Improvements in hand function after intensive bimanual training are not associated with corticospinal tract dysgenesis in children with unilateral cerebral palsy

Abstract

Unilateral cerebral palsy (CP) results from damage to the developing brain that occurs within the first 2 years of life. Previous studies found associations between asymmetry in the size of the corticospinal tract (CST) from the two hemispheres and severity of hand impairments in children with unilateral CP. The extent to which CST damage affects the capacity for hand function improvement is unknown. This study examines the association between an estimate of CST dysgenesis and (1) hand function and (2) the efficacy of intensive bimanual training in improving hand function. Children with unilateral CP, age 3.6-14.9 years, n = 35, received intensive bimanual training. Children engaged in bimanual functional/play activities (6 h/day, 15 days). Peduncle asymmetry, an estimate of CST dysgenesis, was measured on T1-weighted magnetic resonance imaging scans. Hand function was measured pre- and post-treatment using the assisting hand assessment (AHA) and Jebsen-Taylor test of hand function (JTTHF). AHA and JTTHF improved post-treatment (p < 0.001). Peduncle asymmetry was correlated with baseline AHA and JTTHF (p < 0.001) but not with AHA or JTTHF improvement post-training (R(2) < 0.1, p > 0.2). An estimate of CST dysgenesis is correlated with baseline hand function but is a poor predictor of training efficacy, possibly indicating a flexibility of developing motor systems to mediate recovery.

Fig. 1

Intensive bimanual therapy improves a bimanual and b unimanual hand function (*p < 0.001). Error bars represent SEM

Fig. 2

Peduncle asymmetry predicts baseline a bimanual and b unimanual hand function. Pre-treatment AHA and peduncle asymmetry were positively linearly associated [F(1,33) = 12.56.93, p = 0.01, R ² = 0.28]. Pre-treatment JTTHF and peduncle asymmetry were strongly and positively linearly associated [F(1,33) = 50.93, p < 0.0001, R ² = 0.6]. Inset T1-weighted MRI showing cerebral peduncles, outlined

Fig. 3

Response to therapy is not linearly associated with peduncle asymmetry. a Percent improvement in AHA was not significantly linearly correlated with peduncle asymmetry [F(1,33) = 1.29, p > 0.2, R ² = 0.038]. b Percent improvement in JTTHF was not significantly linearly correlated with peduncle asymmetry [F(1,33) = 2.72, p > 0.11, R ² = 0.074]