30 results on '"Simon-Martinez C"'
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2. The impact of brain lesion characteristics and the corticospinal tract wiring on mirror movements in unilateral cerebral palsy
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Simon-Martinez, C., Decraene, L., Zielinski, I.M., Hoare, B., Williams, J., Mailleux, L., Steenbergen, B., Ortibus, E., Feys, H., Klingels, K., Simon-Martinez, C., Decraene, L., Zielinski, I.M., Hoare, B., Williams, J., Mailleux, L., Steenbergen, B., Ortibus, E., Feys, H., and Klingels, K.
- Abstract
Contains fulltext : 283400.pdf (Publisher’s version ) (Open Access), Mirror movements (MM) influence bimanual performance in children with unilateral cerebral palsy (uCP). Whilst MM are related to brain lesion characteristics and the corticospinal tract (CST) wiring pattern, the combined impact of these neurological factors remains unknown. Forty-nine children with uCP (mean age 10y6mo) performed a repetitive squeezing task to quantify similarity (MM-similarity) and strength (MM-intensity) of the MM activity. We used MRI data to evaluate lesion type (periventricular white matter, N = 30; cortico-subcortical, N = 19), extent of ipsilesional damage, presence of bilateral lesions, and damage to basal ganglia, thalamus and corpus callosum. The CST wiring was assessed with Transcranial Magnetic Stimulation (17 CSTcontralateral, 16 CSTipsilateral, 16 CSTbilateral). Data was analyzed with regression analyses. In the more-affected hand, MM-similarity and intensity were higher with CSTbilateral/ipsilateral. In the less-affected hand, MM-similarity was higher in children with (1) CSTcontra with CSC lesions, (2) CSTbilat/ipsi with PVL lesions and (3) CSTbilat/ipsi with unilateralized lesions. MM-intensity was higher with larger damage to the corpus callosum and unilateral lesions. A complex combination of neurological factors influences MM characteristics, and the mechanisms differ between hands.
- Published
- 2022
3. Unravelling upper limb function and treatment response in unilateral cerebral palsy: a behavioral and neurological perspective : Bovenste lidmaat functie en behandelingseffecten bij unilaterale cerebrale parese: een gedragsmatig en neurologisch perspectief
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Simon Martinez, C, Ortibus, E, Klingels, K, and Feys, H
- Abstract
The exploration of the environment mainly occurs through interaction with our hands: we touch, manipulate, and inspect objects to learn how to use them. In this process, both sensory and motor systems are coordinated to provide integrated information which contribute to an optimal learning and is crucial during the first period after birth. A disruption in the brain regions responsible for these interactions might have devastating consequences for the development. This is what happens to children suffering from unilateral Cerebral Palsy (CP), whose unilateral brain lesions causes motor and sensory disturbances, leading to immediate alterations of the required hand-environment interactions. Consequently, these deficits negatively influence the children's independence in performing daily life activities as well as their quality of life. The clinical presentation of the upper limb (hand and arm) problems that children with unilateral CP present with may depend on behavioral or neurological factors. Among the behavioral factors we can find the sensorimotor impairments, which have been shown to affect upper limb movement patterns. More specifically, these movement patterns can be affected by increased spasticity or muscle weakness. Among the neurological factors, we can include the characteristics of the brain lesion, the underlying wiring pattern of the main motor drive (the corticospinal tract) and the functional connectivity of the sensorimotor network. However, it seems that no single factor has enough power to explain the variability in upper limb function, and that the combination of these factors should be investigated in a larger cohort. In addition to understanding which are the behavioral and neurological factors that can explain the deficits in upper limb function, defining new therapy approaches is fundamental to help the child reach its maximum functional potential. A variety of upper limb function training approaches have been investigated, mostly all focusing on motor execution, and it seems that one size does not fit all. Other training approaches focusing as well on motor representation and action understanding, also known problems in children with unilateral CP, may be beneficial. The combination of different treatment approaches may result in larger gains and will contribute to the identification of predictors of treatment response. The main scope of this doctoral thesis is threefold. First, we used a quantitative evaluation and analysis approach to better understand upper limb movement patterns in typically developing children and children with unilateral CP. We focused on determining the effect of age in typically developing children and ascertaining the impact of sensorimotor impairments on upper limb movement patterns in children with unilateral CP (Chapter 2). Second, we aimed to determine which neurological factors composed the best cocktail to understand the pathophysiology of upper limb function in children with unilateral CP (Chapter 3). Lastly, we developed a novel treatment approach combining modified constraint-induced movement therapy and action-observation training and investigated its effects on clinical and kinematic measures as well as the value of behavioral and neurological factors to predict treatment response (Chapter 4). To achieve the first goal, we first evaluated whether upper limb movement patterns changed with age in typically developing children. Here, we found that upper limb motion reaches its maturation around the age of 11-12 years old, with movement duration, peak velocity, trajectory straightness, as well as joint kinematics reaching a plateau at this age (chapter 2.1). The reference values provided in this study helped to further optimize the interpretation of upper limb deficits in children with neurodevelopmental disorders. In chapter 2.2, we included both children with unilateral CP and typically developing children and identified pathological movement patterns in children with unilateral CP. Secondly, we mapped the negative impact of spasticity and muscle weakness on these movement patterns, providing useful insights that will contribute to treatment planning. A collateral result from this study was the identification of a subset of three relevant tasks for studying upper limb movements in children with unilateral CP, i.e. reaching upward, reach-to-grasp a vertically oriented cylinder, and hand-to-shoulder. As previous research had shed light onto the important role of brain lesion characteristics and the type of corticospinal tract wiring pattern for an adequate upper limb functioning, we aimed to further investigate these factors in chapter 3.1. Our first finding showed that a combination of lesion locations significantly contributed to differentiate between the corticospinal tract wiring groups, re-classifying the participants in their original group with 57% of accuracy. Secondly, motor function was predicted by the combination of the type of corticospinal tract wiring (more preserved in individuals with contralateral corticospinal tract wiring), lesion extent and damage to the basal ganglia and thalamus, whilst sensory deficits seemed to be best predicted by the combination of a large and later lesion, and an ipsilateral or bilateral corticospinal tract wiring. Lastly, we found that the underlying corticospinal tract wiring seemed to disrupt the association between sensory and motor function, pointing toward different mechanisms of sensorimotor integration in unilateral CP. Since we found large variability in upper limb functionality in the