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DiPiero MA, Rodrigues PG, Justman M, Roche S, Bond E, Gonzalez JG, Davidson RJ, Planalp EM, Dean DC. Gray matter based spatial statistics framework in the 1-month brain: insights into gray matter microstructure in infancy. Brain Struct Funct 2024:10.1007/s00429-024-02853-w. [PMID: 39313671 DOI: 10.1007/s00429-024-02853-w] [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: 04/17/2024] [Accepted: 08/27/2024] [Indexed: 09/25/2024]
Abstract
The neurodevelopmental epoch from fetal stages to early life embodies a critical window of peak growth and plasticity in which differences believed to be associated with many neurodevelopmental and psychiatric disorders first emerge. Obtaining a detailed understanding of the developmental trajectories of the cortical gray matter microstructure is necessary to characterize differential patterns of neurodevelopment that may subserve future intellectual, behavioral, and psychiatric challenges. The neurite orientation dispersion density imaging (NODDI) Gray-Matter Based Spatial Statistics (GBSS) framework leverages information from the NODDI model to enable sensitive characterization of the gray matter microstructure while limiting partial volume contamination and misregistration errors between images collected in different spaces. However, limited contrast of the underdeveloped brain poses challenges for implementing this framework with infant diffusion MRI (dMRI) data. In this work, we aim to examine the development of cortical microstructure in infants. We utilize the NODDI GBSS framework and propose refinements to the original framework that aim to improve the delineation and characterization of gray matter in the infant brain. Taking this approach, we cross-sectionally investigate age relationships in the developing gray matter microstructural organization in infants within the first month of life and reveal widespread relationships with the gray matter architecture.
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Affiliation(s)
- Marissa A DiPiero
- Waisman Center, University of Wisconsin-Madison, Madison, 53705, WI, USA
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, USA
- Department of Pediatrics, University of Wisconsin-Madison, Madison, WI, USA
| | | | - McKaylie Justman
- Waisman Center, University of Wisconsin-Madison, Madison, 53705, WI, USA
| | - Sophia Roche
- Waisman Center, University of Wisconsin-Madison, Madison, 53705, WI, USA
| | - Elizabeth Bond
- Waisman Center, University of Wisconsin-Madison, Madison, 53705, WI, USA
| | - Jose Guerrero Gonzalez
- Waisman Center, University of Wisconsin-Madison, Madison, 53705, WI, USA
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, USA
| | - Richard J Davidson
- Waisman Center, University of Wisconsin-Madison, Madison, 53705, WI, USA
- Department of Psychology, University of Wisconsin-Madison, Madison, WI, USA
- Center for Healthy Minds, University of Wisconsin-Madison, Madison, WI, USA
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, USA
| | - Elizabeth M Planalp
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Douglas C Dean
- Waisman Center, University of Wisconsin-Madison, Madison, 53705, WI, USA.
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, USA.
- Department of Pediatrics, University of Wisconsin-Madison, Madison, WI, USA.
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Surgent O, Guerrero-Gonzalez J, Dean DC, Adluru N, Kirk GR, Kecskemeti SR, Alexander AL, Li JJ, Travers BG. Microstructural neural correlates of maximal grip strength in autistic children: the role of the cortico-cerebellar network and attention-deficit/hyperactivity disorder features. Front Integr Neurosci 2024; 18:1359099. [PMID: 38808069 PMCID: PMC11130426 DOI: 10.3389/fnint.2024.1359099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 04/24/2024] [Indexed: 05/30/2024] Open
Abstract
Introduction Maximal grip strength, a measure of how much force a person's hand can generate when squeezing an object, may be an effective method for understanding potential neurobiological differences during motor tasks. Grip strength in autistic individuals may be of particular interest due to its unique developmental trajectory. While autism-specific differences in grip-brain relationships have been found in adult populations, it is possible that such differences in grip-brain relationships may be present at earlier ages when grip strength is behaviorally similar in autistic and non-autistic groups. Further, such neural differences may lead to the later emergence of diagnostic-group grip differences in adolescence. The present study sought to examine this possibility, while also examining if grip strength could elucidate the neuro-motor sources of phenotypic heterogeneity commonly observed within autism. Methods Using high resolution, multi-shell diffusion, and quantitative R1 relaxometry imaging, this study examined how variations in key sensorimotor-related white matter pathways of the proprioception input, lateral grasping, cortico-cerebellar, and corticospinal networks were associated with individual variations in grip strength in 68 autistic children and 70 non-autistic (neurotypical) children (6-11 years-old). Results In both groups, results indicated that stronger grip strength was associated with higher proprioceptive input, lateral grasping, and corticospinal (but not cortico-cerebellar modification) fractional anisotropy and R1, indirect measures concordant with stronger microstructural coherence and increased myelination. Diagnostic group differences in these grip-brain relationships were not