Brain structure and executive functions in children with cerebral palsy: a systematic review

Randomised controlled trial of an online cognitive training program in school-aged children with cerebral palsy

BACKGROUND

Children with cerebral palsy (CP) experience deficits in nonverbal reasoning. The SMART online cognitive intervention has been associated with gains in IQ and nonverbal IQ in previous studies in typically developing school-aged children and children experiencing learning difficulties.

AIM

To assess the efficacy of an online cognitive intervention in school-aged children with CP.

METHODS AND PROCEDURES

21 children with CP (male n = 17; 76.2%), mean age 9 y 8 m, SD 1 y 1 month (range 8 y 3 m to 12 y 6 m) were randomised into the intervention group (n = 9) or a waitlist control group. A mixed-methods approach with an explanatory sequential design was used, with a randomised controlled trial followed by qualitative interviews. Participants were assessed on measures of intelligence, academic ability, attention and executive functioning, and social-emotional functioning at baseline, then after completing the training, or the waitlist period. Analyses included ANCOVAs and paired samples t tests. Semi-structured interviews explored participants' experiences with the training.

RESULTS AND OUTCOMES

Training completion was low with a mean of 16.9 modules completed out of 55 available. No significant effect of training was found for the primary outcome of intelligence, or for any secondary outcomes. Participants reported barriers and facilitators for accessing the program.

IMPLICATIONS

Cognitive training programs addressing relational framing ability may require significant modifications before they can be effectively tested with children with CP.

Exploring early life social and executive function development in infants and risk for autism: a prospective cohort study protocol of NICU graduates and infants at risk for cerebral palsy

BACKGROUND

Delays in early social and executive function are predictive of later developmental delays and eventual neurodevelopmental diagnoses. There is limited research examining such markers in the first year of life. High-risk infant groups commonly present with a range of neurodevelopmental challenges, including social and executive function delays, and show higher rates of autism diagnoses later in life. For example, it has been estimated that up to 30% of infants diagnosed with cerebral palsy (CP) will go on to be diagnosed with autism later in life.

METHODS

This article presents a protocol of a prospective longitudinal study. The primary aim of this study is to identify early life markers of delay in social and executive function in high-risk infants at the earliest point in time, and to explore how these markers may relate to the increased risk for social and executive delay, and risk of autism, later in life. High-risk infants will include Neonatal Intensive Care Unit (NICU) graduates, who are most commonly admitted for premature birth and/or cardiovascular problems. In addition, we will include infants with, or at risk for, CP. This prospective study will recruit 100 high-risk infants at the age of 3-12 months old and will track social and executive function across the first 2 years of their life, when infants are 3-7, 8-12, 18 and 24 months old. A multi-modal approach will be adopted by tracking the early development of social and executive function using behavioural, neurobiological, and caregiver-reported everyday functioning markers. Data will be analysed to assess the relationship between the early markers, measured from as early as 3-7 months of age, and the social and executive function as well as the autism outcomes measured at 24 months.

DISCUSSION

This study has the potential to promote the earliest detection and intervention opportunities for social and executive function difficulties as well as risk for autism in NICU graduates and/or infants with, or at risk for, CP. The findings of this study will also expand our understanding of the early emergence of autism across a wider range of at-risk groups.

Comparison of Executive Function Skills between Patients with Cerebral Palsy and Typically Developing Populations: A Systematic Review and Meta-Analysis

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.

Corpus Callosum Functional Activities in Children with Cerebral Palsy

Background

Since cerebral palsy (CP) is a corollary to brain damage, persistent treatment should accompany an alteration in brain functional activity in line with clinical improvements. In this regard, the corpus callosum (CC), as a connecting bridge between the two hemispheres, plays an essential role.

Objective

This study aimed to investigate the therapeutic effects of occupational therapy (OT) on CC functional activity and walking capacity in children with cerebral palsy.

Material and Methods

In this clinical trial study, 4 children with CP (8.25±1.71 years) received 45 min OT sessions 3 times weekly for 8 weeks. Functional magnetic resonance imaging (fMRI) was acquired while conducting passive motor tasks to quantify CC activation. The pre-post activation changes in CC following therapy were quantified in terms of activated voxels. Walking capacity was evaluated using the timed-up-and-go (TUG), 6-minute walk test (6 MWT), and 10-meter walk test (10 MWT) in pre-and post-treatment.

Results

The number of activated voxels in CC indicated significant improvement in participants. Post-treatment activated voxels substantially exceeded pre-treatment active voxels. Clinical measures, including TUG, 6 MWT, and 10 MWT are improved by 11.9%, 12.6%, and 25.4%, respectively.

Conclusion

Passive task-based fMRI can detect the effects of OT on CC functional activity in children with CP. According to the results, OT improves CC functional activity in addition to gait and balance performance.

Touch may reduce cognitive load during assisted typing by individuals with developmental disabilities

Many techniques have attempted to provide physical support to ease the execution of a typing task by individuals with developmental disabilities (DD). These techniques have been controversial due to concerns that the support provider's touch can influence the typed content. The most common interpretation of assisted typing as an ideomotor phenomenon has been qualified recently by studies showing that users with DD make identifiable contributions to the process. This paper suggests a neurophysiological pathway by which touch could lower the cognitive load of seated typing by people with DD. The required sensorimotor processes (stabilizing posture and planning and executing manual reaching movements) and cognitive operations (generating and transcribing linguistic material) place concurrent demands on cognitive resources, particularly executive function (EF). A range of developmental disabilities are characterized by deficits in sensorimotor and EF capacity. As light touch has been shown to facilitate postural coordination, it is proposed that a facilitator's touch could assist the seated typist with sensorimotor and EF deficits by reducing their sensorimotor workload and thereby freeing up shared cognitive resources for the linguistic elements of the task. This is the first theoretical framework for understanding how a facilitator's touch may assist individuals with DD to contribute linguistic content during touch-assisted typing.

Structural and pathophysiological muscle changes up to one year after post-stroke hemiplegia: a systematic review

INTRODUCTION

Muscle changes after stroke cannot be explained solely on the basis of corticospinal bundle damage. Muscle-specific changes contribute to limited functional recovery but have been poorly characterized.