ipsilateral and bilateral corticospinal tract wiring groups, we conducted a second study evaluating the impact of functional connectivity of the sensorimotor network in participants with a periventricular lesion (without cortical damage) and further explored the additional role of the corticospinal tract wiring pattern to predict upper limb motor function (chapter 3.2). In this study, we found that aberrant sensorimotor functional connectivity seemed to be corticospinal tract-dependent rather than specific from all the unilateral CP population: in the dominant hemisphere, the contralateral corticospinal tract group showed increased connectivity between primary motor cortex and premotor cortices, whereas the bilateral corticospinal tract group showed higher connectivity between primary motor cortex and somatosensory association areas. Lastly, we found little impact of sensorimotor functional connectivity on upper limb motor function, suggesting that the corticospinal tract wiring pattern still is the main factor predicting upper limb function. The last objective of this doctoral thesis was to develop and explore the effects of a novel intervention approach combining modified constraint-induced therapy (mCIMT) and action-observation training (AOT) on upper limb sensorimotor function. The rationale for this chapter was the necessity to develop new treatment strategies with a broaden focus on the upper limb sensorimotor deficits that children with unilateral CP typically present with. Effective treatment approaches, like mCIMT, are mainly targeting motor execution problems (i.e. movement quality or efficiency), whilst children with unilateral CP also have motor planning and motor representation deficits. These deficits could then be targeted with action-observation training (AOT), which is a novel neurophysiological-based treatment model that activates brain areas in charge of executing the movement that the participant is observing. The combination of mCIMT and AOT may provide new opportunities for enhanced motor learning. In chapter 4.1, we defined and described the protocol to be used in chapters 4.2 and 4.3 and stated our hypotheses. We developed an evaluator-blinded randomized controlled trial including 44 children aged between 6 and 12 years. Children were randomized according to their hand function, age and type of corticospinal tract wiring. They participated in a 2-week day-camp and received intensive mCIMT therapy for six hours a day on 9 out of 11 consecutive days (54h), including AOT or control condition (15h). Children who additionally received AOT watched goal-directed actions and executed the observed actions with the more impaired upper limb. The control group performed the same actions after watching human-motion-free computer games. Results did not show between-group differences after a two-week intervention, although both groups improved in all outcome measures and retained the gains at follow-up (chapter 4.2). Although the additional AOT to mCIMT did not seem to further improve upper limb function in the general population of children with unilateral CP, we found that it is beneficial in those children with an initially impaired motor function, as this subgroup showed higher gains in bimanual performance. As a response to mCIMT, with or without AOT, in this intensive camp model, we found that children with initially impaired sensory function showed higher gains in manual dexterity after the intervention. In addition, we found that all children with and without mirror movements could improve after a mCIMT intervention, although children who had stronger mirror movements between hands had difficulties in retaining the gains. Regarding neurological predictors, we found that all children improved after the intervention irrespective of the underlying type of the lesion or the corticospinal tract wiring pattern. However, the combination of these two factors could better predict treatment response. Lastly, chapter 4.3 documented the effects of this intervention (mCIMT+AOT) on upper limb kinematic measures. After the intervention, children receiving mCIMT+AOT became faster than the control group (mCIMT+placebo). The combined total group showed a smoother and more efficient execution of the tasks. Furthermore, we identified improvements in scapular and shoulder movements, which could not have been identified with other clinical assessments. The results of these studies highlighted interesting findings on response to this intensive therapy model and are therefore are a step forward toward individualized treatment planning in children with unilateral CP. The additional value of AOT requires further investigation when integrating it in an intensive training model. These insights are needed to transfer this training approach to the clinical practice. In conclusion, this doctoral thesis increased our knowledge in the behavioral and neurological determinants of upper limb function in children with unilateral CP contributing to the understanding of the underlying pathophysiology of upper limb dysfunction. In addition, this thesis applied a novel treatment model and showed that its effects depend on behavioral and neurological characteristics of the children, providing crucial information in the clinical decision-making process. status: published
- Published
- 2019
4. O 026 – Negative impact of muscle weakness and spasticity on gait in children with unilateral cerebral palsy
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Papageorgiou, E., primary, Simon-Martinez, C., additional, Van Campenhout, A., additional, and Desloovere, K., additional
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- 2018
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5. How does the interaction of presumed timing, location and extent of the underlying brain lesion relate to upper limb function in children with unilateral cerebral palsy?
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Mailleux, L., Klingels, K., Fiori, S., Simon-Martinez, C., Demaerel, P., Locus, M., Fosseprez, E., Boyd, Roslyn, Guzzetta, A., Ortibus, E., Feys, H., Mailleux, L., Klingels, K., Fiori, S., Simon-Martinez, C., Demaerel, P., Locus, M., Fosseprez, E., Boyd, Roslyn, Guzzetta, A., Ortibus, E., and Feys, H.
- Abstract
© 2017 European Paediatric Neurology Society Background Upper limb (UL) function in children with unilateral cerebral palsy (CP) vary largely depending on presumed timing, location and extent of brain lesions. These factors might exhibit a complex interaction and the combined prognostic value warrants further investigation. This study aimed to map lesion location and extent and assessed whether these differ according to presumed lesion timing and to determine the impact of structural brain damage on UL function within different lesion timing groups. Materials and methods Seventy-three children with unilateral CP (mean age 10 years 2 months) were classified according to lesion timing: malformations (N = 2), periventricular white matter (PWM, N = 42) and cortical and deep grey matter (CDGM, N = 29) lesions. Neuroanatomical damage was scored using a semi-quantitative MRI scale. UL function was assessed at body function and activity level. Results CDGM lesions were more pronounced compared to PWM lesions (p = 0.0003). Neuroanatomical scores were correlated with a higher degree to UL function in the CDGM group (r s = −0.39 to r s = −0.84) compared to the PWM group (r rb = −0.42 to r s = −0.61). Regression analysis found lesion location and extent to explain 75% and 65% (p < 0.02) respectively, of the variance in AHA performance in the CDGM group, but only 24% and 12% (p < 0.03) in the PWM group. Conclusions In the CDGM group, lesion location and extent seems to impact more on UL function compared to the PWM group. In children with PWM lesions, other factors like corticospinal tract (re)organization and structural connectivity may play an additional role.
