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Objective: The aim of this study was to investigate the effect of Playstation 2-Eye Toy Play on upper extremity motor functions and functional independence in children with hemiparetic cerebral palsy. Methods: The study included 30 children with hemiparetic cerebral palsy with an average age of 9.8+-2.3 years. Children were randomly assigned to the two groups. Group 1 received traditional therapy and Playstation 2-Eye Toy Play, and group 2 received only traditional therapy for 2 days a week. Bruininks- Oseretsky Test of Motor Proficiency Short Form (BOT2-SF), Fugl-Meyer Motor Function Assessment (FMA), and Pediatric Functional Independence Measure (Wee-FIM) were used for the evaluation of both groups before and after the training. Results: There was a statistically significant difference in the FMA (all sub-parameters and total score), Wee-FIM (self-care, locomotion, communication and total score) and BOT2-SF (all score) after training compared to before in the group 1 (p=0.00-0.02). In the group 2, it was found that the difference in FMA (hand, coordination and total score) and Wee-FIM (self-care, transfer, locomotion, and total score) were statistically significant (p=0.00-0.02). When the results between the groups were compared after training, it was found that the increase in only manual coordination and speed measurements of FMA was statistically significant in favor of the group 1 (p=0.00 and 0.01). Conclusion: because of this study, it is concluded that virtual reality applications performed in addition to conventional training have a positive effect, especially on coordination and speed with manual functions in children with hemiparetic cerebral palsy.

To investigate effect of modified constraint-induced movement therapy (mCIMT) administered on consecutive or intermittent days on upper limb function in children with hemiparetic cerebral palsy (CP). Thirty-three children (age range 5–18 y) with hemiparetic CP separated into three groups: consecutive mCIMT group (n = 11), intermittent mCIMT group (n = 11), control group (n = 11). The outcome measures consist of Gross Motor Function Classification System (GMFCS), Manual Ability Classification System (MACS), Pediatric Balance Scale (PBS), Modified Tardieu Scale (MTS), Jebsen-Taylor Hand Function Test (JTHFT), Children's Hand Use Experience Questionnaire (CHEQ), Abilhand Kids Questionnaire, surface Electromyography (sEMG). The evaluations were made baseline, 10 days after, 5 weeks after the treatment. Improvements were achieved in all groups. The use of upper extremities in daily life activities (p < 0.01), speed of performing the activities (p < 0.001), grasping efficiency (p < 0.001), the amount of a decrease in the children's sense of discomfort while performing activities (p < 0.001) on the affected side in both mCIMT groups were better than the control group. The gain levels in mCIMT groups were similar (p > 0.05). Administration of mCIMT on intermittent days facilitate the adaptation of a child, it was concluded to be a more tolerable method and could be more effective. mCIMT is more effective than low-dose conventional therapeutic interventions in improving paretic upper limb functions in children with hemiparetic CP. The application of mCIMT in the child's natural environment increases the motivation to participate in the treatment. The application of mCIMT on intermittent days will be more easily tolerated in paediatric individuals and will increase participation in the treatment. [ABSTRACT FROM AUTHOR]

Abstract Background Hemiparetic cerebral palsy impacts millions of people worldwide. Assessment of bilateral motor function in real life remains a major challenge. We evaluated quantification of upper extremity movement in hemiparetic children using bilateral actigraphy. We hypothesized that movement asymmetry correlates with standard motor outcome measures. Methods Hemiparetic and control participants wore bilateral wrist Actiwatch2 (Philips) for 48 h with movement counts recorded in 15-s intervals. The primary outcome was a novel statistic of movement asymmetry, the Actigraphic Movement Asymmetry Index (AMAI). Relationships between AMAI and standard motor outcomes (Assisting Hand Assessment, Melbourne Assessment, and Box and Block Test [BB]) were explored with Pearson or Spearman correlation. Results 30 stroke (mean 11 years 2 months (3 years 10 months); 13 female, 17 male) and 23 control (mean 11 years 1 month (4 years 5 months); 8 female, 15 male) were enrolled. Stroke participants demonstrated higher asymmetry. Correlations between AMAI and standard tests were moderate and strongest during sleep (BB: r = 0.68, p

