Mirror movements and brain pathology in children with unilateral cerebral palsy.

Aim: We systematically examined the relationship between mirror movements and brain lesion type, corticospinal tract (CST) organization, and hand function to determine the relevance between mirror movements, brain lesion, the CST pattern, and hand function in children with unilateral cerebral palsy (CP).

Method: Forty-eight children (mean age 9y 9mo [SD 3y 3mo], range 6-18y; 30 males, 18 females) with unilateral CP participated. Mirror movements, brain lesion type, CST pattern identified by transcranial magnetic stimulation, and clinical outcomes were evaluated.

HABIT+tDCS: a study protocol of a randomised controlled trial (RCT) investigating the synergistic efficacy of hand-arm bimanual intensive therapy (HABIT) plus targeted non-invasive brain stimulation to improve upper extremity function in school-age children with unilateral cerebral palsy.

Introduction: Unilateral spastic cerebral palsy (USCP) is characterised by movement deficits primarily on one body side. The best available upper extremity (UE) therapies are costly and intensive. Thus, there is an urgent need for better, more efficient and thus more accessible therapies.

Intensive Bimanual Intervention for Children Who Have Undergone Hemispherectomy: A Pilot Study.

Purpose: To conduct a pilot study to assess the feasibility and effectiveness of an intensive bimanual intervention on upper limb function in children who have undergone hemispherectomy.

Methods: Thirteen children received 90 hours of intensive bimanual training (Hand-Arm Bimanual Intensive Therapy, HABIT). The Jebsen-Taylor Test of Hand Function (JTTHF), Box and Block Test (BBT), Assisting Hand Assessment (AHA), ABILHAND-Kids, and Canadian Occupational Performance Measure (COPM) were assessed by a masked clinician twice before, immediately, and 6 months after treatment.

Improvements in Upper Extremity Function Following Intensive Training Are Independent of Corticospinal Tract Organization in Children With Unilateral Spastic Cerebral Palsy: A Clinical Randomized Trial.

Intensive training of the more affected upper extremity (UE) has been shown to be effective for children with unilateral spastic cerebral palsy (USCP). Two types of UE training have been particularly successful: Constraint-Induced Movement Therapy (CIMT) and Bimanual training. Reorganization of the corticospinal tract (CST) early during development often occurs in USCP.

Corpus Callosum Integrity Relates to Improvement of Upper-Extremity Function Following Intensive Rehabilitation in Children With Unilateral Spastic Cerebral Palsy.

Background: The corpus callosum (CC) plays an important role in upper extremity (UE) function. The impact on UE function in children with unilateral spastic cerebral palsy (USCP) and improvements following intensive interventions remain unknown.

Objectives: To examine the (1) relationship between UE function and CC integrity and (2) relationship between CC integrity and changes in UE function following intensive interventions.

Upper Extremity Muscle Strength in Children With Unilateral Spastic Cerebral Palsy: A Bilateral Problem?

Objective: The objective was to investigate whether muscle strength in the nonaffected and affected upper extremities (UEs) in children (7-12 years) with unilateral spastic cerebral palsy (USCP) differs from that in children with typical development (TD).

Methods: A cross-sectional study design was used. Isometric arm strength (wrist flexion, wrist extension with flexed and extended fingers, elbow flexion/extension) was assessed in 72 children (mean age = 9.

A perspective on the development of hemispheric specialization, infant handedness, and cerebral palsy.

Cerebral Palsy (CP), a common form of neurological pediatric disability, results from pre- or perinatal brain injury. Although there is growing evidence of the efficacy of motor learning-based therapies, several factors interact to produce variability in impairment and limit the effectiveness of these therapies. The variability of hand function present in children with CP indicates that a range of developmental pathways must contribute to the manifestation of individually unique characteristics of impairment.

Anatomical and Functional Characterization in Children With Unilateral Cerebral Palsy: An Atlas-Based Analysis.

. Variability in hand function among children with unilateral cerebral palsy (UCP) might reflect the type of brain injury and resulting anatomical sequelae. .

Effectiveness of Lower-Extremity Functional Training (LIFT) in Young Children With Unilateral Spastic Cerebral Palsy: A Randomized Controlled Trial.

. Children with unilateral spastic cerebral palsy (USCP) have strength, coordination, and balance deficits affecting gross motor skills, such as walking, running, and jumping. However, there is a paucity of evidence for effective treatments for lower-extremity (LE) function in children with USCP.

The Relationship Between Hand Function and Overlapping Motor Representations of the Hands in the Contralesional Hemisphere in Unilateral Spastic Cerebral Palsy.

Background: In many children with unilateral spastic cerebral palsy (USCP), the corticospinal tract to the affected hand atypically originates in the hemisphere ipsilateral to the affected hand. Such ipsilateral connectivity is on average a predictor of poor hand function. However, there is high variability in hand function in these children, which might be explained by the complexity of motor representations of both hands in the contralesional hemisphere.

Does Dosage Matter? A Pilot Study of Hand-Arm Bimanual Intensive Training (HABIT) Dose and Dosing Schedule in Children with Unilateral Cerebral Palsy.

Aim: We compared the efficacy of hand-arm bimanual intensive training (HABIT) in two doses (90 vs. 45 hours) and two schedules of the same dose (90 vs. 2 × 45 hours) on hand and daily functioning.

Improvements in Kinematic Performance After Home-Based Bimanual Intensive Training for Children with Unilateral Cerebral Palsy.

Aims: To evaluate the effects of home-based intensive bimanual training for children with unilateral spastic cerebral palsy (USCP) on bimanual coordination using 3-D kinematic analyses.