observed, but the autistic group exhibited more variability particularly in the cortico-cerebellar modification indices. An examination into the variability within the autistic group revealed that attention-deficit/hyperactivity disorder (ADHD) features moderated the relationships between grip strength and both fractional anisotropy and R1 relaxometry in the premotor-primary motor tract of the lateral grasping network and the cortico-cerebellar network tracts. Specifically, in autistic children with elevated ADHD features (60% of the autistic group) stronger grip strength was related to higher fractional anisotropy and R1 of the cerebellar modification network (stronger microstructural coherence and more myelin), whereas the opposite relationship was observed in autistic children with reduced ADHD features. Discussion Together, this work suggests that while the foundational elements of grip strength are similar across school-aged autistic and non-autistic children, neural mechanisms of grip strength within autistic children may additionally depend on the presence of ADHD features. Specifically, stronger, more coherent connections of the cerebellar modification network, which is thought to play a role in refining and optimizing motor commands, may lead to stronger grip in children with more ADHD features, weaker grip in children with fewer ADHD features, and no difference in grip in non-autistic children. While future research is needed to understand if these findings extend to other motor tasks beyond grip strength, these results have implications for understanding the biological basis of neuromotor control in autistic children and emphasize the importance of assessing co-occurring conditions when evaluating brain-behavior relationships in autism.
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Affiliation(s)
- Olivia Surgent
- Waisman Center, University of Wisconsin-Madison, Madison, WI, United States
- Neuroscience Training Program, University of Wisconsin-Madison, Madison, WI, United States
| | - Jose Guerrero-Gonzalez
- Waisman Center, University of Wisconsin-Madison, Madison, WI, United States
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, United States
| | - Douglas C. Dean
- Waisman Center, University of Wisconsin-Madison, Madison, WI, United States
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, United States
- Department of Pediatrics, University of Wisconsin-Madison, Madison, WI, United States
| | - Nagesh Adluru
- Waisman Center, University of Wisconsin-Madison, Madison, WI, United States
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, United States
| | - Gregory R. Kirk
- Waisman Center, University of Wisconsin-Madison, Madison, WI, United States
| | | | - Andrew L. Alexander
- Waisman Center, University of Wisconsin-Madison, Madison, WI, United States
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, United States
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, United States
| | - James J. Li
- Waisman Center, University of Wisconsin-Madison, Madison, WI, United States
- Psychology Department, University of Wisconsin-Madison, Madison, WI, United States
| | - Brittany G. Travers
- Waisman Center, University of Wisconsin-Madison, Madison, WI, United States
- Occupational Therapy Program in the Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, United States
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Travers BG, Surgent O, Guerrero-Gonzalez J, Dean DC, Adluru N, Kecskemeti SR, Kirk GR, Alexander AL, Zhu J, Skaletski EC, Naik S, Duran M. Role of autonomic, nociceptive, and limbic brainstem nuclei in core autism features. Autism Res 2024; 17:266-279. [PMID: 38278763 PMCID: PMC10922575 DOI: 10.1002/aur.3096] [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: 10/20/2023] [Accepted: 01/08/2024] [Indexed: 01/28/2024]
Abstract
Although multiple theories have speculated about the brainstem reticular formation's involvement in autistic behaviors, the in vivo imaging of brainstem nuclei needed to test these theories has proven technologically challenging. Using methods to improve brainstem imaging in children, this study set out to elucidate the role of the autonomic, nociceptive, and limbic brainstem nuclei in the autism features of 145 children (74 autistic children, 6.0-10.9 years). Participants completed an assessment of core autism features and diffusion- and T1-weighted imaging optimized to improve brainstem images. After data reduction via principal component analysis, correlational analyses examined associations among autism features and the microstructural properties of brainstem clusters. Independent replication was performed in 43 adolescents (24 autistic, 13.0-17.9 years). We found specific nuclei, most robustly the parvicellular reticular formation-alpha (PCRtA) and to a lesser degree the lateral parabrachial nucleus (LPB) and ventral tegmental parabrachial pigmented complex (VTA-PBP), to be associated with autism features. The PCRtA and some of the LPB associations were independently found in the replication sample, but the VTA-PBP associations were not. Consistent with theoretical perspectives, the findings suggest that individual differences in pontine reticular formation nuclei contribute to the prominence of autistic features. Specifically, the PCRtA, a nucleus involved in mastication, digestion, and cardio-respiration in animal models, was associated with social communication in children, while the LPB, a pain-network nucleus, was associated with repetitive behaviors. These findings highlight the contributions of key autonomic brainstem nuclei to the expression of core autism features.