Perinatal stroke causes hemiparetic cerebral palsy (HCP) and lifelong disability. Constraint-induced movement therapy (CIMT) and neurostimulation may enhance motor function, but the individual factors associated with responsiveness are undetermined. We explored the clinical and neurophysiological factors associated with responsiveness to CIMT and/or brain stimulation within a clinical trial. PLASTIC CHAMPS was a randomized, blinded, sham-controlled trial (n = 45) of CIMT and neurostimulation paired with intensive, goal-directed therapy. Primary outcome was the Assisting Hand Assessment (AHA). Classification trees created through recursive partitioning suggested clinical and neurophysiological profiles associated with improvement at 6-months. Both clinical (stroke side (left) and age >14 years) and neurophysiological (intracortical inhibition/facilitation and motor threshold) were associated with responsiveness across treatment groups with positive predictive values (PPV) approaching 80%. This preliminary analysis suggested sets of variables that may be associated with response to intensive therapies in HCP. Further modeling in larger trials is required. [ABSTRACT FROM AUTHOR]

Abstract Background Activities of daily living frequently require children to make rapid decisions and execute desired motor actions while inhibiting unwanted actions. Children with hemiparetic cerebral palsy due to perinatal stroke may have deficits in executive functioning in addition to motor impairments. The objective of this study was to use a robotic object hit and avoid task to assess the ability of children with hemiparetic cerebral palsy to make rapid motor decisions. Methods Forty-five children with hemiparetic cerebral palsy due to perinatal stroke and 146 typically developing children (both groups ages 6–19 years) completed a robotic object hit and avoid task using the Kinarm Exoskeleton. Objects of different shapes fell from the top of the screen with increasing speed and frequency. Children were instructed to hit two specific target shapes with either hand, while avoiding six distractor shapes. The number of targets and distractors hit were compared between children with hemiparetic cerebral palsy and typically developing children, accounting for age effects. We also compared performance to a simpler object hit task where there were no distractors. Results We found that children with hemiparetic cerebral palsy hit a greater proportion of total distractors compared to typically developing children, demonstrating impairments in inhibitory control. Performance for all children improved with age. Children with hemiparetic cerebral palsy hit a greater percentage of targets with each arm on the more complex object hit and avoid task compared to the simpler object hit task, which was not found in typically developing children. Conclusions Children with hemiparetic cerebral palsy due to perinatal stroke demonstrated impairments in rapid motor decision making including inhibitory control, which can impede their ability to perform real-world tasks. Therapies that address both motor performance and executive functions are necessary to maximize function in children with hemiparetic cerebral palsy.

Background: Hemiparetic cerebral palsy impacts millions of people worldwide. Assessment of bilateral motor function in real life remains a major challenge. We evaluated quantification of upper extremity movement in hemiparetic children using bilateral actigraphy. We hypothesized that movement asymmetry correlates with standard motor outcome measures.Methods: Hemiparetic and control participants wore bilateral wrist Actiwatch2 (Philips) for 48 h with movement counts recorded in 15-s intervals. The primary outcome was a novel statistic of movement asymmetry, the Actigraphic Movement Asymmetry Index (AMAI). Relationships between AMAI and standard motor outcomes (Assisting Hand Assessment, Melbourne Assessment, and Box and Block Test [BB]) were explored with Pearson or Spearman correlation.Results: 30 stroke (mean 11 years 2 months (3 years 10 months); 13 female, 17 male) and 23 control (mean 11 years 1 month (4 years 5 months); 8 female, 15 male) were enrolled. Stroke participants demonstrated higher asymmetry. Correlations between AMAI and standard tests were moderate and strongest during sleep (BB: r = 0.68, p < 0.01).Conclusions: Standard tests may not reflect the extent of movement asymmetry during daily life in hemiparetic children. Bilateral actigraphy may be a valuable complementary tool for measuring arm movement, potentially enabling improved evaluation of therapies with a focus on child participation. [ABSTRACT FROM AUTHOR]