EVIDENCE ACQUISITION

We conducted a systematic review of muscular changes occurring at the histological, neuromuscular and functional levels during the first year after the onset of post-stroke hemiplegia. A literature search was performed on PubMed, Embase and CINHAL databases up to November 2022 using a keyword combination comprising cerebral stroke, hemiplegic, atrophy, muscle structure, paresis, skeletal muscle fiber type, motor unit, oxidative stress, strength, motor control.

EVIDENCE SYNTHESIS

Twenty-seven trial reports were included in the review, out of 12,798 articles screened. Structural modifications described on the paretic side include atrophy, transformation of type II fibers into type I fibers, decrease in fiber diameter and apparent myofilament disorganization from the first week post-stroke up to the fourth month. Reported biochemical changes comprise the abnormal presence of lipid droplets and glycogen granules in the subsarcolemmal region during the first month post-stroke. At the neurophysiological level, studies indicate an early decrease in the number and activity of motor units, correlated with the degree of motor impairment. All these modifications were present to a lesser degree on the non-paretic side. Although only sparse data concerning the subacute stage are available, these changes seem to appear during the first two weeks post-stroke and continue up to the third or fourth month.

CONCLUSIONS

Considering these early pathophysiological changes on both the paretic and non-paretic sides, it seems crucial to promptly stimulate central and also peripheral muscular activation after stroke through specific rehabilitation programs focused on the maintenance of muscle capacities associated with neurological recovery or plasticity.

Brain structural and functional connectivity and network organization in cerebral palsy: A scoping review

AIM

To explore altered structural and functional connectivity and network organization in cerebral palsy (CP), by clinical CP subtype (unilateral spastic, bilateral spastic, dyskinetic, and ataxic CP).

METHOD

PubMed and Embase databases were systematically searched. Extracted data included clinical characteristics, analyses, outcome measures, and results.

RESULTS

Sixty-five studies were included, of which 50 investigated structural connectivity, and 20 investigated functional connectivity using functional magnetic resonance imaging (14 studies) or electroencephalography (six studies). Five of the 50 studies of structural connectivity and one of 14 of functional connectivity investigated whole-brain network organization. Most studies included patients with unilateral spastic CP; none included ataxic CP.

INTERPRETATION

Differences in structural and functional connectivity were observed between investigated clinical CP subtypes and typically developing individuals on a wide variety of measures, including efferent, afferent, interhemispheric, and intrahemispheric connections. Directions for future research include extending knowledge in underrepresented CP subtypes and methodologies, evaluating the prognostic potential of specific connectivity and network measures in neonates, and understanding therapeutic effects on brain connectivity.

Impact of early brain lesions on the optic radiations in children with cerebral palsy

Due to their early brain lesion, children with unilateral spastic cerebral palsy (USCP) present important changes in brain gray and white matter, often manifested by perturbed sensorimotor functions. We predicted that type and side of the lesion could influence the microstructure of white matter tracts. Using diffusion tensor imaging in 40 children with USCP, we investigated optic radiation (OR) characteristics: fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD) and radial diffusivity (RD). First, we compared the OR of the lesional and non-lesional hemisphere. Then we evaluated the impact of the brain lesion type (periventricular or cortico-subcortical) and side in the differences observed in the lesional and non-lesional OR. Additionally, we examined the relationship between OR characteristics and performance of a visuospatial attention task. We observed alterations in the OR of children with USCP on the lesional hemisphere compared with the non-lesional hemisphere in the FA, MD and RD. These differences were influenced by the type of lesion and by the side of the lesion. A correlation was also observed between FA, MD and RD and the visuospatial assessment mainly in children with periventricular and right lesions. Our results indicate an important role of the timing and side of the lesion in the resulting features of these children’s OR and probably in the compensation resulting from neuroplastic changes.

Changes in kinematics, kinetics, and muscle activity in patients with lumbar spinal stenosis during gait: systematic review

BACKGROUND CONTEXT

Lumbar spinal stenosis (LSS) is one of the most common orthopaedic conditions and affects more than half a million people over the age of 65 in the US. Patients with LSS have gait dysfunction and movement deficits due to pain and symptoms caused by compression of the nerve roots within a narrowed spinal canal.

PURPOSE

The purpose of the current systematic review was to summarize existing literature reporting biomechanical changes in gait function that occur with LSS, and identify knowledge gaps that merit future investigation in this important patient population.

STUDY DESIGN/SETTING

This study is a systematic literature review.

OUTCOME MEASURES

The current study included biomechanical variables (e.g., kinematic, kinetic, and muscle activity parameters).

METHODS

Relevant articles were selected through MEDLINE, Scopus, Embase, and Web of Science. Articles were included if they: 1) included participants with LSS or LSS surgery, 2) utilized kinematic, kinetic, or muscle activity variables as the primary outcome measure, 3) evaluated walking or gait tasks, and 4) were written in English.

RESULTS

A total of 11 articles were included in the current systematic review. The patients with LSS exhibited altered gait function as compared to healthy controls. Improvements in some biomechanical variables were found up to one year after surgery, but most gait changes were found within one month after surgery.

CONCLUSIONS

Although numerous studies have investigated gait function in patients with LSS, gait alterations in joint kinetics and muscle activity over time remain largely unknown. In addition, there are limited findings of spinal kinematics in patients with LSS during gait. Thus, future investigations are needed to investigate longer-term gait changes with regard to spinal kinematics, joint kinetics, and muscle activity beyond one month after LSS surgery.

Sleep, cognition and executive functioning in young children with cerebral palsy

Children with cerebral palsy (CP) are at higher risk for sleep disturbances than their typically developing peers. In typically developing young children, lack of sufficient sleep results in deficits in cognition, behavior and executive functioning. Unfortunately, research on sleep in infancy rarely focuses on children with neurodevelopmental disabilities. Studies of older children with CP demonstrate that roughly half of children with CP have a sleep disorder, though screening for sleep disorders in children with CP is not routinely performed. Given the high prevalence of sleep abnormalities in older children with CP and the resulting adverse effects on functioning, understanding sleep derangements and how they affect cognition and executive functioning in these children at earlier ages is critical. In this chapter, we present the state of the evidence for sleep characteristics, cognition and executive functions for infants and toddlers 0-3years old with CP.

Kinematic and Kinetic Changes after Total Hip Arthroplasty during Sit-To-Stand Transfers: Systematic Review

Background

Total hip arthroplasty (THA) is a common and effective surgical procedure that allows patients with hip osteoarthritis to restore functional ability and relieve pain. Sit-to-stand transfers are common demanding tasks during activities of daily living and are performed more than 50 times per day. The purpose of this systematic review is to obtain a comprehensive understanding of biomechanical changes during sit-to-stand transfers after THA.