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Affiliation(s)
- Brittany G. Travers
- Waisman Center, University of Wisconsin-Madison, Madison, WI, USA
- Department of Kinesiology, Occupational Therapy Program, University of Wisconsin-Madison, Madison, WI, USA
| | - Olivia Surgent
- Waisman Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Jose Guerrero-Gonzalez
- Waisman Center, University of Wisconsin-Madison, Madison, WI, USA
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, USA
| | - Douglas C. Dean
- Waisman Center, University of Wisconsin-Madison, Madison, WI, USA
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, USA
- Department of Pediatrics, University of Wisconsin-Madison, Madison, WI, USA
| | - Nagesh Adluru
- Waisman Center, University of Wisconsin-Madison, Madison, WI, USA
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
| | | | - Gregory R. Kirk
- Waisman Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Andrew L. Alexander
- Waisman Center, University of Wisconsin-Madison, Madison, WI, USA
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, USA
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, USA
| | - Jun Zhu
- Department of Statistics, University of Wisconsin-Madison, Madison, WI, USA
| | - Emily C. Skaletski
- Waisman Center, University of Wisconsin-Madison, Madison, WI, USA
- Department of Kinesiology, Occupational Therapy Program, University of Wisconsin-Madison, Madison, WI, USA
| | - Sonali Naik
- Waisman Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Monica Duran
- Waisman Center, University of Wisconsin-Madison, Madison, WI, USA
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DiPiero M, Cordash H, Prigge MB, King CK, Morgan J, Guerrero-Gonzalez J, Adluru N, King JB, Lange N, Bigler ED, Zielinski BA, Alexander AL, Lainhart JE, Dean DC. Tract- and gray matter- based spatial statistics show white matter and gray matter microstructural differences in autistic males. Front Neurosci 2023; 17:1231719. [PMID: 37829720 PMCID: PMC10565827 DOI: 10.3389/fnins.2023.1231719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 09/07/2023] [Indexed: 10/14/2023] Open
Abstract
Background Autism spectrum disorder (ASD) is a neurodevelopmental condition commonly studied in the context of early childhood. As ASD is a life-long condition, understanding the characteristics of brain microstructure from adolescence into adulthood and associations to clinical features is critical for improving outcomes across the lifespan. In the current work, we utilized Tract Based Spatial Statistics (TBSS) and Gray Matter Based Spatial Statistics (GBSS) to examine the white matter (WM) and gray matter (GM) microstructure in neurotypical (NT) and autistic males. Methods Multi-shell diffusion MRI was acquired from 78 autistic and 81 NT males (12-to-46-years) and fit to the DTI and NODDI diffusion models. TBSS and GBSS were performed to analyze WM and GM microstructure, respectively. General linear models were used to investigate group and age-related group differences. Within the ASD group, relationships between WM and GM microstructure and measures of autistic symptoms were investigated. Results All dMRI measures were significantly associated with age across WM and GM. Significant group differences were observed across WM and GM. No significant age-by-group interactions were detected. Within the ASD group, positive relationships with WM microstructure were observed with ADOS-2 Calibrated Severity Scores. Conclusion Using TBSS and GBSS our findings provide new insights into group differences of WM and GM microstructure in autistic males from adolescence into adulthood. Detection of microstructural differences across the lifespan as well as their relationship to the level of autistic symptoms will deepen to our understanding of brain-behavior relationships of ASD and may aid in the improvement of intervention options for autistic adults.
