Reduced corticospinal drive to antagonist muscles of upper and lower limbs during hands-and-knees crawling in infants with cerebral palsy: Evidence from intermuscular EMG-EMG coherence.

Background: There is growing interest in understanding the central control of hands-and-knees crawling, especially as a significant motor developmental milestone for early assessment of motor dysfunction in infants with cerebral palsy (CP) who have not yet acquired walking ability. In particular, CP is known to be associated with walking dysfunctions caused by early damage and incomplete maturation of the corticospinal tract. However, the extent of damage to the corticospinal connections during crawling in infants with CP has not been fully clarified. Therefore, this study aimed to investigate the disparities in intermuscular EMG-EMG coherence, which serve as indicators of corticospinal drives to antagonist muscles in the upper and lower limbs during crawling, between infants with and without CP.

Methods: This study involved 15 infants diagnosed with CP and 20 typically developing (TD) infants. Surface EMG recordings were obtained from two pairs of antagonist muscles in the upper limbs (triceps brachii (TB) and biceps brachii (BB)) and lower limbs (quadriceps femoris (QF) and hamstrings (HS)), while the infants performed hands-and-knees crawling at their self-selected velocity. Intermuscular EMG-EMG coherence was computed in two frequency bands, the beta band (15-30 Hz) and gamma band (30-60 Hz), which indicate corticospinal drive. Additionally, spatiotemporal parameters, including crawling velocity, cadence, duration, and the percentage of stance phase time, were calculated for comparison. Spearman rank correlations were conducted to assess the relationship between EMG-EMG coherence and crawling spatiotemporal parameters.

Results: Infants with CP exhibited significantly reduced crawling velocity, decreased cadence, longer cycle duration, and a higher percentage of stance phase time compared to TD infants. Furthermore, CP infants demonstrated decreased coherence in the beta and gamma frequency bands (indicators of corticospinal drive) in both upper and lower limb muscles. Regarding limb-related differences in the beta and gamma coherence, significant disparities were found between upper and lower limb muscles in TD infants (p < 0.05), but not in infants with CP (p > 0.05). Additionally, significant correlations between coherence metrics and crawling spatiotemporal parameters were identified in the TD group (p < 0.05), while such correlations were not evident in the CP group.

Conclusions: Our findings suggest that the corticospinal drive may functionally influence the central control of antagonist muscles in the limbs during typical infant crawling. This functional role could be impaired by neurological conditions such as cerebral palsy. The neurophysiological markers of corticospinal drive, specifically intermuscular EMG-EMG coherence during crawling in infants with cerebral palsy, could potentially serve as a tool to assess developmental response to therapy.