Methods

Relevant articles were selected through MEDLINE, Scopus, Embase, and Web of Science. Articles were included if they met the following inclusion criteria: 1) participants underwent total hip arthroplasty without restriction on the arthroplasty design, 2) involved either kinematic or kinetic variables as the primary outcome measure, 3) evaluated sit-to-stand, and 4) were written in English.

Results

A total of 11 articles were included in the current systematic review. The THA group exhibited altered movement patterns as compared to healthy controls. Improvement in loading asymmetry was found up to 1 year after THA, but other kinetic changes indicate intensified contralateral limb loading. Limb differences were apparent, but whether these differences persist over 10 months after THA is still unknown.

Conclusion

Despite the inevitable changes in kinematics and kinetics in sit-to-stand transfers after THA, it appears to be important to resolve asymmetrical loading between the operative and nonoperative limbs to minimize risk for subsequent joint problems.

Short report: Improving motor competence skills in early childhood has corollary benefits for executive function and numeracy skills

Previous studies have documented that individual differences in fine and gross motor skills are associated with executive function (EF) skills. This study used an experimental design to test whether participating in cognitively challenging motor skills activities was causally related to improvements in motor skills and two key indicators of school readiness: executive function and early numeracy skills. The motor skill program involved fine and gross motor game-like activities that were delivered in a small group format. Activities were socially engaging and progressively challenged children based on their motor competencies. Fifty-three preschool-aged children participated in 16 motor skill sessions across 8 weeks. There were significant treatment effects for all outcomes, such that children in the treatment condition exhibited significant improvements in motor, EF, and early numeracy skills, compared to their peers in the waitlist control condition. Treatment effects on EF skills were stronger for inhibitory control than working memory. Improvements in numeracy were most pronounced for children with initially lower levels of ability. Motor skill-based interventions are an ecologically valid and developmentally appropriate approach for fostering school readiness skills in early childhood.

Gastrointestinal and hepatic abnormalities in patients with confirmed COVID-19: A systematic review and meta-analysis

Although not common, gastrointestinal and liver symptoms have reportedly been the initial presentation of coronavirus disease‐2019 (COVID‐19) in a large group of patients. Therefore, knowing the frequency and characteristics of these manifestations of COVID‐19 is important for both clinicians and health policy makers. A systematic review and meta‐analysis of the available data on the gastrointestinal and liver manifestations of patients with COVID‐19 was performed. PubMed and Scopus databases and Google Scholar search engine were searched for published and unpublished preprint articles up to 10 April 2020. Original studies providing information on clinical digestive symptoms or biomarkers of liver function in patients with polymerase chain reaction confirmed diagnosis of COVID‐19 were included. After quality appraisal, data were extracted. Prevalence data from individual studies were pooled using a random‐effects model. Overall, 67 studies were included in this systematic review and meta‐analysis, comprising a pooled population of 13 251 patients with confirmed COVID‐19. The most common gastrointestinal symptoms were anorexia (10.2%, 95% confidence interval [CI] = 6.2%‐16.4%), diarrhea (8.4%, 95% CI = 6.2%‐11.2%), and nausea (5.7%, 95% CI = 3.7%‐8.6%), respectively. Decreased albumin levels (39.8%, 95% CI = 15.3%‐70.8%), increased aspartate aminotransferase (22.8%, 95% CI = 18.1%‐28.4%), and alanine aminotransferase (20.6%, 95% CI = 16.7%‐25.1%) were common hepatic findings. After adjusting for preexisting gastrointestinal (5.9%) and liver diseases (4.2%), the most common gastrointestinal findings were diarrhea (8.7%, 95% CI = 5.4%‐13.9%), anorexia (8.0%, 95% CI = 3.0%‐19.8%), and nausea (5.1%, 95% CI = 2.2%‐14.3%). Gastrointestinal and liver manifestations are not rare in patients with COVID‐19, but their prevalence might be affected by preexisting diseases. Diarrhea and mild liver abnormalities seem to be relatively common in COVID‐19, regardless of comorbidities

Anorexia (10.2%), diarrhea (8.4%), and nausea (5.7%) were the most common gastrointestinal manifestations in confirmed COVID‐19 patients.

Serum albumin reduction (39.8%), AST elevation (22.8%), and ALT elevation (20.6%) were the most common hepatic abnormalities in confirmed COVID‐19 patients.

Preexisting gastrointestinal and liver diseases were present in 5.9% and 4.2% of COVID‐19 patients. After adjusting for these illnesses, diarrhea (8.7%) became the most prevalent gastrointestinal finding.

The prevalence of gastrointestinal and hepatic abnormalities were markedly higher in patients with severe COVID‐19 infection, compared to non‐severe cases.

Protocol of changes induced by early Hand-Arm Bimanual Intensive Therapy Including Lower Extremities (e-HABIT-ILE) in pre-school children with bilateral cerebral palsy: a multisite randomized controlled trial

BACKGROUND

Cerebral palsy (CP), which is the leading cause of motor disability during childhood, can produce sensory and cognitive impairments at different degrees. Most recent therapeutic interventions for these patients have solely focused on upper extremities (UE), although more than 60% of these patients present lower extremities (LE) deficits. Recently, a new therapeutic concept, Hand-arm Bimanual Intensive Therapy Including Lower Extremities (HABIT-ILE), has been proposed, involving the constant stimulation of UE and LE. Based on motor skill learning principles, HABIT-ILE is delivered in a day-camp setting, promoting voluntary movements for several hours per day during 10 consecutive week days. Interestingly, the effects of this intervention in a large scale of youngsters are yet to be observed. This is of interest due to the lack of knowledge on functional, neuroplastic and biomechanical changes in infants with bilateral CP. The aim of this randomized controlled study is to assess the effects of HABIT-ILE adapted for pre-school children with bilateral CP regarding functional, neuroplastic and biomechanical factors.