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- 2017
6. Tibialis Anterior electromyographic analysis during fast dorsiflexion: Relationship with recovery of gait, muscle strength and evoked potentials during subacute spinal cord injury
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Bravo-Esteban, E, primary, Taylor, J, additional, Avila-Martin, G, additional, Simon-Martinez, C, additional, Torricelli, D, additional, Pons, JL, additional, and Gomez-Soriano, J, additional
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- 2015
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7. Stereoptic serious games as a visual rehabilitation tool for individuals with a residual amblyopia (AMBER trial): a protocol for a crossover randomized controlled trial.
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Simon-Martinez C, Antoniou MP, Bouthour W, Bavelier D, Levi D, Backus BT, Dornbos B, Blaha JJ, Kropp M, Müller H, Murray M, Thumann G, Steffen H, and Matusz PJ
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- Child, Humans, Vision, Binocular physiology, Visual Acuity, Treatment Outcome, Randomized Controlled Trials as Topic, Amblyopia therapy, Video Games
- Abstract
Background: Amblyopia is the most common developmental vision disorder in children. The initial treatment consists of refractive correction. When insufficient, occlusion therapy may further improve visual acuity. However, the challenges and compliance issues associated with occlusion therapy may result in treatment failure and residual amblyopia. Virtual reality (VR) games developed to improve visual function have shown positive preliminary results. The aim of this study is to determine the efficacy of these games to improve vision, attention, and motor skills in patients with residual amblyopia and identify brain-related changes. We hypothesize that a VR-based training with the suggested ingredients (3D cues and rich feedback), combined with increasing the difficulty level and the use of various games in a home-based environment is crucial for treatment efficacy of vision recovery, and may be particularly effective in children., Methods: The AMBER study is a randomized, cross-over, controlled trial designed to assess the effect of binocular stimulation (VR-based stereoptic serious games) in individuals with residual amblyopia (n = 30, 6-35 years of age), compared to refractive correction on vision, selective attention and motor control skills. Additionally, they will be compared to a control group of age-matched healthy individuals (n = 30) to account for the unique benefit of VR-based serious games. All participants will play serious games 30 min per day, 5 days per week, for 8 weeks. The games are delivered with the Vivid Vision Home software. The amblyopic cohort will receive both treatments in a randomized order according to the type of amblyopia, while the control group will only receive the VR-based stereoscopic serious games. The primary outcome is visual acuity in the amblyopic eye. Secondary outcomes include stereoacuity, functional vision, cortical visual responses, selective attention, and motor control. The outcomes will be measured before and after each treatment with 8-week follow-up., Discussion: The VR-based games used in this study have been conceived to deliver binocular visual stimulation tailored to the individual visual needs of the patient, which will potentially result in improved basic and functional vision skills as well as visual attention and motor control skills., Trial Registration: This protocol is registered on ClinicalTrials.gov (identifier: NCT05114252) and in the Swiss National Clinical Trials Portal (identifier: SNCTP000005024)., (© 2023. The Author(s).)
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- 2023
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8. Exploring structural connectomes in children with unilateral cerebral palsy using graph theory.
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Radwan A, Decraene L, Dupont P, Leenaerts N, Simon-Martinez C, Klingels K, Ortibus E, Feys H, Sunaert S, Blommaert J, and Mailleux L
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- Humans, Child, Brain, Magnetic Resonance Imaging, Upper Extremity, Cerebral Palsy, Connectome
- Abstract
We explored structural brain connectomes in children with spastic unilateral cerebral palsy (uCP) and its relation to sensory-motor function using graph theory. In 46 children with uCP (mean age = 10 years 7 months ± 2 years 9 months; Manual Ability Classification System I = 15, II = 16, III = 15) we assessed upper limb somatosensory and motor function. We collected multi-shell diffusion-weighted, T1-weighted and T2-FLAIR MRI and identified the corticospinal tract (CST) wiring pattern using transcranial magnetic stimulation. Structural connectomes were constructed using Virtual Brain Grafting-modified FreeSurfer parcellations and multi-shell multi-tissue constrained spherical deconvolution-based anatomically-constrained tractography. Graph metrics (characteristic path length, global/local efficiency and clustering coefficient) of the whole brain, the ipsilesional/contralesional hemisphere, and the full/ipsilesional/contralesional sensory-motor network were compared between lesion types (periventricular white matter (PWM) = 28, cortical and deep gray matter (CDGM) = 18) and CST-wiring patterns (ipsilateral = 14, bilateral = 14, contralateral = 12, unknown = 6) using ANCOVA with age as covariate. Using elastic-net regularized regression we investigated how graph metrics, lesion volume, lesion type, CST-wiring pattern and age predicted sensory-motor function. In both the whole brain and subnetworks, we observed a hyperconnectivity pattern in children with CDGM-lesions compared with PWM-lesions, with higher clustering coefficient (p = [<.001-.047], η p 2 =[0.09-0.27]), characteristic path length (p = .003, η p 2 =0.19) and local efficiency (p = [.001-.02], η p 2 =[0.11-0.21]), and a lower global efficiency with age (p = [.01-.04], η p 2 =[0.09-0.15]). No differences were found between CST-wiring groups. Overall, good predictions of sensory-motor function were obtained with elastic-net regression (R
2 = .40-.87). CST-wiring pattern was the strongest predictor for motor function. For somatosensory function, all independent variables contributed equally to the model. In conclusion, we demonstrated the potential of structural connectomics in understanding disease severity and brain development in children with uCP., (© 2023 The Authors. Human Brain Mapping published by Wiley Periodicals LLC.)- Published
- 2023
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9. The impact of brain lesion characteristics and the corticospinal tract wiring on mirror movements in unilateral cerebral palsy.