Background: Perinatal stroke often leads to lifelong motor impairment. Two common subtypes differ in timing, location, and mechanism of injury: periventricular venous infarcts (PVI) are fetal white matter lesions while most arterial ischemic strokes (AIS) are cortical injuries acquired near term birth. Both alter motor system development and primary motor cortex (M1) plasticity, often with retained ipsilateral corticospinal fibers from the non-lesioned motor cortex (M1').Methods: Task-based functional magnetic resonance imaging was used to define patterns of motor cortex activity during paretic and unaffected hand movement. Peak coordinates of M1, M1', and the supplementary motor area in the lesioned and intact hemispheres were compared to age-matched controls. Correlations between displacements and clinical motor function were explored.Results: Forty-nine participants included 14 PVI (12.59 ± 3.7 years), 13 AIS (14.91 ± 3.9 years), and 22 controls (13.91 ± 3.4 years). AIS displayed the greatest M1 displacement from controls in the lesioned hemisphere while PVI locations approximated controls. Peak M1' activations were displaced from the canonical hand knob in both PVI and AIS. Extent of M1 and M1' displacement were correlated (r = 0.50, P = 0.025) but were not associated with motor function. Supplementary motor area activity elicited by paretic tapping was displaced in AIS compared to controls (P = 0.003).Conclusion: Motor network components may be displaced in both hemispheres after perinatal stroke, particularly in AIS and those with ipsilateral control of the affected limb. Modest correlations with clinical function may support that more complex models of developmental plasticity are needed to inform targets for individualized neuromodulatory therapies in children with perinatal stroke. [ABSTRACT FROM AUTHOR]

Background: Activities of daily living frequently require children to make rapid decisions and execute desired motor actions while inhibiting unwanted actions. Children with hemiparetic cerebral palsy due to perinatal stroke may have deficits in executive functioning in addition to motor impairments. The objective of this study was to use a robotic object hit and avoid task to assess the ability of children with hemiparetic cerebral palsy to make rapid motor decisions.Methods: Forty-five children with hemiparetic cerebral palsy due to perinatal stroke and 146 typically developing children (both groups ages 6-19 years) completed a robotic object hit and avoid task using the Kinarm Exoskeleton. Objects of different shapes fell from the top of the screen with increasing speed and frequency. Children were instructed to hit two specific target shapes with either hand, while avoiding six distractor shapes. The number of targets and distractors hit were compared between children with hemiparetic cerebral palsy and typically developing children, accounting for age effects. We also compared performance to a simpler object hit task where there were no distractors.Results: We found that children with hemiparetic cerebral palsy hit a greater proportion of total distractors compared to typically developing children, demonstrating impairments in inhibitory control. Performance for all children improved with age. Children with hemiparetic cerebral palsy hit a greater percentage of targets with each arm on the more complex object hit and avoid task compared to the simpler object hit task, which was not found in typically developing children.Conclusions: Children with hemiparetic cerebral palsy due to perinatal stroke demonstrated impairments in rapid motor decision making including inhibitory control, which can impede their ability to perform real-world tasks. Therapies that address both motor performance and executive functions are necessary to maximize function in children with hemiparetic cerebral palsy. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to investigate the effects of live and video form action observation training (AOT) on upper limb (UL) movement acceleration and function in children with cerebral palsy (CP).Methods: In total, 12 children (7 boys, 5 girls) with CP participated in this study. The children were allocated randomly to live (experimental) and video (control) AOT groups. All children completed 20 treatment sessions, each 30 minutes in duration, 5 days per week for a month. Mediolateral (ML) and vertical (VT) acceleration data, Jebsen-Taylor Hand Function (JTHF) scores, and Box and Block Test (BBT) scores were obtained at baseline and at 4 weeks after the intervention.Results: ML and VT movement acceleration and JTHF scores were significantly lower in the live group (p< 0.05). The BBT score was significantly higher in the live than in the video group (p< 0.05).Conclusions: Our findings suggest that live AOT is more effective than video AOT for improving UL movement acceleration and function. Clinically, our findings offer important insights for clinicians when planning AOT interventions to reduce UL movement acceleration and improve UL function. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to compare the effects of extracorporeal shock wave therapy (ESWT) versus hinged ankle foot orthosis (h-AFO) on spastic plantar flexor muscles in hemiparetic cerebral palsy children. Methods: Thirty spastic hemiparetic cerebral palsied children (17 boys and 13 girls) participated in this study. Their age ranged from 5-8 years. The thirty children were assigned to two groups; (A) and (B) each group consisted of 15 children. Group A received ESWT and group B used h-AFOs. Both groups received same traditional physical therapy program. Spatiotemporal gait parameters and H/M ratio were measured before and after the 3 months intervention. Results: There were no significant differences in any parameter between the two groups before the intervention (p>0.05). Both groups showed significant reduction in plantar flexors spasticity at the end of the treatment program (p<0.05). But the ESWT group showed significant reduction than the h-AFOs group. Conclusion: It may be concluded that the shock wave therapy is more effective than h-AFOs in the treatment of spastic calf muscles which help hemiparetic cerebral palsy children to overcome spasticity and become more independent and participate in activities of daily living. [ABSTRACT FROM AUTHOR]

