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Zimonyi N, Kói T, Dombrádi V, Imrei M, Nagy R, Pulay MÁ, Lang Z, Hegyi P, Takacs ZK, Túri I. Comparison of Executive Function Skills between Patients with Cerebral Palsy and Typically Developing Populations: A Systematic Review and Meta-Analysis. J Clin Med 2024; 13:1867. [PMID: 38610632 PMCID: PMC11012391 DOI: 10.3390/jcm13071867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 03/13/2024] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Children with CP show deficits in executive function compared to their typically developing peers, based on the majority of the available evidence. However, the magnitude of these deficits, as well as the proportions of the shortfalls in the three main components, have not yet been examined. This is the first meta-analysis to synthesize evidence on the magnitude of differences between patients with cerebral palsy (CP) and typically developing populations in different components of executive function skills (working memory, inhibitory control and cognitive flexibility), and thus makes recommendations on which areas of executive functioning are in greatest need of intervention. Methods: We conducted a systematic literature search of four databases for studies that measured executive functions in these two groups until 31 August 2023. We calculated the standardized mean difference (Hedges' g), an average effect size overall, and for the three components of executive function skills separately, we used several moderator analyses, including methodological differences between the primary studies. Results: Fifteen articles were included in the meta-analysis. The average mean difference in executive functioning overall was large (g+ = -0.82). Furthermore, large significant differences were found in working memory (g+ = -0.92) and inhibitory control (g+ = -0.82) and a moderate difference was identified in cognitive flexibility (g+ = -0.57). In addition, results of moderator analyses reveal the importance of a rigorous matching of control group participants and CP patients. Conclusions: The results demonstrate a severe impairment in all executive functions among CP patients compared to typically developing peers, which do not decrease over time.
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Affiliation(s)
- Nóra Zimonyi
- Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary; (T.K.); (M.I.); (R.N.); (M.Á.P.); (Z.L.); (P.H.)
- Pető András Faculty, Semmelweis University, 1085 Budapest, Hungary;
- School of PhD Studies, Semmelweis University, 1085 Budapest, Hungary
| | - Tamás Kói
- Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary; (T.K.); (M.I.); (R.N.); (M.Á.P.); (Z.L.); (P.H.)
- Department of Stochastics, Institute of Mathematics, Budapest University of Technology and Economics, 1111 Budapest, Hungary
| | - Viktor Dombrádi
- Patient Safety Department, Health Services Management Training Centre, Faculty of Health and Public Administration, Semmelweis University, 1085 Budapest, Hungary;
| | - Marcell Imrei
- Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary; (T.K.); (M.I.); (R.N.); (M.Á.P.); (Z.L.); (P.H.)
- Institute for Translational Medicine, Medical School, University of Pécs, 7622 Pécs, Hungary
| | - Rita Nagy
- Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary; (T.K.); (M.I.); (R.N.); (M.Á.P.); (Z.L.); (P.H.)
- Institute for Translational Medicine, Medical School, University of Pécs, 7622 Pécs, Hungary
- Heim Pál National Pediatric Institute, 1089 Budapest, Hungary
| | - Márk Ágoston Pulay
- Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary; (T.K.); (M.I.); (R.N.); (M.Á.P.); (Z.L.); (P.H.)
- Pető András Faculty, Semmelweis University, 1085 Budapest, Hungary;
- Department of Ergonomics and Psychology, Faculty of Economic and Social Sciences, Budapest University of Technology and Economics, 1111 Budapest, Hungary
| | - Zsolt Lang
- Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary; (T.K.); (M.I.); (R.N.); (M.Á.P.); (Z.L.); (P.H.)
- Department of Biostatistics, University of Veterinary Medicine Budapest, 1078 Budapest, Hungary
| | - Péter Hegyi
- Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary; (T.K.); (M.I.); (R.N.); (M.Á.P.); (Z.L.); (P.H.)
- Institute for Translational Medicine, Medical School, University of Pécs, 7622 Pécs, Hungary
- Institute of Pancreatic Diseases, Semmelweis University, 1085 Budapest, Hungary
| | - Zsofia K. Takacs
- School of Health in Social Science, University of Edinburgh, Edinburgh EH10 5HF, UK;
| | - Ibolya Túri
- Pető András Faculty, Semmelweis University, 1085 Budapest, Hungary;
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Sand K, Starrfelt R, Robotham RJ. Cognitive Functioning and Assessment in Adults with Cerebral Palsy: A Scoping Review. Dev Neurorehabil 2024; 27:57-67. [PMID: 38702978 DOI: 10.1080/17518423.2024.2347991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 04/23/2024] [Indexed: 05/06/2024]
Abstract
In this scoping review, we summarize the current knowledge of cognitive functioning in adults with cerebral palsy (CP), and identify the neuropsychological tests typically used in this population. 39 studies from the period January 1990 - August 2023 were included in the review, and they differ widely in their aims and approach to studying cognition. Very few studies have cognitive assessment as their core aim and use a neuropsychological test battery. The included studies show great variability in reported intelligence and cognitive functioning in adults with CP, and cognitive deficits have been reported in all cognitive domains. Most of the studies suffer from methodological limitations, and there is ample room for improvement within the field. We conclude by suggesting a number of recommendations that may contribute to increasing our understanding of cognitive impairments in adults with CP.