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Simon-Martinez C, Decraene L, Zielinski I, Hoare B, Williams J, Mailleux L, Steenbergen B, Ortibus E, Feys H, and Klingels K
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- Brain, Child, Humans, Pyramidal Tracts diagnostic imaging, Cerebral Palsy diagnostic imaging, Movement Disorders, Nervous System Diseases
- Abstract
Mirror movements (MM) influence bimanual performance in children with unilateral cerebral palsy (uCP). Whilst MM are related to brain lesion characteristics and the corticospinal tract (CST) wiring pattern, the combined impact of these neurological factors remains unknown. Forty-nine children with uCP (mean age 10y6mo) performed a repetitive squeezing task to quantify similarity (MM-similarity) and strength (MM-intensity) of the MM activity. We used MRI data to evaluate lesion type (periventricular white matter, N = 30; cortico-subcortical, N = 19), extent of ipsilesional damage, presence of bilateral lesions, and damage to basal ganglia, thalamus and corpus callosum. The CST wiring was assessed with Transcranial Magnetic Stimulation (17 CSTcontralateral, 16 CSTipsilateral, 16 CSTbilateral). Data was analyzed with regression analyses. In the more-affected hand, MM-similarity and intensity were higher with CSTbilateral/ipsilateral. In the less-affected hand, MM-similarity was higher in children with (1) CSTcontra with CSC lesions, (2) CSTbilat/ipsi with PVL lesions and (3) CSTbilat/ipsi with unilateralized lesions. MM-intensity was higher with larger damage to the corpus callosum and unilateral lesions. A complex combination of neurological factors influences MM characteristics, and the mechanisms differ between hands., (© 2022. The Author(s).)
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- 2022
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10. Participation after childhood stroke: Is there a relationship with lesion size, motor function and manual ability?
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Simon-Martinez C, Kamal S, Frickmann F, Steiner L, Slavova N, Everts R, Steinlin M, and Grunt S
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- Adolescent, Child, Hand Strength, Humans, Magnetic Resonance Imaging, Paresis etiology, Stroke complications
- Abstract
Background: Childhood arterial ischemic stroke (AIS) is associated with significant morbidity with up to 50% of affected children developing hemiparesis. Hemiparesis is assumed to influence participation within the peer group, but it is unclear to what extent its severity affects participation in different areas of social life., Methods: Thirteen children (mean age 9y6m) with AIS (6 without hemiparesis, 7 with hemiparesis) and 21 controls (mean age 9y8m) participated. We scored hemiparesis severity with hand strength asymmetry (pinch and grip strength), measured with a dynamometer. We assessed manual ability (ABILHAND-Kids), socioeconomic status (Family Affluence Scale) and participation (Participation and Environment Measure - Children and Youth). From structural MRI, we measured lesion size. We investigated differences in participation and its relationship with hemiparesis severity using non-parametric partial correlations (controlling for lesion size, manual ability, and socioeconomic status), interpreted as absent (r < 0.25), weak (r = 0.25-0.50), moderate (r = 0.50-0.75) or strong (r > 0.75). Analyses were performed in jamovi 1.6.3., Results: Children with AIS (with or without hemiparesis) showed reduced participation frequency at school (p < 0.001), whilst participation at home and in the community resembled that of their peers. Severity of hemiparesis was moderately related to frequency and involvement at home and to involvement and desire for change in the community, although unrelated to school participation., Conclusion: Reduced participation in school life requires close attention in the follow-up of children with AIS - regardless of the severity of hemiparesis. Participation at home and in the community is related to hemiparesis severity and may be improved with participation-focused motor intervention strategies., Competing Interests: Declaration of competing interest The authors declare no competing interests., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)
- Published
- 2021
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11. Tyneside Pegboard Test for unimanual and bimanual dexterity in unilateral cerebral palsy: association with sensorimotor impairment.
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Decraene L, Feys H, Klingels K, Basu A, Ortibus E, Simon-Martinez C, and Mailleux L
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- Adolescent, Child, Cross-Sectional Studies, Female, Hand physiopathology, Humans, Male, Psychometrics, Cerebral Palsy physiopathology, Functional Laterality physiology, Hand Strength physiology, Motor Skills physiology, Upper Extremity physiopathology
- Abstract
Aim: We explored the psychometric properties of the recently developed Tyneside Pegboard Test (TPT) for unimanual and bimanual dexterity in children with unilateral cerebral palsy (CP) and investigated the impact of sensorimotor impairments on manual dexterity., Method: In this cross-sectional study, the TPT was assessed in 49 children with unilateral CP (mean age 9y 8mo, SD 1y 11mo, range 6-15y; 30 males, 19 females; 23 with right unilateral CP). All participants additionally underwent a standardized upper limb evaluation at body function and activity level. We investigated: (1) known-group, concurrent, and construct validity and (2) impact of sensorimotor impairments including spasticity, grip force, stereognosis, and mirror movements using analysis of covariance, Spearman's rank correlation (r), and multiple linear regression (R
2 ) respectively., Results: TPT outcomes significantly differed according to the Manual Ability Classification System (p<0.001, known-group validity). Relationships were found between the unimanual TPT tasks and the Jebsen-Taylor Hand Function Test (r=0.86-0.88, concurrent validity). Bimanual TPT tasks were negatively correlated with the Assisting Hand Assessment, ABILHAND-Kids, and Children's Hand-use Experience Questionnaire (r=-0.38 to -0.78, construct validity). Stereognosis was the main determinant influencing all tasks (p<0.001, R2 =37-50%). Unimanual dexterity was additionally determined by grip strength (p<0.05, R2 =8-9%) and mirror movements in the more impaired hand (p<0.05, R2 =4-8%). Bimanual dexterity was also explained by mirror movements in the more impaired hand (p<0.01, R2 =10-16%) and spasticity (p=0.04, R2 =5%)., Interpretation: The TPT is a valid test to measure unimanual and bimanual dexterity in unilateral CP. The results further emphasize the importance of somatosensory impairments in children with unilateral CP. What this paper adds The Tyneside Pegboard Test is valid for measuring unimanual and bimanual dexterity in unilateral cerebral palsy. Children with poorer manual ability show worse unimanual and bimanual dexterity. Stereognosis is the main predictor of both unimanual and bimanual dexterity. Stronger mirror movements in the more impaired hand result in worse bimanual dexterity., (© 2021 Mac Keith Press.)- Published
- 2021
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12. Assessment of mirror movements in children and adolescents with unilateral cerebral palsy: reliability of the Woods and Teuber scale.