METHODS

This international, multicentric study will include 50 pre-school children with CP from 12 to 60 months of age, comparing the effect of 50 h (2 weeks) of HABIT-ILE versus regular motor activity and/or customary rehabilitation. HABIT-ILE presents structured activities and functional tasks with continuous increase in difficulty while the child evolves. Assessments will be performed at 3 period times: baseline, two weeks later and 3 months later. The primary outcome will be the Gross Motor Function Measure 66. Secondary outcomes will include Both Hands Assessment, Melbourne Assessment-2, Semmes-Weinstein Monofilament Test, algometry assessments, executive function tests, ACTIVLIM-CP questionnaire, Pediatric Evaluation of Disability Inventory (computer adaptative test), Young Children's Participation and Environment Measure, Measure of the Process of Care, Canadian Occupational Performance Measure, neuroimaging and kinematics.

DISCUSSION

The results of this study should highlight the impact of a motor, intensive, goal-directed therapy (HABIT-ILE) in pre-school children at a functional, neuroplastic and biomechanical level. In addition, this changes could demonstrated the impact of this intervention in the developmental curve of each child, improving functional ability, activity and participation in short-, mid- and long-term.

NAME OF THE REGISTRY

Evaluation of Functional, Neuroplastic and Biomechanical Changes Induced by an Intensive, Playful Early-morning Treatment Including Lower Limbs (EARLY-HABIT-ILE) in Preschool Children With Uni and Bilateral Cerebral Palsy (HABIT-ILE).

TRIAL REGISTRATION

NCT04017871 REGISTRATION DATE: July 12, 2019.

Evidence of Construct Validity for the Modified Mental Fatigue Scale When Used in Persons with Cerebral Palsy

Introduction: Fatigue impacts negatively on everyday activities in individuals with cerebral palsy (CP). More knowledge is needed about how mental fatigue is manifested in this target group. The purpose of this study was to gather evidence about the validity of the modified Mental Fatigue Scale (m-MFS) in adults with CP.Methods: Mixed sequential exploratory design. The respondents were ten persons aged 22-56 with CP (MACS I-II).Results: The respondents perceived the m-MFS as easy to read and understand. Its structure was characterised as straightforward and the text of the rating options was deemed to assist identification with life situations. Very good agreement was seen between the respondents' and the instrument designers' intended meaning for the items in the m-MFS; the weighted kappa was 0.92.Conclusion: This study showed evidence of construct validity, based on response processes and content, for use of the modified MFS in adults with CP.

Brain magnetic resonance imaging is a predictor of bimanual performance and executive function in children with unilateral cerebral palsy

AIM

To examine the association between brain magnetic resonance imaging (MRI) characteristics and executive function and bimanual performance in children with unilateral cerebral palsy (CP).

METHOD

Clinical MRI brain scans were classified as: (1) predominant pathological pattern (normal, white matter injury [WMI]; grey matter injury; focal vascular insults [FVI]; malformations; or miscellaneous); and (2) focal lesions (frontal, basal ganglia, and/or thalamus). Assessments included: (1) bimanual performance; (2) unimanual dexterity; and (3) executive function tasks (information processing, attention control, cognitive flexibility, and goal setting) and behavioural ratings (parent).

RESULTS

From 131 recruited children, 60 were ineligible for analysis, leaving 71 children (47 males, 24 females) in the final sample (mean age 9y [SD 2y], 6y-12y 8mo). Brain MRIs were WMI (69%) and FVI (31%); and frontal (59%), thalamic (45%), basal ganglia (37%), and basal ganglia plus thalamic (21%). Bimanual performance was lower in FVI versus WMI (p<0.003), and with frontal (p=0.36), basal ganglia (p=0.032), and thalamic/basal ganglia lesions (p=0.013). Other than information processing, executive function tasks were not associated with predominant pattern. Frontal lesions predicted attention control (p=0.049) and cognitive flexibility (p=0.009) but not goal setting, information processing, or behavioural ratings.

INTERPRETATION

Clinical brain MRI predicts cognitive and motor outcomes when focal lesions and predominate lesion patterns are considered. What this paper adds Early brain magnetic resonance imaging (MRI) predicts bimanual performance and cognitive outcomes. Brain MRI may identify children requiring targeted interventions. Basal ganglia with/without thalamic lesions predicted bimanual performance. Frontal lesions were associated with attention control and cognitive flexibility. Brain MRI predominant patterns predicted motor, not cognitive outcomes, other than information processing.

Functional, neuroplastic and biomechanical changes induced by early Hand-Arm Bimanual Intensive Therapy Including Lower Extremities (e-HABIT-ILE) in pre-school children with unilateral cerebral palsy: study protocol of a randomized control trial

BACKGROUND

Cerebral palsy (CP) causes motor, cognitive and sensory impairment at different extents. Many recent rehabilitation developments (therapies) have focused solely on the upper extremities (UE), although the lower extremities (LE) are commonly affected. Hand-arm Bimanual Intensive Therapy Including Lower Extremities (HABIT-ILE) applies the concepts of motor skill learning and intensive training to both the UE and LE. It involves constant stimulation of the UE and LE, for several hours each day over a 2-week period. The effects of HABIT-ILE have never been evaluated in a large sample of young children. Furthermore, understanding of functional, neuroplastic and biomechanical changes in infants with CP is lacking. The aim of this study is to carry out a multi-center randomized controlled trial (RCT) to evaluate the effects of HABIT-ILE in pre-school children with unilateral CP on functional, neuroplastic and biomechanical parameters.

METHODS

This multi-center, 3-country study will include 50 pre-school children with CP aged 1-4 years. The RCT will compare the effect of 50 h (two weeks) of HABIT-ILE versus usual motor activity, including regular rehabilitation. HABIT-ILE will be delivered in a day-camp setting, with structured activities and functional tasks that will be continuously progressed in terms of difficulty. Assessments will be performed at 3 intervals: baseline (T0), two weeks later and 3 months later. Primary outcomes will be the Assisting Hand Assessment; secondary outcomes include the Melbourne Assessment-2, executive function assessments, questionnaires ACTIVLIM-CP, Pediatric Evaluation of Disability Inventory, Young Children's Participation and Environment Measure, Measure of the Process of Care, Canadian Occupational Performance Measure, as well as neuroimaging and kinematics measures.

DISCUSSION

We expect that HABIT-ILE will induce functional, neuroplastic and biomechanical changes as a result of the intense, activity-based rehabilitation process and these changes will impact the whole developmental curve of each child, improving functional ability, activity and participation in the short-, mid- and long-term. Name of the registry: Changes Induced by Early HABIT-ILE in Pre-school Children With Uni- and Bilateral Cerebral Palsy (EarlyHABIT-ILE).