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Dukkipati SS, Walker SJ, Trevarrow MP, Busboom MT, Kurz MJ. Spinal cord H-reflex post-activation depression is linked with hand motor control in adults with cerebral palsy. Clin Neurophysiol 2023; 148:9-16. [PMID: 36773504 PMCID: PMC9998348 DOI: 10.1016/j.clinph.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 12/08/2022] [Accepted: 01/01/2023] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Cerebral palsy (CP) is associated with upper extremity motor impairments that are largely assumed to arise from alterations in the supraspinal networks. The objective of this study was to determine if post-activation depression of the spinal H-reflexes is altered in adults with CP and connected with altered upper extremity function. METHODS The post-activation depression of the flexor carpi radialis (FCR) H-reflex of adults with CP and healthy adults (HA) controls were assessed by 1) a 1 Hz continuous single-pulse stimulus train and 2) 0.11 Hz / 1 Hz paired-pulse stimuli. Secondarily, we measured the maximum key grip force and the box and blocks assessment of manual dexterity. RESULTS Our results revealed that adults with CP had reduced post-activation depression of the FCR H-reflex during the stimulus train and the paired pulse protocol. A greater reduction in H-reflex post-activation depression was connected to lower manual dexterity and weaker grip forces. CONCLUSIONS Our results indicate that the post-activation depression of the upper extremity spinal H-reflex pathways is altered in adults with CP and possibly linked with their uncharacteristic upper extremity motor performance. Alterations in the spinal networks may also play a significant role in the altered motor control of adults with CP. SIGNIFICANCE Our results identify spinal H-reflex modulation as a possible locus for hand motor control in CP.
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Affiliation(s)
- Shekar S Dukkipati
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE, USA
| | - Sarah J Walker
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE, USA
| | - Michael P Trevarrow
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE, USA
| | - Morgan T Busboom
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE, USA
| | - Max J Kurz
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE, USA; Department of Pharmacology & Neuroscience, Creighton University, Omaha, NE, USA.
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Li Y, Chen X, Zhang Q, Xu W, Li J, Ji F, Dong Q, Chen C, Li J. Effects of working memory span training on top-down attentional asymmetry at both neural and behavioral levels. Cereb Cortex 2023; 33:5937-5946. [PMID: 36617305 DOI: 10.1093/cercor/bhac472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 11/07/2022] [Accepted: 11/08/2022] [Indexed: 01/09/2023] Open
Abstract
The leftward asymmetry of the visual field and posterior brain regions, a feature of the normal attention process, can be strengthened by brain stimulation, e.g. administering alpha frequency stimulation to the left posterior cortex. However, whether it can be strengthened by cognitive training, especially with nonlateralized tasks, is unknown. We used a dataset from a 2-month-long randomized controlled trial and compared the control group with 2 training groups trained with backward or forward memory span tasks. A lateralized change detection task with varied memory loads was administered as the pre-, mid-, and post-tests with simultaneous electroencephalographic recording. Intrasubject response variability (IRV) and the alpha modulation index (MI) were calculated. Analysis of IRV showed more enhanced leftward attentional bias in the backward group than in the other groups. Consistently, analysis of MI found that its enhancements in the left hemisphere (but not the right hemisphere) of the backward group were significantly higher than those of the other groups. Further analysis revealed that left MI changes predicted left IRV improvement. All of these results indicated that backward memory span training enhanced leftward attentional asymmetry at both the behavioral and neural levels.