Methods: Seven children with USCP (aged 29-54 months, MACS level: I-III) received 90 hours (2 hrs/day, 5days/week for 9 weeks) of Home Hand-Arm Bimanual Intensive Training (H-HABIT) provided by trained caregivers. A bimanual drawer-opening task was evaluated with eight infrared cameras using VICON workstation4.

Coaction of individual and environmental factors: a review of intensive therapy paradigms for children with unilateral spastic cerebral palsy.

Unlabelled: Evidence-based treatment approaches for children with unilateral spastic cerebral palsy are expanding and being modified to fit the constraints of families and the child receiving treatment. In this review, we first provide an overview of a theoretical framework that considers the intricate interactions between the individual child and the environment in which treatment is provided. Next, we describe intensive interventions that have strong support for their efficacy.

Caregiver-directed home-based intensive bimanual training in young children with unilateral spastic cerebral palsy: a randomized trial.

Aim: To examine the efficacy of caregiver-directed, home-based intensive bimanual training in children with unilateral spastic cerebral palsy (USCP) using a randomized control trial.

Method: Twenty-four children (ages 2y 6mo-10y 1mo; 10 males, 14 females) performed home-based activities directed by a caregiver for 2 hours per day, 5 days per week, for 9 weeks (total=90h). Cohorts of children were age-matched into groups and randomized to receive home-based hand-arm bimanual intensive therapy (H-HABIT; n=12) or lower-limb functional intensive training (LIFT-control; n=12).

Does Corticospinal Tract Connectivity Influence the Response to Intensive Bimanual Therapy in Children With Unilateral Cerebral Palsy?

Background: Reorganization of the corticospinal tract (CST) can occur in unilateral spastic cerebral palsy (USCP). The affected hand can be controlled via (1) typical contralateral projections from the lesioned hemisphere, (2) ipsilateral projections from the nonlesioned hemisphere, and (3) a combination of contralateral and ipsilateral projections (ie, bilateral). Intensive bimanual therapy and constraint-induced movement therapy (CIMT) improve hand function of children with USCP.

Using diffusion tensor imaging to identify corticospinal tract projection patterns in children with unilateral spastic cerebral palsy.

Aim: To determine whether diffusion tensor imaging (DTI) can be an independent assessment for identifying the corticospinal tract (CST) projecting from the more-affected motor cortex in children with unilateral spastic cerebral palsy (CP).

Method: Twenty children with unilateral spastic CP participated in this study (16 males, four females; mean age 9y 2mo [standard deviation (SD) 3y 2mo], Manual Ability Classification System [MACS] level I-III). We used DTI tractography to reconstruct the CST projecting from the more-affected motor cortex.

Skilled Bimanual Training Drives Motor Cortex Plasticity in Children With Unilateral Cerebral Palsy.

Background Intensive bimanual therapy can improve hand function in children with unilateral spastic cerebral palsy (USCP). We compared the effects of structured bimanual skill training versus unstructured bimanual practice on motor outcomes and motor map plasticity in children with USCP. Objective We hypothesized that structured skill training would produce greater motor map plasticity than unstructured practice.

Feasibility of caregiver-directed home-based hand-arm bimanual intensive training: a brief report.

Objective: To determine feasibility of a home-based, intensive bimanual intervention with children with unilateral spastic cerebral palsy.

Methods: Eleven children (aged 29-54 months) received 90 hours of home hand-arm bimanual intensive therapy (H-HABIT) provided by their trained caregivers. Parenting stress levels and compliance were monitored using the Parenting Stress Index and daily logs.

Efficacy of constraint-induced movement therapy and bimanual training in children with hemiplegic cerebral palsy in an educational setting.

We examined the efficacy of modified constraint-induced movement therapy (CIMT) and hand-arm bimanual intensive therapy (HABIT) in a special education preschool/kindergarten in Israel. Twelve children (1.5-7 years) with congenital hemiplegic cerebral palsy were randomized to receive modified CIMT (n = 6) or HABIT (n = 6).

Bimanual training and constraint-induced movement therapy in children with hemiplegic cerebral palsy: a randomized trial.

Background: Constraint-induced movement therapy (CIMT) promotes hand function using intensive unimanual practice along with restraint of the less-affected hand. CIMT has not been compared with a treatment with equivalent dosing frequency and intensity in children with cerebral palsy (CP).

Objectives: The authors report a randomized trial comparing CIMT and a bimanual intervention (hand-arm intensive bimanual therapy; HABIT) that maintains the intensity of practice associated with CIMT but where children are engaged in functional bimanual tasks.

Development of infant prehension handedness: a longitudinal analysis during the 6- to 14-month age period.

Handedness is a developmental phenomenon that becomes distinctively identifiable during infancy. Although infant hand-use preferences sometimes have been reported as unstable, other evidence demonstrates that infant hand-use preference for apprehending objects can be reliably assessed during the second half of the infant's first year of life. The current study provides further insight into the stability of prehension preferences.

Development of role-differentiated bimanual manipulation during the infant's first year.

Role-differentiated bimanual manipulation (RDBM) is a complementary movement of both hands that requires differentiation between actions of the hands. Previous research showed that RDBM can be observed in infants as early as 7 months. However, RDBM could be considered a skill only when its frequency, duration, and use is appropriate for the type of manual task, and there is some evidence of intentionality in use.

Relation of stable hand-use preferences to the development of skill for managing multiple objects from 7 to 13 months of age.

Expression of multiple object management skills (manual acquisition and storage of objects) was examined longitudinally at 7, 9, 11, and 13 months for 38 infants (19 females) whose hand use preference was either stable (consistently right or left across the ages) or nonstable (either no hand-use preference exhibited or inconsistent preference across the ages). Four separate sets of four distinctive objects each were presented singly to the infant's right and left side, with the presentation of each subsequent object contingent on the infant manipulating the previous object. Expression of multiple object management skills significantly increased with age.