The purpose of this paper, which was conducted on 175 children with hemiparetic cerebral palsy (H-CP), was to verify the etiological risk period for this disease. Etiological risk factors (ERF) were detected through anamnesis: 23% in the prenatal period, 18% in the perinatal period and 59% of the patients the period was undefined (ERF in the prenatal and perinatal period was 41% and no ERF was 18% of the cases. The computerized tomographic scan (CT) and MRI were performed on all the patients, who were then classified according to their etiopathogenic data: CT1= normal (18%); CT 2= unilateral ventricular enlargement (25%); CT 3= cortical/ subcortical cavities (28%); CT4= hemispheric atrophy and other findings (14%); CT 5= malformations (15%). CT 5 was associated with physical malformations beyond the central nervous system and with prenatal ERF's , while CT 2 was associated with the perinatal ERF's, mainly in premature births. Magnetic resonance imaging was performed on 57 patients and demonstrated a good degree of concordance with the CT. Etiology remained undefined in only 37% of the cases after neuroimaging was related to ERF. A high perinatal RF frequency (59%) was observed and emphasized the need for special care during this period.Foram estudadas 175 crianças com paralisia cerebral hemiparética (PC-H) para elucidar o período de risco etiológico. Através da anamnese constataram-se fatores de risco para etiologia (FRE) pré-natal em 23%, perinatal em18% e período indefinido em 59% dos pacientes (com FRE pré e perinatal 41% e sem FRE 18%). A tomografia computadorizada (TC) foi realizada em todos os sujeitos e classificada de acordo com dados etiopatogênicos em: TC1= normal (18%); TC2= alargamento ventricular unilateral (25%); TC3= cavidades córtico-subcorticais (28%); TC4= atrofia hemisférica e outros achados (14%); TC5= malformações (15%). A TC5 se associada a malformações físicas fora do sistema nervoso central e aos FRE pré-natais e a TC2 aos perinatais, principalmente, nascer prematuro. A ressonância magnética foi realizada em 57 sujeitos demonstrando boa concordância com a TC. Após associação da neuroimagem e FRE a etiologia ficou indefinida em apenas 37%. Constatou-se alta frequência de FRE perinatais (59%), alertando para melhores cuidados neste período.

In the present EEG study we investigated the neural and temporal dynamics of motor imagery in participants with right-sided HCP (n = 10) and in left-handed control participants (n = 10). A mental rotation task was used in which participants were required to judge the laterality of hand pictures. At a behavioral level participants with HCP were slower in making hand laterality judgments compared to control subjects, especially when presented with pictures representing the affected hand. At a neural level, individuals with HCP were characterized by a reduced rotation-related negativity (RRN) over parietal areas, that was delayed in onset with respect to control participants. Interestingly, participants that were relatively mildly impaired showed a stronger RRN for the rotation of right hand stimuli than participants that were more strongly impaired in their motor function, suggesting a direct relation between the motor imagery process and the biomechanical constraints of the participant. Together, the results provide new insights in the relation between motor imagery and motor capabilities and indicate that participants with HCP may be characterized by a compromised ability to use motor imagery.