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Affiliation(s)
- Yang Li
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, No.19, Xinjiekouwai Street, Haidian District, Beijing 100875, P.R. China
| | - Xiongying Chen
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, No.5, Ankang Hutong, Xicheng District, Beijing 100088, P.R. China
| | - Qiumei Zhang
- School of Mental Health, Jining Medical University, 45# Jianshe South Road, Jining, Shandong 272013, P.R. China
| | - Wending Xu
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, No.19, Xinjiekouwai Street, Haidian District, Beijing 100875, P.R. China
| | - Jin Li
- Brainnetome Center, Institute of Automation, Chinese Academy of Sciences, No. 95 Zhongguancun East Road, Haidian District, Beijing 100190, P.R. China.,National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, No. 95 Zhongguancun East Road, Haidian District, Beijing 100190, P.R. China
| | - Feng Ji
- School of Mental Health, Jining Medical University, 45# Jianshe South Road, Jining, Shandong 272013, P.R. China
| | - Qi Dong
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, No.19, Xinjiekouwai Street, Haidian District, Beijing 100875, P.R. China
| | - Chuansheng Chen
- Department of Psychological Science, University of California, Irvine, 4201 Social & Behavioral Sciences Gateway,CA 92697, United States
| | - Jun Li
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, No.19, Xinjiekouwai Street, Haidian District, Beijing 100875, P.R. China
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Dukkipati SS, Walker SJ, Trevarrow MP, Busboom M, Baker SE, Kurz MJ. Reduced wrist flexor H-reflex excitability is linked with increased wrist proprioceptive error in adults with cerebral palsy. Front Neurol 2022; 13:930303. [PMID: 36016542 PMCID: PMC9396222 DOI: 10.3389/fneur.2022.930303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/18/2022] [Indexed: 12/03/2022] Open
Abstract
Although most neurophysiological studies of persons with cerebral palsy (CP) have been focused on supraspinal networks, recent evidence points toward the spinal cord as a central contributor to their motor impairments. However, it is unclear if alterations in the spinal pathways are also linked to deficits in the sensory processing observed clinically. This investigation aimed to begin to address this knowledge gap by evaluating the flexor carpi radialis (FCR) H-reflex in adults with CP and neurotypical (NT) controls while at rest and during an isometric wrist flexion task. The maximal H-wave (Hmax) and M-wave (Mmax) at rest were calculated and utilized to compute Hmax/Mmax ratios (H:M ratios). Secondarily, the facilitation of the H-wave was measured while producing an isometric, voluntary wrist flexion contraction (i.e., active condition). Finally, a wrist position sense test was used to quantify the level of joint position sense. These results revealed that the adults with CP had a lower H:M ratio compared with the NT controls while at rest. The adults with CP were also unable to facilitate their H-reflexes with voluntary contraction and had greater position sense errors compared with the controls. Further, these results showed that the adults with CP that had greater wrist position sense errors tended to have a lower H:M ratio at rest. Overall, these findings highlight that aberration in the spinal cord pathways of adults with CP might play a role in the sensory processing deficiencies observed in adults with CP.
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Affiliation(s)
- S. Shekar Dukkipati
- Boys Town National Research Hospital, Omaha, NE, United States
- College of Medicine, University of Nebraska Medical Center, Omaha, NE, United States
| | - Sarah J. Walker
- Boys Town National Research Hospital, Omaha, NE, United States
| | | | - Morgan Busboom
- Boys Town National Research Hospital, Omaha, NE, United States
| | - Sarah E. Baker
- Boys Town National Research Hospital, Omaha, NE, United States
| | - Max J. Kurz
- Boys Town National Research Hospital, Omaha, NE, United States
- School of Medicine, Creighton University, Omaha, NE, United States
- *Correspondence: Max J. Kurz
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Trevarrow MP, Reelfs A, Ott LR, Penhale SH, Lew BJ, Goeller J, Wilson TW, Kurz MJ. Altered spontaneous cortical activity predicts pain perception in individuals with cerebral palsy. Brain Commun 2022; 4:fcac087. [PMID: 35441137 PMCID: PMC9014448 DOI: 10.1093/braincomms/fcac087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 01/13/2022] [Accepted: 03/31/2022] [Indexed: 12/04/2022] Open
Abstract
Cerebral palsy is the most common paediatric neurological disorder and results in extensive impairment to the sensorimotor system. However, these individuals also experience increased pain perception, resulting in decreased quality of life. In the present study, we utilized magnetoencephalographic brain imaging to examine whether alterations in spontaneous neural activity predict the level of pain experienced in a cohort of 38 individuals with spastic diplegic cerebral palsy and 67 neurotypical controls. Participants completed 5 min of an eyes closed resting-state paradigm while undergoing a magnetoencephalography recording. The magnetoencephalographic data were then source imaged, and the power within the delta (2–4 Hz), theta (5–7 Hz), alpha (8–12 Hz), beta (15–29 Hz), low gamma (30–59 Hz) and high gamma (60–90 Hz) frequency bands were computed. The resulting power spectral density maps were analysed vertex-wise to identify differences in spontaneous activity between groups. Our findings indicated that spontaneous cortical activity was altered in the participants with cerebral palsy in the delta, alpha, beta, low gamma and high gamma bands across the occipital, frontal and secondary somatosensory cortical areas (all pFWE < 0.05). Furthermore, we also found that the altered beta band spontaneous activity in the secondary somatosensory cortices predicted heightened pain perception in the individuals with cerebral palsy (P = 0.039). Overall, these results demonstrate that spontaneous cortical activity within individuals with cerebral palsy is altered in comparison to their neurotypical peers and may predict increased pain perception in this patient population. Potentially, changes in spontaneous resting-state activity may be utilized to measure the effectiveness of current treatment approaches that are directed at reducing the pain experienced by individuals with cerebral palsy.
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Affiliation(s)
- Michael P. Trevarrow
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE, USA
| | - Anna Reelfs
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE, USA
| | - Lauren R. Ott
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE, USA
| | - Samantha H. Penhale
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE, USA
| | - Brandon J. Lew
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE, USA
| | - Jessica Goeller
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Tony W. Wilson
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE, USA
- Department of Pharmacology & Neuroscience, Creighton University, Omaha, NE, USA
| | - Max J. Kurz
- Institute for Human Neuroscience, Boys Town National Research Hospital, Omaha, NE, USA
- Department of Pharmacology & Neuroscience, Creighton University, Omaha, NE, USA
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