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Interhemispheric and intrahemispheric connectivity and manual skills in children with unilateral cerebral palsy

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Abstract

This study investigated patterns of motor brain activation, white matter (WM) integrity of inter- and intrahemispheric connectivity and their associations with hand function in children with unilateral cerebral palsy (CP-U). Fourteen CP-U (mean age 10.6 ± 2.7 years) and 14 typically developing children (TDC) underwent magnetic resonance imaging. CP-U underwent extensive motor evaluation. Pattern of brain activation during a motor task was studied in 12 CP-U and six TDC, by calculating laterality index (LI) and percent activation in the sensorimotor areas (around the central sulcus), and quantifying the activation in the supplementary motor area (SMA). Diffusivity parameters were measured in CP-U and eight other TDC for the corpus callosum (CC), affected and less affected cortico-spinal tracts (CST), and posterior limb of the internal capsule (PLIC). Abnormal patterns of brain activation were detected in areas around the central sulcus in 9/12 CP-U, with bilateral activation and/or reduced percent activation. More activation in areas around the central sulcus of the affected hemisphere was associated with better hand function. CP-U demonstrated more activation in the SMA when moving the affected hand compared to the less affected hand. CP-U displayed reduced WM integrity compared to TDC, in the midbody and splenium of the CC, affected CST and affected PLIC. WM integrity in these tracts was correlated with hand function. While abnormal pattern of brain activation was detected mainly when moving the affected hand, the integrity of the CC was correlated with function of both hands and bimanual skills. This study highlights the importance of interhemispheric connectivity for hand function in CP-U, which may have clinical implications regarding prognosis and management.

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Notes

  1. One child, subject 14, acquired her brain lesion at 3 months of age and all analyses were run excluding her data with no significant differences in results.

Abbreviations

WM:

White matter

CP-U:

Unilateral cerebral palsy

TDC:

Typically developing children

MRI:

Magnetic resonance imaging

fMRI:

Functional MRI

DTI:

Diffusion tensor imaging

MD:

Mean diffusivity

FA:

Fractional anisotropy

Da:

Axial diffusivity

Dr:

Radial diffusivity

LI:

Laterality index

CC:

Corpus callosum

CST:

Cortico-spinal tracts

PLIC:

Posterior limb of the internal capsule

M1:

Primary motor areas

CIMT:

Constraint induced movement therapy

HABIT:

Hand-arm bimanual intensive therapy

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Acknowledgments

We want to thank all the children and their families who took part in this study. We would also like to thank Dr Liat Ben-Sira and staff at the Tel Aviv Sourasky Medical Centre who contributed to this study. This project was supported by grants from the Guy’s and St Thomas’ Charity and the Marnie Kimelman Trust. The second author was also supported by the Department of Immigration and Absorption for earlier parts of this study.

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Authors and Affiliations

  1. Functional Brain Center, The Wohl Institute for Advanced Imaging, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel

    Maya Weinstein, Moran Artzi, Vicki Myers & Dafna Ben Bashat

  2. Gonda Multidisciplinary Brain Research Center, Bar Ilan University, Ramat Gan, Israel

    Maya Weinstein & Ronny Geva

  3. Department of Occupational Therapy, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Dido Green

  4. Health and Life Sciences, Oxford Brookes University, Oxford, UK

    Dido Green

  5. Child Development and Pediatric Neurology Service, Meuhedet, Haifa, Israel

    Mitchell Schertz

  6. Paediatric Neurology Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel

    Mitchell Schertz & Aviva Fattal-Valevski

  7. Sackler Faculty of Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel

    Moran Artzi & Dafna Ben Bashat

  8. Department of Radiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel

    Shelly Shiran

  9. Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, USA

    Andrew M. Gordon

  10. Neuropediatric Unit, Shaare-Zedek Medical Center, Jerusalem, Israel

    Varda Gross-Tsur

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  1. Maya Weinstein
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Correspondence to Dafna Ben Bashat.

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M. Weinstein and D. Green are equal contributors to this work.

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Weinstein, M., Green, D., Geva, R. et al. Interhemispheric and intrahemispheric connectivity and manual skills in children with unilateral cerebral palsy. Brain Struct Funct 219, 1025–1040 (2014). https://doi.org/10.1007/s00429-013-0551-5

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