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Magne VA, Adde L, Hoare B, Klingels K, Simon-Martinez C, Mailleux L, Lydersen S, and Elvrum AG
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- Adolescent, Child, Disability Evaluation, Female, Humans, Male, Reproducibility of Results, Sensitivity and Specificity, Young Adult, Cerebral Palsy physiopathology, Functional Laterality physiology, Motor Skills physiology, Movement physiology
- Abstract
Aim: To investigate the inter- and intrarater reliability of the Woods and Teuber scale to detect mirror movements in children and adolescents with unilateral cerebral palsy (CP)., Method: A convenience sample of children and adolescents with unilateral CP (n=68; 31 males, 37 females; mean age 12y 2mo, SD 3y 6mo) in Manual Ability Classification levels I to III was recruited from Norway, Australia, and Belgium. Three therapists scored mirror movements according to the Woods and Teuber scale from three video-recorded tasks at two separate time points. A two-way, mixed model regression was used to calculate intraclass correlation coefficients (ICCs) reflecting overall inter- and intrarater reliability. In addition, ICCs for each hand and task were calculated separately., Results: The overall interrater reliability ICC was 0.90 and the corresponding intrarater reliability ICC was 0.92. The ICCs for each hand ranged from 0.86 to 0.92 and for each task from 0.63 to 0.89., Interpretation: The Woods and Teuber scale shows excellent reliability for scoring mirror movements in children and adolescents with unilateral CP. The assessment is easy to administer with no need for specific equipment and scoring can be determined from short video recordings, making it a feasible instrument in research and clinical practice., (© 2021 Mac Keith Press.)
- Published
- 2021
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13. Structural Brain Lesions and Gait Pathology in Children With Spastic Cerebral Palsy.
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Papageorgiou E, De Beukelaer N, Simon-Martinez C, Mailleux L, Van Campenhout A, Desloovere K, and Ortibus E
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The interaction between brain damage and motor function is not yet fully understood in children with spastic cerebral palsy (CP). Therefore, a semi-quantitative MRI (sqMRI) scale was used to explore whether identified brain lesions related to functional abilities and gait pathology in this population. A retrospective cohort of ambulatory children with spastic CP was selected [ N = 104; 52 bilateral (bCP) and 52 unilateral (uCP)]. Extent and location-specific scores were defined according to the sqMRI scale guidelines. The gross motor function classification system (GMFCS), the gait profile score (GPS), GPSs per motion plane, gait variable scores (GVS) and multiple-joint (MJ) gait patterns were related to brain lesion scores. In all groups, the global total brain scores correlated to the GPS (total: r
s = 0.404, p ≤ 0.001; bCP: rs = 0.335, p ≤ 0.05; uCP: rs = 0.493, p ≤ 0.001). The global total hemispheric scores correlated to the GMFCS (total: rs = 0.392, p ≤ 0.001; bCP: rs = 0.316, p ≤ 0.05; uCP: rs = 0.331, p ≤ 0.05). The laterality scores of the hemispheres in the total group correlated negatively to the GMFCS level ( rs = -0.523, p ≤ 0.001) and the GVS-knee sagittal ( rs = -0.311, p ≤ 0.01). Lesion location, for the total group demonstrated positive correlations between parietal lobe involvement and the GPS ( rs = 0.321, p ≤ 0.001) and between periventricular layer damage and the GMFCS ( rs = 0.348, p ≤ 0.001). Involvement of the anterior part of the corpus callosum (CC) was associated with the GVS-hip sagittal in all groups (total: rpb = 0.495, p ≤ 0.001; bCP: rpb = 0.357, p ≤ 0.05; uCP: rpb = 0.641, p ≤ 0.001). The global total hemispheric and laterality of the hemispheres scores differentiated between the minor and both the extension ( p ≤ 0.001 and p ≤ 0.001) and flexion ( p = 0.016 and p = 0.013, respectively) MJ patterns in the total group. Maximal periventricular involvement and CC intactness were associated with extension patterns (p ≤ 0.05 and p ≤ 0.001, respectively). Current findings demonstrated relationships between brain structure and motor function as well as pathological gait, in this cohort of children with CP. These results might facilitate the timely identification of gait pathology and, ultimately, guide individualized treatment planning of gait impairments in children with CP., (Copyright © 2020 Papageorgiou, De Beukelaer, Simon-Martinez, Mailleux, Van Campenhout, Desloovere and Ortibus.)- Published
- 2020
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14. Effects of combining constraint-induced movement therapy and action-observation training on upper limb kinematics in children with unilateral cerebral palsy: a randomized controlled trial.