TRIAL REGISTRATION

Trial registration number: NCT04020354-Registration date on the International Clinical Trials Registry Platform (ICTRP): November 20th, 2018; Registration date on NIH Clinical Trials Registry: July 16th, 2019.

Gait alterations in posterior tibial tendonitis: A systematic review and meta-analysis

BACKGROUND

Posterior tibial tendon dysfunction (PTTD) is a common and debilitating tendinopathy that can lead to a profound decrease in gait function. While the clinical diagnosis and treatment of this disorder are well described, the pathomechanics have not been adequately characterized. The purpose of this systematic review and meta-analysis is to compare foot/ankle kinematics and kinetics in patients with PTTD with healthy controls during gait.

METHODS

Relevant articles were selected thought Medline (Pubmed), Scopus, CINAHL, and Web of Science. Studies focused on foot/ankle kinematics and kinetics in patients with PTTD were involved. Articles were included if they: 1) compared patients with PTTD to healthy controls, 2) utilized kinematics or kinetics as the primary outcome measure, 3) evaluated gait tasks, and 4) were written in English.

RESULTS

Eleven articles were included in this systematic review, and 8 studies were synthesized and analyzed. Our meta-analyses indicated increased dorsiflexion and abduction of the forefoot, as well as increased plantarflexion and eversion of hindfoot for patients with PTTD during stance of walking.

CONCLUSION

Our results from the meta-analysis showed more conclusive changes in the forefoot (increased dorsiflexion and abduction) and hindfoot (increased plantarflexion and eversion) kinematics during stance of walking, which may be associated with a pathological process of PTTD. This review provides an improved understanding of gait function in patients with PTTD and preliminary knowledge for future research.

Changes of Structural Brain Network Following Repetitive Transcranial Magnetic Stimulation in Children With Bilateral Spastic Cerebral Palsy: A Diffusion Tensor Imaging Study

Introduction: Bilateral spastic cerebral palsy (BSCP) is the most common subtype of cerebral palsy (CP), which is characterized by various motor and cognitive impairments, as well as emotional instability. However, the neural basis of these problems and how repetitive transcranial magnetic stimulation (rTMS) can make potential impacts on the disrupted structural brain network in BSCP remain unclear. This study was aimed to explore the topological characteristics of the structural brain network in BSCP following the treatment of rTMS. Methods: Fourteen children with BSCP underwent 4 weeks of TMS and 15 matched healthy children (HC) were enrolled. Diffusion tensor imaging (DTI) data were acquired from children with bilateral spastic cerebral palsy before treatment (CP1), children with bilateral spastic cerebral palsy following treatment (CP2) and HC. The graph theory analysis was applied to construct the structural brain network. Then nodal clustering coefficient (C _i ) and shortest path length (L _i ) were measured and compared among groups. Results: Brain regions with significant group differences in C _i were located in the left precental gyrus, middle frontal gyrus, calcarine fissure, cuneus, lingual gyrus, postcentral gyrus, inferior parietal gyri, angular gyrus, precuneus, paracentral lobule and the right inferior frontal gyrus (triangular part), insula, posterior cingulate gyrus, precuneus, paracentral lobule, pallidum. In addition, significant differences were detected in the L _i of the left precental gyrus, lingual gyrus, superior occipital gyrus, middle occipital gyrus, superior parietal gyrus, precuneus and the right median cingulate gyrus, posterior cingulate gyrus, hippocampus, putamen, thalamus. Post hoc t-test revealed that the CP2 group exhibited increased C _i in the right inferior frontal gyrus, pallidum and decreased L _i in the right putamen, thalamus when compared with the CP1 group. Conclusion: Significant differences of node-level metrics were found in various brain regions of BSCP, which indicated a disruption in structural brain connectivity in BSCP. The alterations of the structural brain network provided a basis for understanding of the pathophysiological mechanisms of motor and cognitive impairments in BSCP. Moreover, the right inferior frontal gyrus, putamen, thalamus could potentially be biomarkers for predicting the efficacy of TMS.

Executive functions and drawing in young children with cerebral palsy: Comparisons with typical development

There is evidence that school-aged children with cerebral palsy (CP) may present deficits in executive functions (EF) greater than would be expected considering their intellectual ability. However, no studies have focused on characterizing EF in this group at an earlier critical period - the preschool years. Furthermore, and given evidence from typically-developing (TD) children, deficits in EF are associated with potential detrimental effects on social and educational development - which can include drawing. Our aim was to compare preschool children with CP, matched in chronological age and intellectual ability with a group of TD children, regarding their executive functioning and drawing abilities. In addition, we examined the relationships between these variables in each of the groups. Twenty-eight children were evaluated in executive functions and drawing tasks. Differences were found in some aspects of cognitive flexibility and inhibitory control, but not in working memory. Additionally, the quality of the drawings was significantly poorer in the CP group. In the TD group, there was an association between greater inhibitory control (but not cognitive flexibility or working memory) and drawing quality. In the CP group, although non-significant, medium-sized correlations were observed between drawing and several aspects of executive functioning. Overall, our results suggest more similarities than differences in the executive functioning of children with CP (and preserved cognitive ability) and TD children. However, there were still important between-group differences in their drawing abilities. There was also a distinct pattern of associations between drawing and executive functions in the clinical group.

Biomechanical Changes Following Knee Arthroplasty During Sit-To-Stand Transfers: Systematic Review

BACKGROUND

Knee arthroplasty (KA) is a common and effective surgical procedure that allows patients with knee osteoarthritis to restore functional ability and relieve pain. Sit-to-stand is a common demanding task during activities of daily living and is performed more than 50 times per day. The purpose of this systematic review is to obtain a comprehensive understanding of biomechanical changes during sit-to-stand transfers following KA.

METHODS

Relevant articles were selected through MEDLINE (PubMed), Scopus, Embrace, and Web of Science. Articles were included if they met the following inclusion criteria: (1) underwent KA without restriction on the arthroplasty design, (2) involve kinematic, kinetic, or muscle activity variables as the primary outcome measure, (3) evaluated sit-to-stand, and (4) were written in English.

RESULTS

A total of 13 articles were included in the current systematic review. The KA group exhibited altered movement patterns as compared to healthy controls. Considering the time course of recovery, improvement in knee joint kinematics was found up to 2 years but kinetic changes indicate intensified contralateral limb loading. For comparisons for limbs, limb differences were apparent, but those differences were resolved by 1 year.