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Affiliation(s)
- Marissa DiPiero
- Neuroscience Training Program, University of Wisconsin-Madison, Madison, WI, United States
- Waisman Center, University of Wisconsin-Madison, Madison, WI, United States
| | - Hassan Cordash
- Waisman Center, University of Wisconsin-Madison, Madison, WI, United States
| | - Molly B. Prigge
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, United States
| | - Carolyn K. King
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, United States
| | - Jubel Morgan
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, United States
| | | | - Nagesh Adluru
- Waisman Center, University of Wisconsin-Madison, Madison, WI, United States
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, United States
| | - Jace B. King
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, United States
| | - Nicholas Lange
- Department of Psychiatry, Harvard School of Medicine, Boston, MA, United States
| | - Erin D. Bigler
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, United States
- Department of Neurology, University of Utah, Salt Lake City, UT, United States
- Department of Psychiatry, University of Utah, Salt Lake City, UT, United States
- Department of Psychology and Neuroscience Center, Brigham Young University, Provo, UT, United States
- Department of Neurology, University of California, Davis, Davis, CA, United States
| | - Brandon A. Zielinski
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, United States
- Department of Neurology, University of Utah, Salt Lake City, UT, United States
- Department of Pediatrics, University of Utah, Salt Lake City, UT, United States
- Departments of Pediatrics and Neurology, University of Florida, Gainesville, FL, United States
- McKnight Brain Institute, University of Florida, Gainesville, FL, United States
| | - Andrew L. Alexander
- Waisman Center, University of Wisconsin-Madison, Madison, WI, United States
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, United States
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, United States
| | - Janet E. Lainhart
- Waisman Center, University of Wisconsin-Madison, Madison, WI, United States
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, United States
| | - Douglas C. Dean
- Waisman Center, University of Wisconsin-Madison, Madison, WI, United States
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, United States
- Department of Pediatrics, University of Wisconsin-Madison, Madison, WI, United States
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Surgent O, Guerrero-Gonzalez J, Dean DC, Kirk GR, Adluru N, Kecskemeti SR, Alexander AL, Travers BG. How we get a grip: Microstructural neural correlates of manual grip strength in children. Neuroimage 2023; 273:120117. [PMID: 37062373 PMCID: PMC10161685 DOI: 10.1016/j.neuroimage.2023.120117] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 03/23/2023] [Accepted: 04/13/2023] [Indexed: 04/18/2023] Open
Abstract
Maximal grip strength is associated with a variety of health-related outcome measures and thus may be reflective of the efficiency of foundational brain-body communication. Non-human primate models of grip strength strongly implicate the cortical lateral grasping network, but little is known about the translatability of these models to human children. Further, it is unclear how supplementary networks that provide proprioceptive information and cerebellar-based motor command modification are associated with maximal grip strength. Therefore, this study employed high resolution, multi-shell diffusion and quantitative T1 imaging to examine how variations in lateral grasping, proprioception input, and cortico-cerebellar modification network white matter microstructure are associated with variations in grip strength across 70 children. Results indicated that stronger grip strength was associated with higher lateral grasping and proprioception input network fractional anisotropy and R1, indirect measures consistent with stronger microstructural coherence and increased myelination. No relationships were found in the cerebellar modification network. These results provide a neurobiological mechanism of grip behavior in children which suggests that increased myelination of cortical sensory and motor pathways is associated with stronger grip. This neurobiological mechanism may be a signature of pediatric neuro-motor behavior more broadly as evidenced by the previously demonstrated relationships between grip strength and behavioral outcome measures across a variety of clinical and non-clinical populations.
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Affiliation(s)
- Olivia Surgent
- Waisman Center, University of Wisconsin-Madison, Madison, WI, United States; Neuroscience Training Program, University of Wisconsin-Madison, Madison, WI, United States
| | - Jose Guerrero-Gonzalez
- Waisman Center, University of Wisconsin-Madison, Madison, WI, United States; Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, United States
| | - Douglas C Dean
- Waisman Center, University of Wisconsin-Madison, Madison, WI, United States; Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, United States; Department of Pediatrics, University of Wisconsin-Madison, Madison, WI, United States
| | - Gregory R Kirk
- Waisman Center, University of Wisconsin-Madison, Madison, WI, United States
| | - Nagesh Adluru
- Waisman Center, University of Wisconsin-Madison, Madison, WI, United States; Department of Radiology, University of Wisconsin-Madison, Madison, WI, United States
| | | | - Andrew L Alexander
- Waisman Center, University of Wisconsin-Madison, Madison, WI, United States; Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, United States; Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, United States
| | - Brittany G Travers
- Waisman Center, University of Wisconsin-Madison, Madison, WI, United States; Occupational Therapy Program in the Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, United States.