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Simon-Martinez C, Mailleux L, Jaspers E, Ortibus E, Desloovere K, Klingels K, and Feys H
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- Biomechanical Phenomena physiology, Cerebral Palsy physiopathology, Child, Female, Humans, Male, Treatment Outcome, Cerebral Palsy rehabilitation, Exercise Therapy methods, Movement physiology, Upper Extremity physiopathology
- Abstract
Modified constraint-induced movement therapy (mCIMT) improves upper limb (UL) motor execution in unilateral cerebral palsy (uCP). As these children also show motor planning deficits, action-observation training (AOT) might be of additional value. Here, we investigated the combined value of AOT to mCIMT on UL kinematics in children with uCP in a randomized controlled trial. Thirty-six children with uCP completed an UL kinematic and clinical evaluation after participating in a 9-day mCIMT camp wearing a splint for 6 h/day. The experimental group (mCIMT + AOT, n = 20) received 15 h of AOT, i.e. video-observation and execution of unimanual tasks. The control group (mCIMT + placebo, n = 16) watched biological-motion free videos and executed the same tasks. We examined changes in motor control (movement duration, peak velocity, time-to-peak velocity, and trajectory straightness) and kinematic movement patterns (using Statistical Parametric Mapping) during the execution of three unimanual, relevant tasks before the intervention, after and at 6 months follow-up. Adding AOT to mCIMT mainly affected movement duration during reaching, whereas little benefit is seen on UL movement patterns. mCIMT, with or without AOT, improved peak velocity and trajectory straightness, and proximal movement patterns. Clinical and kinematic improvements are poorly related. Although there seem to be limited benefits of AOT to CIMT on UL kinematics, our results support the inclusion of kinematics to capture changes in motor control and movement patterns of the proximal joints.
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- 2020
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15. White matter characteristics of motor, sensory and interhemispheric tracts underlying impaired upper limb function in children with unilateral cerebral palsy.
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Mailleux L, Simon-Martinez C, Radwan A, Blommaert J, Gooijers J, Wenderoth N, Klingels K, Ortibus E, Sunaert S, and Feys H
- Subjects
- Adolescent, Anisotropy, Child, Child, Preschool, Diffusion Magnetic Resonance Imaging, Humans, Pyramidal Tracts pathology, Pyramidal Tracts physiopathology, Transcranial Magnetic Stimulation, Brain pathology, Brain physiopathology, Cerebral Palsy pathology, Cerebral Palsy physiopathology, Upper Extremity physiopathology, White Matter pathology, White Matter physiopathology
- Abstract
This study explored the role of lesion timing (periventricular white matter versus cortical and deep grey matter lesions) and type of corticospinal tract (CST) wiring pattern (contralateral, bilateral, ipsilateral) on white matter characteristics of the CST, medial lemniscus, superior thalamic radiations and sensorimotor transcallosal fibers in children with unilateral cerebral palsy (CP), and examined the association with upper limb function. Thirty-four children (mean age 10 years 7 months ± 2 years 3 months) with unilateral CP underwent a comprehensive upper limb evaluation and diffusion weighted imaging (75 directions, b value 2800). Streamline count, fractional anisotropy and mean diffusivity were extracted from the targeted tracts and asymmetry indices were additionally calculated. Transcranial magnetic stimulation was applied to assess the CST wiring pattern. Results showed a more damaged CST in children with cortical and deep grey matter lesions (N = 10) and ipsilateral CST projections (N = 11) compared to children with periventricular white matter lesions (N = 24; p < 0.02) and contralateral CST projections (N = 9; p < 0.025), respectively. Moderate to high correlations were found between diffusion metrics of the targeted tracts and upper limb function (r = 0.45-0.72; p < 0.01). Asymmetry indices of the CST and sensory tracts could best explain bimanual performance (74%, p < 0.0001) and unimanual capacity (50%, p = 0.004). Adding lesion timing and CST wiring pattern did not further improve the model of bimanual performance, while for unimanual capacity lesion timing was additionally retained (58%, p = 0.0002). These results contribute to a better understanding of the underlying neuropathology of upper limb function in children with unilateral CP and point towards a clinical potential of tractography.
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- 2020
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16. Randomized controlled trial combining constraint-induced movement therapy and action-observation training in unilateral cerebral palsy: clinical effects and influencing factors of treatment response.
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Simon-Martinez C, Mailleux L, Hoskens J, Ortibus E, Jaspers E, Wenderoth N, Sgandurra G, Cioni G, Molenaers G, Klingels K, and Feys H
- Abstract
Introduction: Constraint-induced movement therapy (CIMT) improves upper limb (UL) motor execution in unilateral cerebral palsy (uCP). As these children also show motor planning deficits, action-observation training (AOT) might be of additional value. Here, we investigated the combined effect of AOT to CIMT and identified factors influencing treatment response., Methods: A total of 44 children with uCP (mean 9 years 6 months, SD 1 year 10 months) participated in a 9-day camp wearing a splint for 6 h/day and were allocated to the CIMT + AOT ( n = 22) and the CIMT + placebo group ( n = 22). The CIMT + AOT group received 15 h of AOT (i.e. video-observation) and executed the observed tasks, whilst the CIMT + AOT group watched videos free of biological motion and executed the same tasks. The primary outcome measure was bimanual performance. Secondary outcomes included measures of body function and activity level assessed before (T1), after the intervention (T2), and at 6 months follow-up (T3). Influencing factors included behavioural and neurological characteristics., Results: Although no between-groups differences were found ( p > 0.05; η
2 = 0-16), the addition of AOT led to higher gains in children with initially poorer bimanual performance ( p = 0.02; η2 = 0.14). Both groups improved in all outcome measures after the intervention and retained the gains at follow up ( p < 0.01; η2 = 0.02-0.71). Poor sensory function resulted in larger improvements in the total group ( p = 0.03; η2 = 0.25) and high amounts of mirror movements tended to result in a better response to the additional AOT training ( p = 0.06; η2 = 0.18). Improvements were similar irrespective of the type of brain lesion or corticospinal tract wiring pattern., Conclusions: Adding AOT to CIMT, resulted in a better outcome for children with poor motor function and high amounts of mirror movements. CIMT with or without AOT seems to be more beneficial for children with poor sensory function., Trial Registration: Registered at ClinicalTrials.gov on 22nd August 2017 (ClinicalTrials.gov identifier: NCT03256357)., Competing Interests: Conflict of interest statement: The authors declare that there is no conflict of interest., (© The Author(s), 2020.)- Published
- 2020
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17. Are spasticity, weakness, selectivity, and passive range of motion related to gait deviations in children with spastic cerebral palsy? A statistical parametric mapping study.