CONCLUSION

Despite the inevitable changes in kinematics, kinetics, and muscle activity in sit-to-stand since KA, it appears to be important to restore quadriceps strength for the operative limb in order to minimize risk for subsequent joint problems.

Inhibitory control and temporal perception in cerebral palsy

Prepotent response inhibition and temporal perception abilities were explored in a sample of individuals with cerebral palsy relative to typically developing peers. The extent to which inhibitory control difficulties might affect temporal processing was also investigated. For this purpose, two inhibitory control tasks and two duration estimation tasks were given to the groups of cerebral palsy and typically developing children. Results showed inhibition and temporal perception problems in the group with cerebral palsy. A relationship was found between inhibition and temporal estimation performances, which indicates that inhibitory control contributes, at least partially, to acquisition of the temporal processing ability.

Cognition and bimanual performance in children with unilateral cerebral palsy: protocol for a multicentre, cross-sectional study

Background

Motor outcomes of children with unilateral cerebral palsy are clearly documented and well understood, yet few studies describe the cognitive functioning in this population, and the associations between the two is poorly understood. Using two hands together in daily life involves complex motor and cognitive processes. Impairment in either domain may contribute to difficulties with bimanual performance. Research is yet to derive whether, and how, cognition affects a child’s ability to use their two hands to perform bimanual tasks.

Methods/Design

This study will use a prospective, cross-sectional multi-centre observational design. Children (aged 6–12 years) with unilateral cerebral palsy will be recruited from one of five Australian treatment centres. We will examine associations between cognition, bimanual performance and brain neuropathology (lesion type and severity) in a sample of 131 children. The primary outcomes are: Motor - the Assisting Hand Assessment; Cognitive - Executive Function; and Brain – lesion location on structural MRI. Secondary data collected will include: Motor - Box and Blocks, ABILHAND- Kids, Sword Test; Cognitive – standard neuropsychological measures of intelligence. We will use generalized linear modelling and structural equation modelling techniques to investigate relationships between bimanual performance, executive function and brain lesion location.

Discussion

This large multi-centre study will examine how cognition affects bimanual performance in children with unilateral cerebral palsy. First, it is anticipated that distinct relationships between bimanual performance and cognition (executive function) will be identified. Second, it is anticipated that interrelationships between bimanual performance and cognition will be associated with common underlying neuropathology. Findings have the potential to improve the specificity of existing upper limb interventions by providing more targeted treatments and influence the development of novel methods to improve both cognitive and motor outcomes in children with unilateral cerebral palsy.

Trial registration

ACTRN12614000631606; Date of retrospective registration 29/05/2014.

How Executive Functions Are Evaluated in Children and Adolescents with Cerebral Palsy? A Systematic Review

Aims: The aim of the present study was to examine how executive functions are assessed in children and adolescents with Cerebral Palsy.

Method: A systematic literature review was conducted using four bibliographic databases (WebScience, Scopus, PubMed, and Psycinfo), and only studies that evaluated at least one executive function were selected. Both the research and reporting of results were based on Cochrane's recommendations and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines.

Results: The instrument most frequently used was the D-KEFS. All studies point to the existence of impairments in the executive functions among children and adolescents with Cerebral Palsy with an impact on several cognitive and life domains.

Interpretation: There is a need to further systematize the research protocols to study the executive functions and their assessment in the intervention context. Findings of this review presented a diversity of tests (e.g., D-KEFS) or tasks (e.g., The inhibitory ability task) used with children with Cerebral Palsy. However, no information was given about adaptations performed to the test/task to meet Cerebral Palsy's specificities. Future research could consider including this information, which is key both to researchers and practitioners. The results of this study have important implications and suggestions for future avenues and guidelines for research and practice.

Mobile assessment of the lower limb kinematics in healthy persons and in persons with degenerative knee disorders: A systematic review

Inertial sensor systems are increasingly used in the assessment of persons with knee osteoarthritis (KOA) and total knee replacement (TKR). This systematic review aims to (1) investigate the application of inertial sensor systems and kinematics derived from these systems, and (2) assess if current assessment protocols consist of tasks which are, according to the International Classification of Functioning, Disability and Health (ICF) for KOA, relevant for persons with KOA and TKR. A search was conducted in six electronic databases (ACM, CINAHL, EMBASE, IEEE, PubMed, Web of Science) to include papers assessing the knee and one or more adjacent joints by means of inertial sensors in healthy persons or persons with KOA or TKR. Two reviewers checked the methodological quality. Twenty-three papers were included: 18 in healthy persons and five in persons with KOA or TKR. In healthy persons, 11 tasks were related to metrics of the ICF-function and ICF-activity level. In persons with KOA, only walking was assessed. Apart from walking, four additional tasks were related to the ICF-function and ICF-activity level in persons with TKR. In healthy persons, joints located proximally and distally to the knee were assessed, while in persons with KOA and TKR, only the knee and ankle were assessed. This is a shortcoming since hip and trunk motion potentially contain clinically relevant information, in terms of identifying (mal)adaptive compensatory movement strategies. Additionally, physically more demanding tasks should be evaluated as these might be superior in detecting compensatory movement strategies. Former considerations warrant attention in future research.

The impact of group occupational therapy using a cueing system on executive function of preschool-aged children with brain lesions

[Purpose] This study investigates the effects of group occupational therapy using a cueing system on the executive function of preschool-aged children with brain lesions. [Subjects and Methods] Six preschool-aged children with brain lesions participated in this study. A 24-session occupational therapy program (1 session/week, 50 minutes/session) designed based on a cueing system was administered to examine the changes in the participants’ executive function. The behavior rating inventory of executive function-preschool (BRIEF-P) was used to check the magnitude of improvement of executive functions after therapy. [Results] A Wilcoxon signed rank test revealed that occupational therapy significantly improved all domains, indices, and the global executive composite in the BRIEF-P. [Conclusion] The occupational therapy intervention incorporating a type of cognitive behavioral approach known as the cueing system may assist improving executive functions in preschool-aged children with brain lesions

Barriers to Addressing Social Determinants of Health in Pediatric Nursing Practice: An Integrative Review

PROBLEM

Despite a substantial body of knowledge regarding the importance of the social determinants of health, recognizing and responding to the psychosocial circumstances of seriously and chronically ill children and their families is not well established in routine pediatric nursing care.