Most cerebral palsy children have deficits in balance, co-ordination, and gait throughout childhood and adulthood. So, it is essential to seek an ideal physical therapy program to help in solving such widespread problem. The present study was conducted to compare between the effect of vibration training and suspension therapy on balance in children with hemiparetic cerebral palsy. Patients and methods: Thirty children born with hemiparetic cerebral palsy from both sexes ranging in age from eight to ten years old were assigned into two groups of equal number. Study group I received vibration training in addition to a designed physical therapy program and study group II received suspension therapy in addition to the same physical therapy program given to the study group I. Stability indices were evaluated via using Biodex instrument system before and after six months of treatment. Results: The results revealed no significant difference when comparing the pre-treatment mean values of the two groups (study I and study II), while significant improvement was observed in all the measuring variables of the two groups when comparing their pre and post treatment mean values. Significant difference was also observed when comparing the post treatment results of the two groups in favor of the study group II. Conclusion: Suspension therapy for children with hemiparetic cerebral palsy is an excellent supplement to regularly scheduled physical therapy intervention for the purpose of improving degree of stability in those patients. [ABSTRACT FROM AUTHOR]

Objective Epilepsy is reported in 15-90% of the children with Cerebral Palsy (CP) but its clinical course is not well defined. We conducted a retrospective study on children with hemiparetic CP who were referred to Pediatric Neurology Department of Mofid Hospital. The aim of our study was to evaluate the risk factors and prognosis of epilepsy in children with hemiparetic CP. Materials & Methods We evaluated 64 children with hemiparetic CP who were referred to Pediatric Neurology Department of Mofid Hospital between 2006 and 2008. According to our protocol, patients were divided into two groups: 34 children in the case group (hemiparetic patients with epilepsy) and 30 children in the control group (hemiparetic patients without epilepsy).Results Prenatal, perinatal and postnatal events, maternal age at the time of delivery,socioeconomic status of the family, familial history of epilepsy, neuroimaging findings, side of the hemiparesia and age at diagnosis of hemiparesis were not considered as risk factors for epilepsy in hemiparetic children, but microcephaly, severity of hemiparetic CP and mental retardation were significantly associated with an increased risk of epilepsy in children with hemiparetic CP. Conclusion Our study showed that microcephaly, severity of hemiparesis and mental retardation were risk factors for developing epilepsy in children with hemiparetic CP; furthermore, they had negative effects on rehabilitation outcome in these patients. [ABSTRACT FROM AUTHOR]

Abstract: Recent studies suggest that in addition to low-level motor impairments, individuals with hemiparetic cerebral palsy (HCP) are characterized by anticipatory action planning deficits as well. In the present EEG study we investigated the neural and temporal dynamics of action planning in participants with right-sided HCP (n =10) and in left-handed control subjects (n =10). An anticipatory planning task was used in which participants were required to grasp and rotate a hexagonal knob over different angles (60°, 120° or 180°). At a behavioral level, participants with HCP were slower in their movements and often selected an inappropriate grip when grasping the object. At a neural level, individuals with HCP showed a strong reduction in the amplitude of the P2 component, likely reflecting an impaired process of action selection. In addition, a strong correlation was observed between the P2 amplitude and grasping and rotation times. The P2 component was localized to sources in the dorsal posterior cingulate cortex (dPCC), an area that is known to be involved in orienting visual body parts in space. Together these findings suggest that anticipatory planning deficits in cerebral palsy arise mainly due to an impaired process of action selection. [ABSTRACT FROM AUTHOR]

Clinical assessment and imaging studies of twenty-six children with hemiparetic cerebral palsy (HCP) were conducted. For each child 20 artifact-free EEG epochs, each of 2 s duration were selected for spectral analysis to calculate spectral power and coherence functions. A fast Fourier transformation alogorithm of signal processing was used to obtain the power spectrum of each lead. The objective of this study was to estimate EEG spectral power as well as the interhemispheric (ICoh) and intrahemispheric (Hcoh) coherence in children with hemiparetic cerebral palsy (HCP) as compared with healthy children. Significant differences between the HCP and control children were noted in the distribution of the alpha, theta and delta rhythms over the left and right hemispheres. In this study we found significant differences between the HCP and control children in the distribution of alpha, theta, delta and beta rhythm over the left and right hemispheres. Significant differences between the HCP and control children were in the distribution of the theta rhythm over the right and left hemispheres. The lower ICoh at the temporal, parietal and occipital derivations in the alpha band implies hypoconnectivity between the right and left hemispheres. The HCoh asymmetry, which implies relative hypoconnectivity within the right and left hemispheres, suggests the functional hemispheric differentiation may be diminished in comparison with the controls. [ABSTRACT FROM AUTHOR]

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