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Papageorgiou E, Simon-Martinez C, Molenaers G, Ortibus E, Van Campenhout A, and Desloovere K
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- Child, Female, Humans, Joints physiopathology, Male, Cerebral Palsy physiopathology, Gait physiology, Muscle Spasticity physiopathology, Muscle Weakness physiopathology, Range of Motion, Articular physiology, Statistics as Topic
- Abstract
This study aimed to identify the relationships between clinical impairments and gait deviations in children with cerebral palsy (CP). A retrospective convenience sample of 367 children with CP was selected (3-18 years old) and divided in two groups based on clinical symptomatology [unilateral (uCP) / bilateral CP (bCP), (n = 167/200)]. All children underwent a three-dimensional gait analysis and a standardized clinical examination. Gait was inspected on a vector level (all sagittal motions combined), and an individual joint level (pelvis, hip, knee and ankle joint motions). Statistical non-parametric mapping was applied to identify specific parts of the gait cycle displaying relationships between the gait deviations of both groups and the impairment scores of spasticity, weakness, selectivity, and passive range of motion. Impairment scores were summarized in two ways: a) composite impairment scores (e.g. combined spasticity of all assessed muscles acting around the hip, knee and ankle joints) and b) joint specific impairment scores (e.g. spasticity of the muscles acting around the knee joint). Results showed that the vector and most of the individual motions were related to the composite scores. Direct and carry-over relationships were found between certain individual motions and joint impairment scores (around the same or neighboring joints, respectively). All correlations were more prominent for children with bCP compared to uCP, especially regarding the relationships of gait deviations with weakness and reduced selectivity. In conclusion, this study enabled the mapping of relationships between clinical impairments and gait deviations in children with CP, by identifying specific parts of the gait cycle that are related to each of these impairments. These results provide a comprehensive description of these relationships, while simultaneously highlighting the differences between the two CP groups. Integration of these findings could lead to a better understanding of the pathophysiology of gait deviations and, eventually, support individualized treatment planning., Competing Interests: The authors have declared that no competing interests exist.
- Published
- 2019
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18. Influence of the corticospinal tract wiring pattern on sensorimotor functional connectivity and clinical correlates of upper limb function in unilateral cerebral palsy.
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Simon-Martinez C, Jaspers E, Alaerts K, Ortibus E, Balsters J, Mailleux L, Blommaert J, Sleurs C, Klingels K, Amant F, Uyttebroeck A, Wenderoth N, and Feys H
- Subjects
- Adolescent, Child, Female, Functional Laterality, Humans, Male, Young Adult, Cerebral Palsy physiopathology, Motor Activity physiology, Nerve Net physiopathology, Pyramidal Tracts physiopathology, Upper Extremity physiopathology
- Abstract
In children with unilateral cerebral palsy (uCP), the corticospinal tract (CST)-wiring patterns may differ (contralateral, ipsilateral or bilateral), partially determining motor deficits. However, the impact of such CST-wiring on functional connectivity remains unknown. Here, we explored resting-state sensorimotor functional connectivity in 26 uCP with periventricular white matter lesions (mean age (standard deviation): 12.87 m (±4.5), CST wiring: 9 contralateral, 9 ipsilateral, 6 bilateral) compared to 60 healthy controls (mean age (standard deviation): 14.54 (±4.8)), and between CST-wiring patterns. Functional connectivity from each M1 to three bilateral sensorimotor regions of interest (primary sensory cortex, dorsal and ventral premotor cortex) and the supplementary motor area was compared between groups (controls vs. uCP; and controls vs. each CST-wiring group). Seed-to-voxel analyses from bilateral M1 were compared between groups. Additionally, relations with upper limb motor deficits were explored. Aberrant sensorimotor functional connectivity seemed to be CST-dependent rather than specific from all the uCP population: in the dominant hemisphere, the contralateral CST group showed increased connectivity between M1 and premotor cortices, whereas the bilateral CST group showed higher connectivity between M1 and somatosensory association areas. These results suggest that functional connectivity of the sensorimotor network is CST-wiring-dependent, although the impact on upper limb function remains unclear.
- Published
- 2019
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19. Time Course of Upper Limb Function in Children with Unilateral Cerebral Palsy: A Five-Year Follow-Up Study.
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Klingels K, Meyer S, Mailleux L, Simon-Martinez C, Hoskens J, Monbaliu E, Verheyden G, Verbeke G, Molenaers G, Ortibus E, and Feys H
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- Adolescent, Cerebral Palsy diagnosis, Child, Child, Preschool, Cohort Studies, Female, Follow-Up Studies, Humans, Longitudinal Studies, Male, Time Factors, Cerebral Palsy physiopathology, Hand Strength physiology, Upper Extremity physiology
- Abstract
Knowledge on long-term evolution of upper limb function in children with unilateral cerebral palsy (CP) is scarce. The objective was to report the five-year evolution in upper limb function and identify factors influencing time trends. Eighty-one children (mean age 9 y and 11 mo, SD 3 y and 3 mo) were assessed at baseline with follow-up after 6 months, 1, and 5 years. Passive range of motion (PROM), tone, muscle, and grip strength were assessed. Activity measurements included Melbourne Assessment, Jebsen-Taylor test, Assisting Hand Assessment (AHA), and ABILHAND-Kids. At 5-year follow-up, PROM ( p < 0.001) and AHA scores ( p < 0.001) decreased, whereas an improvement was seen for grip strength ( p < 0.001), Melbourne Assessment ( p = 0.003), Jebsen-Taylor test ( p < 0.001), and ABILHAND-Kids ( p < 0.001). Age influenced the evolution of AHA scores ( p = 0.003), with younger children being stable over time, but from 9 years onward, children experienced a decrease in bimanual performance. Manual Ability Classification System (MACS) levels also affected the evolution of AHA scores ( p = 0.02), with stable scores in MACS I and deterioration in MACS II and III. In conclusion, over 5 years, children with unilateral CP develop more limitations in PROM, and although capacity measures improve, the spontaneous use of the impaired limb in bimanual tasks becomes less effective after the age of 9 years.
