Perceptuo-motor dysfunction in the child with hemiplegia

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.

Unilateral neglect in children with hemiplegic cerebral palsy

The purpose of this study was to examine the pattern of attentional deficits in children with right and left hemiplegic cerebral palsy. Unilateral neglect and visuospatial deficits are common findings following right brain injury in adults. It has been suggested by some that children may show a similar pattern. Children were tested on several paper-and-pencil measures of neglect. It was hypothesized that (a) on the left side of the page, children with left hemiplegia (right hemispheric damage) will score significantly lower than both the control group and the right hemiplegia group and (b) on the right side of the page, there will be no significant difference between the control group and the right and left hemiplegic groups. Participants included 32 children with cerebral palsy, 15 with left hemiplegia, 17 with right hemiplegia, and 32 matched controls. The ages ranged from 5 years 10 months to 12 years 6 months; all had normal intelligence. Inventories included 3 subtests of the Conventional part of the Behavioral Inattention Test, the Mesulam Symbol Cancellations tests, and the Rey Osterrieth Complex Figure, copy and recall. Analysis indicated that children with left hemiplegia scored significantly more poorly than controls on seven of the eight measures on the left side of the page, but they did not consistently score more poorly than children with right hemiplegia. Moreover, the poorer performance of the children with left hemiplegia was not specific only to the left side of the page; they also scored significantly lower than the controls on five of the eight measures on the right side. These findings suggest that children with left hemiplegia may have relatively greater attentional and perceptual problems than children with right hemiplegia, but they do not clearly indicate a left unilateral neglect. Results also indicate that children with right hemiplegia have attentional and perceptual problems relative to controls, particularly on the more complex tasks of high demand.

A Standardized Paediatric Sensory Assessment for the Lower Extremity: Preliminary Results of a Reliability Study in Normal School-Aged Children

The aims of this study were to establish a set of standardized sensory procedures for lower extremity sensory assessment in a paediatric population, to gather preliminary data on normal sensory performance, and to derive preliminary reliability estimates. Three subtests derived from the paediatric upper extremity sensory battery under development by Cooper, Majnemer, Rosenblatt and Birnbaum (1993) were performed bilaterally on 50 healthy, school-aged children: i) pressure sensitivity and ii) directionality, on the plantar surface of the distal phalanx of the hallux, using the Semmes-Weinstein Pressure Aesthesiometer, and iii) proprio-ception at the first metatarsal-phalangeal joint. Neither age nor gender exerted any significant effects on the data, whereas dominance did. Cut-offs were determined separately for the dominant and nondominant halluces. Data analysis revealed good test-retest and inter-rater agreements on all subtests. These sensory subtests show promise as a standardized, reliable and therapeutically useful assessment of lower extremity sensation in children at risk for sensory impairment.

Tactile extinction in childhood hemiplegia

Tactile extinction was investigated by the Quality Extinction Test (QET) of Schwartz in 39 patients, 34 of whom had congenital hemiplegia and five early-acquired hemiplegia. Extinction values were significantly higher in hemiplegia patients than in controls and usually contralateral to the side of brain damage, except for four cases with right hemiplegia. Values were also higher in males than in females. There were no significant differences between patients with left and right hemiplegia, and no correlations between extinction and IQ or the presence of epilepsy. There was a correlation between QET scores and neuroradiologically proven cerebral atrophy. The meaning of extinction in hemiplegic patients and the principal theories regarding the pathogenesis of neglect are discussed.