ELIGIBILITY CRITERIA

The search process focused on psychological and social determinants and care in the healthcare setting. Searches were limited to research and review publications written in the English language. The quality of evidence was graded using the National Health and Medical Research Council evidence hierarchy.

RESULTS

Thirteen publications were identified for inclusion. Healthcare providers do recognize emotional distress experienced by patients, but feel unable to address psychosocial issues due to the lack of time, a lack of confidence in their own communication skills, and the perception that patients and their families prioritize physical care over psychosocial care. For patients and their families the main issue was that the healthcare system was focused on physical care with little opportunity to talk about psychosocial concerns.

CONCLUSIONS

The greatest barrier to addressing the social determinants of health in the pediatric context is the dominance of the 'medical model' of care. Also, many healthcare providers believe that they lack the communication skills necessary to talk about psychosocial issues.

IMPLICATIONS

The way forward will be to empower nurses through the sharing of knowledge of the social determinants of health, the development of skills in relationship building and therapeutic communication, and the mentorship of compassionate family-centered care.

Spastic diplegia in preterm-born children: Executive function impairment and neuroanatomical correlates

BACKGROUND

The neuropsychological literature on preterm-born children with spastic diplegia due to periventricular leukomalacia is convergent in reporting deficits in non-verbal intelligence and in visuo-spatial abilities. Nevertheless, other cognitive functions have found to be impaired, but data are scant and not correlated with neuroimaging findings.

AIMS

This study analyzes the neuropsychological strengths and weaknesses in preterm-born children with spastic diplegia (pSD) and their relationships with neuroanatomical findings, investigated by a novel scale for MRI classification.

METHODS AND PROCEDURES

Nineteen children with pSD, mild to moderate upper limb impairment and Verbal IQ>80, and 38 normal controls were evaluated with a comprehensive neuropsychological battery (NEPSY-II), assessing Attention/Executive Functioning, Language, Memory, Sensorimotor, Social Perception and Visuospatial Processing domains. The MRIs were quantitatively scored for lesion severity.

OUTCOMES AND RESULTS

The results showed that, beyond core visuo-spatial and sensory-motor deficits, impairments in attention and executive functions were present in more than half of the sample, particularly in children with damage to the anterior corpus callosum.

CONCLUSIONS AND IMPLICATIONS

The findings are discussed in terms of clinical and rehabilitative implications tailored for pSD subgroups diversified for neuropsychological and neuroanatomical characteristics.

Questionnaire-based assessment of executive functioning: Psychometrics

The psychometric properties of the Learning, Executive, and Attention Functioning (LEAF) scale were investigated in an outpatient clinical pediatric sample. As a part of clinical testing, the LEAF scale, which broadly measures neuropsychological abilities related to executive functioning and learning, was administered to parents of 118 children and adolescents referred for psychological testing at a pediatric psychology clinic; 85 teachers also completed LEAF scales to assess reliability across different raters and settings. Scores on neuropsychological tests of executive functioning and academic achievement were abstracted from charts. Psychometric analyses of the LEAF scale demonstrated satisfactory internal consistency, parent-teacher inter-rater reliability in the small to large effect size range, and test-retest reliability in the large effect size range, similar to values for other executive functioning checklists. Correlations between corresponding subscales on the LEAF and other behavior checklists were large, while most correlations with neuropsychological tests of executive functioning and achievement were significant but in the small to medium range. Results support the utility of the LEAF as a reliable and valid questionnaire-based assessment of delays and disturbances in executive functioning and learning. Applications and advantages of the LEAF and other questionnaire measures of executive functioning in clinical neuropsychology settings are discussed.

Motor imagery difficulties in children with Cerebral Palsy: A specific or general deficit?

AIM

The aim of this study was to examine the specificity of motor imagery (MI) difficulties in children with CP.

METHOD

Performance of 22 children with CP was compared to a gender and age matched control group. MI ability was measured with the Hand Laterality Judgment (HLJ) task, examining specifically the direction of rotation (DOR) effect, and the Praxis Imagery Questionnaire (PIQ).

RESULTS

In the back view condition of the HLJ task both groups used MI, as evidenced by longer response times for lateral compared with medial rotational angles. In the palm view condition children with CP did not show an effect of DOR, unlike controls. Error scores did not differ between groups. Both groups performed well on the PIQ, with no significant difference between them in response pattern.

CONCLUSION AND IMPLICATION

The present study suggests that children with CP show deficits on tasks that trigger implicit use of MI, whereas explicit MI ability was relatively preserved, as assessed using the PIQ. These results suggest that employing more explicit methods of MI training may well be more suitable for children with CP in rehabilitation of motor function.

Repetitive Transcranial Magnetic Stimulation/Behavioral Intervention Clinical Trial: Long-Term Follow-Up of Outcomes in Congenital Hemiparesis

OBJECTIVE

The purpose of this study was to examine long-term outcomes of nonpharmacological intervention in children and adolescents with stroke utilizing repetitive transcranial magnetic stimulation (rTMS) to the primary motor cortex combined with constraint- induced movement therapy (CIMT) to improve motor function in the paretic hand. Outcome measures included function, satisfaction, and medical status review.

METHODS

Fourteen of the original 19 participants (74%) from our rTMS/CIMT clinical trial (real rTMS+CIMT, n = 8; and sham rTMS+CIMT, n = 6) were evaluated. The median age of the subjects at follow up was 13.4 years (range 11-20 years old, 50% male). Median time to follow-up was 47.5 months (range 21-57 months). Descriptive statistics were conducted using frequencies and counts. Motor performance was measured using the Assisting Hand Assessment (AHA) and Canadian Occupational Performance Measure (COPM). Satisfaction was reported with use of the COPM and TMS Tolerance Survey. Open-ended interview was conducted for feedback on study experience and subjective perspectives of current functional status.

RESULTS

Overall, seven of eight individuals who received real rTMS and five of six individuals who received sham rTMS maintained or improved AHA scores. Six of 14 participants reported new onset of co-occurring conditions (four individuals in the real rTMS group, two individuals in the sham rTMS group). The majority (86%) of participants reported study satisfaction. Review of medical status revealed co-occurring conditions including: Epilepsy, obsessive-compulsive disorder, anxiety, depression, unspecified mood disorder, and undiagnosed inattentiveness.