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Surgent O, Riaz A, Ausderau KK, Adluru N, Kirk GR, Guerrero-Gonzalez J, Skaletski EC, Kecskemeti SR, Dean III DC, Weismer SE, Alexander AL, Travers BG. Brainstem white matter microstructure is associated with hyporesponsiveness and overall sensory features in autistic children. Mol Autism 2022; 13:48. [PMID: 36536467 PMCID: PMC9762648 DOI: 10.1186/s13229-022-00524-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 11/25/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Elevated or reduced responses to sensory stimuli, known as sensory features, are common in autistic individuals and often impact quality of life. Little is known about the neurobiological basis of sensory features in autistic children. However, the brainstem may offer critical insights as it has been associated with both basic sensory processing and core features of autism. METHODS Diffusion-weighted imaging (DWI) and parent-report of sensory features were acquired from 133 children (61 autistic children with and 72 non-autistic children, 6-11 years-old). Leveraging novel DWI processing techniques, we investigated the relationship between sensory features and white matter microstructure properties (free-water-elimination-corrected fractional anisotropy [FA] and mean diffusivity [MD]) in precisely delineated brainstem white matter tracts. Follow-up analyses assessed relationships between microstructure and sensory response patterns/modalities and analyzed whole brain white matter using voxel-based analysis. RESULTS Results revealed distinct relationships between brainstem microstructure and sensory features in autistic children compared to non-autistic children. In autistic children, more prominent sensory features were generally associated with lower MD. Further, in autistic children, sensory hyporesponsiveness and tactile responsivity were strongly associated with white matter microstructure in nearly all brainstem tracts. Follow-up voxel-based analyses confirmed that these relationships were more prominent in the brainstem/cerebellum, with additional sensory-brain findings in the autistic group in the white matter of the primary motor and somatosensory cortices, the occipital lobe, the inferior parietal lobe, and the thalamic projections. LIMITATIONS All participants communicated via spoken language and acclimated to the sensory environment of an MRI session, which should be considered when assessing the generalizability of this work to the whole of the autism spectrum. CONCLUSIONS These findings suggest unique brainstem white matter contributions to sensory features in autistic children compared to non-autistic children. The brainstem correlates of sensory features underscore the potential reflex-like nature of behavioral responses to sensory stimuli in autism and have implications for how we conceptualize and address sensory features in autistic populations.
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Affiliation(s)
- Olivia Surgent
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Avenue, Madison, WI 53705 USA
- Neuroscience Training Program, University of Wisconsin-Madison, Madison, WI USA
| | - Ali Riaz
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Avenue, Madison, WI 53705 USA
| | - Karla K. Ausderau
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Avenue, Madison, WI 53705 USA
- Occupational Therapy Program in the Department of Kinesiology, University of Wisconsin-Madison, Madison, WI USA
| | - Nagesh Adluru
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Avenue, Madison, WI 53705 USA
- Department of Radiology, University of Wisconsin-Madison, Madison, WI USA
| | - Gregory R. Kirk
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Avenue, Madison, WI 53705 USA
| | - Jose Guerrero-Gonzalez
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Avenue, Madison, WI 53705 USA
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI USA
| | - Emily C. Skaletski
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Avenue, Madison, WI 53705 USA
- Occupational Therapy Program in the Department of Kinesiology, University of Wisconsin-Madison, Madison, WI USA
| | - Steven R. Kecskemeti
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Avenue, Madison, WI 53705 USA
| | - Douglas C Dean III
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Avenue, Madison, WI 53705 USA
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI USA
- Department of Pediatrics, University of Wisconsin-Madison, Madison, WI USA
| | - Susan Ellis Weismer
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Avenue, Madison, WI 53705 USA
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, WI USA
- Department of Psychology, University of Wisconsin-Madison, Madison, WI USA
- Department of Educational Psychology, University of Wisconsin-Madison, Madison, WI USA
| | - Andrew L. Alexander
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Avenue, Madison, WI 53705 USA
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI USA
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI USA
| | - Brittany G. Travers
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Avenue, Madison, WI 53705 USA
- Occupational Therapy Program in the Department of Kinesiology, University of Wisconsin-Madison, Madison, WI USA
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