areas, that was delayed in onset with respect to control participants. Interestingly, participants that were relatively mildly impaired showed a stronger RRN for the rotation of right-hand stimuli than participants that were more strongly impaired in their motor function, suggesting a direct relation between the motor imagery process and the biomechanical constraints of the participant. Together, the results provide new insights in the relation between motor imagery and motor capabilities and indicate that participants with HCP may be characterized by a compromised ability to use motor imagery.

Compromised motor planning and Motor Imagery in right Hemiparetic Cerebral Palsy

We investigated whether motor planning problems in people with Hemiparetic Cerebral Palsy (HCP) are paralleled by impaired ability to use Motor Imagery (MI). While some studies have shown that individuals with HCP can solve a mental rotation task, it was not clear if they used MI or Visual Imagery (VI). In the present study, motor planning and MI were examined in individuals with right HCP (n=10) and controls. Motor planning was measured using an object manipulation task, where participants had to anticipate the end of the motor action. MI was measured using a mental rotation paradigm, where participants judged laterality of hands presented from a back view and a palm view. To test if participants used MI or VI we compared reaction times of lateral versus medial rotations, under the assumption that MI is subject to biomechanical constraints of rotated hands, but VI is not. Individuals with HCP had a higher proportion of task failures due to inappropriate grip choice, exemplifying impaired planning. Second, individuals with HCP did not show a reaction time difference between lateral and medial rotations, indicating an impaired ability to use MI. These findings show that compromised motor planning in HCP is paralleled by an impairment in the ability to use MI. Training of MI may be a useful entry-point for rehabilitation of motor planning problems.

Motor imagery training in hemiplegic cerebral palsy: a potentially useful therapeutic tool for rehabilitation

Converging evidence indicates that motor deficits in cerebral palsy (CP) are related not only to problems with execution, but also to impaired motor planning. Current rehabilitation mainly focuses on alleviating compromised motor execution. Motor imagery is a promising method of training the more 'cognitive' aspects of motor behaviour, and may, therefore, be effective in facilitating motor planning in patients with CP. In this review first we present the specific motor planning problems in CP followed by a discussion of motor imagery and its use in clinical practice. Second, we present the steps to be taken before motor imagery can be used for rehabilitation of upper limb functioning in CP. Motor imagery training has been shown to be a useful addition to existing rehabilitation protocols for poststroke rehabilitation. No such study has been conducted in CP. The age at which children can reliably use motor imagery, as well as the specific way in which motor imagery training needs to be implemented, must be researched before motor imagery training can be employed in children with CP. Based on the positive results for poststroke rehabilitation, and in light of the motor problems in CP, motor imagery training may be a valuable additional tool for rehabilitation in CP.