CONCLUSIONS

Long-term outcomes of rTMS/CIMT in pediatric stroke were investigated. Variability in performance and unattributed symptoms were noted. Considering the prevalence of co-occurring conditions in children and adolescents with stroke, new-onset symptoms were not attributed to original intervention. With the small sample size, the impact of rTMS on long-term outcomes cannot be fully determined from these data. Characterizing long-term outcomes through performance, participant perspectives, and medical status allows comprehensive assessment of rTMS/CIMT intervention efficacy.

Can an anti-gravity treadmill improve stability of children with cerebral palsy?

We aimed to study the effects of an anti-gravity treadmill (AlterG) training on balance and postural stability in children with cerebral palsy (CP). AlterG training was performed 3 days/week for 8 weeks, with up to 45 minutes of training per session. The subject was evaluated before and after the 8-week training. The effects of training on the balance and postural stability was evaluated based on the Romberg test that was performed by using a posturography device. The parameters quantifying Center-of-Pressure (CoP) were calculated using different analytical approaches including power spectral density and principal components analyses. All of the key parameters including the Stabilogram, the Fast Fourier Transform (FFT) Energy, the Eigenvectors, and the Eigenvalues of CoP were modified between 14%-84%. The results indicated that the balance features were improved substantially after training. The clinical implication is that the AlterG has the potential to effectively improve postural stability in children with cerebral palsy.

Questionnaire-based assessment of executive functioning: Case studies

Delays in the development of executive functioning skills are frequently observed in pediatric neuropsychology populations and can have a broad and significant impact on quality of life. As a result, assessment of executive functioning is often relevant for the development of formulations and recommendations in pediatric neuropsychology clinical work. Questionnaire-based measures of executive functioning behaviors in everyday life have unique advantages and complement traditional neuropsychological measures of executive functioning. Two case studies of children with spina bifida are presented to illustrate the clinical use of a new questionnaire measure of executive and learning-related functioning, the Learning, Executive, and Attention Functioning Scale (LEAF). The LEAF emphasizes clinical utility in assessment by incorporating four characteristics: brevity in administration, breadth of additional relevant content, efficiency of scoring and interpretation, and ease of availability for use. LEAF results were consistent with another executive functioning checklist in documenting everyday behavior problems related to working memory, planning, and organization while offering additional breadth of assessment of domains such as attention, processing speed, and novel problem-solving. These case study results demonstrate the clinical utility of questionnaire-based measurement of executive functioning in pediatric neuropsychology and provide a new measure for accomplishing this goal.

Brain State Before Error Making in Young Patients With Mild Spastic Cerebral Palsy

In the present experiment, children with mild spastic cerebral palsy and a control group carried out a memory recognition task. The key question was if errors of the patient group are foreshadowed by attention lapses, by weak motor preparation, or by both. Reaction times together with event-related potentials associated with motor preparation (frontal late contingent negative variation), attention (parietal P300), and response evaluation (parietal error-preceding positivity) were investigated in instances where 3 subsequent correct trials preceded an error. The findings indicated that error responses of the patient group are foreshadowed by weak motor preparation in correct trials directly preceding an error.

Structural connectivity of the anterior cingulate in children with unilateral cerebral palsy due to white matter lesions

In this work we investigate the structural connectivity of the anterior cingulate cortex (ACC) and its link with impaired executive function in children with unilateral cerebral palsy (UCP) due to periventricular white matter lesions. Fifty two children with UCP and 17 children with typical development participated in the study, and underwent diffusion and structural MRI. Five brain regions were identified for their high connectivity with the ACC using diffusion MRI fibre tractography: the superior frontal gyrus, medial orbitofrontal cortex, rostral middle frontal gyrus, precuneus and isthmus cingulate. Structural connectivity was assessed in pathways connecting these regions to the ACC using three diffusion MRI derived measures: fractional anisotropy (FA), mean diffusivity (MD) and apparent fibre density (AFD), and compared between participant groups. Furthermore we investigated correlations of these measures with executive function as assessed by the Flanker task. The ACC-precuneus tract had significantly different MD (p < 0.0001) and AFD (p = 0.0072) between groups, with post-hoc analysis showing significantly increased MD in the right hemisphere of children with left hemiparesis compared with controls. The ACC-superior frontal gyrus tract had significantly different FA (p = 0.0049) and MD (p = 0.0031) between groups. AFD in this tract (contralateral to side of hemiparesis; right hemisphere in controls) showed a significant relationship with Flanker task performance (p = 0.0045, β = -0.5856), suggesting that reduced connectivity correlates with executive dysfunction. Reduced structural integrity of ACC tracts appears to be important in UCP, in particular the connection to the superior frontal gyrus. Although damage to this area is heterogeneous it may be important in early identification of children with impaired executive function.

How do somatosensory deficits in the arm and hand relate to upper limb impairment, activity, and participation problems after stroke? A systematic review

BACKGROUND

The association between somatosensory impairments and outcome after stroke remains unclear.

PURPOSE

The aim of this study was to systematically review the available literature on the relationship between somatosensory impairments in the upper limb and outcome after stroke.

DATA SOURCES

The electronic databases PubMed, CINAHL, EMBASE, Cochrane Library, PsycINFO, and Web of Science were systematically searched from inception until July 2013.

STUDY SELECTION

Studies were included if adult patients with stroke (minimum n=10) were examined with reliable and valid measures of somatosensation in the upper limb to investigate the relationship with upper limb impairment, activity, and participation measures. Exclusion criteria included measures of somatosensation involving an overall score for upper and lower limb outcome and articles including only lower limb outcomes.

DATA EXTRACTION

Eligibility assessment, data extraction, and quality evaluation were completed by 2 independent reviewers. A cutoff score of ≥65% of the maximal quality score was used for further inclusion in this review.

DATA SYNTHESIS

Six articles met all inclusion criteria. Two-point discrimination was shown to be predictive for upper limb dexterity, and somatosensory evoked potentials were shown to have predictive value in upper limb motor recovery. Proprioception was significantly correlated with perceived level of physical activity and social isolation and had some predictive value in functional movements of the upper limb. Finally, the combination of light touch and proprioception impairment was shown to be significantly related to upper limb motor recovery as well as handicap situations during activities of daily living.

LIMITATIONS

Heterogeneity of the included studies warrants caution when interpreting results.

CONCLUSIONS

Large variation in results was found due to heterogeneity of the studies. However, somatosensory deficits were shown to have an important role in upper limb motor and functional performance after stroke.