Functional connectivity and quality of life in young adults with cerebral palsy: a feasibility study

Abstract

Background: Cerebral Palsy (CP) is a group of disorders that affect the development of movement and posture. CP results from injuries to the immature brain during the prenatal, perinatal, or postnatal stage of development. Neuroimaging research in CP has focused on the structural changes of the brain during early development, but little is known about brain's structural and functional changes during late adolescence and early adulthood, a period in time when individuals experience major changes as they transition into adulthood. The work reported here served as a feasibility study within a larger program of research (MyStory Study). We aimed to determine whether it would be feasible to scan and obtain good quality data without the use of sedation during a resting state condition for functional connectivity (FC) analyses in young adults with CP. Second, we aimed to identify the FC pattern(s) that are associated with depressive mood ratings, indices of pain and fatigue, and quality of life in this group.

Methods: Resting state functional images were collected from 9 young people with CP (18-29 years). We applied a stringent head motion correction and quality control methods following preprocessing.

Results: We were able to scan and obtain good quality data without the use of sedation from this group of young individuals with CP who demonstrated a range of gross motor ability. The functional connectivity networks of interest were identified in the data using standard seed regions. Our analyses further revealed that higher well-being scores were associated with higher levels of FC between the Medial Pre-Frontal Cortex and the right Lateral Parietal regions, which are implicated in prosocial and emotion regulations skills. The implications of this association are discussed.

Conclusion: The findings of the present study demonstrate that it is feasible to conduct resting state functional connectivity in young adults with CP with different gross motor abilities without the use of sedation. Our results also highlight a neural circuitry that is associated with the self-report of quality of life and emotion regulation. These findings identify these regions/circuitries as important seeds for further investigations into mental health and wellbeing in CP.

Keywords: Adults; Cerebral palsy; Functional connectivity; Resting state; fMRI.

Fig. 1

Data Quality Assessment After Denoising. All data comes from a single participant (participant 4), while the similar plots for the other 8 participants are shown in the supplemental material. No scrubbing was performed on this participant. a The distribution of connectivity values was shifted to have a mean value close to zero, and the SD was not overly broad compared to other participants in the study. b The carpet plot indicates several large spikes in the original data, likely representing motion artifacts, have been attenuated by the filtering operations applied. c The image shows BOLD data overlaid by grey-matter edges from the MNI standard brain, with excellent fidelity. For example: (i) the edges of the caudate nucleus (open arrow) are well situated compared to the lateral ventricles visible in the underlying image; (ii) image contrast is visible across the overlaid boundary in the superior frontal cortical region (closed arrow), indicating that the boundary follows the grey-matter/white-matter interface

Fig. 2

Within-Network Functional Connectivity. The regions of interest (ROIs) from the six networks examined in the present study are illustrated. Seed ROIs are indicated by a ring, while the colour of the other ROIs in each network represents the t-statistic associated with its correlation to the seed. The statistical values of the within-network connectivity are shown in Table 2

Fig. 3

Correlation between functional connectivity and well-being. The image (a) identifies the locations of two functionally connected regions in the Default Mode Network (DMN): Medial Prefrontal Cortex (MPFC) and right Lateral Parietal (LP). The connectivity between these two regions was found to be highly correlated with well-being. The graph (b) displays the functional connectivity between MPFC and right LP and a linear regression with well-being. The high R-squared value of the regression indicates that 89% of the variance in functional connectivity is accounted for by the well-being measure