- Published
- 2018
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20. Corticospinal Tract Wiring and Brain Lesion Characteristics in Unilateral Cerebral Palsy: Determinants of Upper Limb Motor and Sensory Function.
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Simon-Martinez C, Jaspers E, Mailleux L, Ortibus E, Klingels K, Wenderoth N, and Feys H
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- Adolescent, Cerebral Palsy diagnostic imaging, Child, Child, Preschool, Female, Humans, Magnetic Resonance Imaging methods, Male, Motor Cortex diagnostic imaging, Nerve Net diagnostic imaging, Pyramidal Tracts diagnostic imaging, Sensation, Transcranial Magnetic Stimulation methods, Upper Extremity diagnostic imaging, Upper Extremity innervation, Young Adult, Cerebral Palsy physiopathology, Motor Cortex physiopathology, Nerve Net physiopathology, Psychomotor Performance physiology, Pyramidal Tracts physiology, Upper Extremity physiopathology
- Abstract
Brain lesion characteristics (timing, location, and extent) and the type of corticospinal tract (CST) wiring have been proposed as determinants of upper limb (UL) motor function in unilateral cerebral palsy (uCP), yet an investigation of the relative combined impact of these factors on both motor and sensory functions is still lacking. Here, we first investigated whether structural brain lesion characteristics could predict the underlying CST wiring and we explored the role of CST wiring and brain lesion characteristics to predict UL motor and sensory functions in uCP. Fifty-two participants with uCP (mean age (SD): 11 y and 3 m (3 y and 10 m)) underwent a single-pulse Transcranial Magnetic Stimulation session to determine CST wiring between the motor cortex and the more affected hand ( n = 17 contralateral, n = 19 ipsilateral, and n = 16 bilateral) and an MRI to determine lesion timing ( n = 34 periventricular (PV) lesion, n = 18 corticosubcortical (CSC) lesion), location, and extent. Lesion location and extent were evaluated with a semiquantitative scale. A standardized protocol included UL motor (grip strength, unimanual capacity, and bimanual performance) and sensory measures. A combination of lesion locations (damage to the PLIC and frontal lobe) significantly contributed to differentiate between the CST wiring groups, reclassifying the participants in their original group with 57% of accuracy. Motor and sensory functions were influenced by each of the investigated neurological factors. However, multiple regression analyses showed that motor function was predicted by the CST wiring (more preserved in individuals with contralateral CST ( p < 0.01)), lesion extent, and damage to the basal ganglia and thalamus. Sensory function was predicted by the combination of a large and later lesion and an ipsilateral or bilateral CST wiring, which led to increased sensory deficits ( p < 0.05). These novel insights contribute to a better understanding of the underlying pathophysiology of UL function and may be useful to delineate individualized treatment strategies.
- Published
- 2018
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21. Windmill-task as a New Quantitative and Objective Assessment for Mirror Movements in Unilateral Cerebral Palsy: A Pilot Study.
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Zielinski IM, Steenbergen B, Schmidt A, Klingels K, Simon Martinez C, de Water P, and Hoare B
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- Adolescent, Child, Female, Humans, Male, Pilot Projects, Prospective Studies, Cerebral Palsy physiopathology, Disability Evaluation
- Abstract
Objective: To introduce the Windmill-task, a new objective assessment tool to quantify the presence of mirror movements (MMs) in children with unilateral cerebral palsy (UCP), which are typically assessed with the observation-based Woods and Teuber scale (W&T)., Design: Prospective, observational, cohort pilot study., Setting: Children's hospital., Participants: Prospective cohort of children (N=23) with UCP (age range, 6-15y, mean age, 10.5±2.7y)., Interventions: Not applicable., Main Outcome Measures: The concurrent validity of the Windmill-task is assessed, and the sensitivity and specificity for MM detection are compared between both assessments. To assess the concurrent validity, Windmill-task data are compared with W&T data using Spearman rank correlations (ρ) for 2 conditions: affected hand moving vs less affected hand moving. Sensitivity and specificity are compared by measuring the mean percentage of children being assessed inconsistently across both assessments., Results: Outcomes of both assessments correlated significantly (affected hand moving: ρ=.520; P=.005; less affected hand moving: ρ=.488; P=.009). However, many children displayed MMs on the Windmill-task, but not on the W&T (sensitivity: affected hand moving: 27.5%; less affected hand moving: 40.6%). Only 2 children displayed MMs on the W&T, but not on the Windmill-task (specificity: affected hand moving: 2.9%; less affected hand moving: 1.4%)., Conclusions: The Windmill-task seems to be a valid tool to assess MMs in children with UCP and has an additional advantage of sensitivity to detect MMs., (Copyright © 2018 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)
- Published
- 2018
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22. Combining constraint-induced movement therapy and action-observation training in children with unilateral cerebral palsy: a randomized controlled trial.
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Simon-Martinez C, Mailleux L, Ortibus E, Fehrenbach A, Sgandurra G, Cioni G, Desloovere K, Wenderoth N, Demaerel P, Sunaert S, Molenaers G, Feys H, and Klingels K
- Subjects
- Child, Humans, Brain diagnostic imaging, Brain physiopathology, Combined Modality Therapy, Research Design, Single-Blind Method, Videotape Recording, Randomized Controlled Trials as Topic, Cerebral Palsy physiopathology, Cerebral Palsy rehabilitation, Exercise Therapy methods, Transcranial Magnetic Stimulation, Upper Extremity physiopathology
- Abstract
Background: Upper limb (UL) deficits in children with unilateral cerebral palsy (uCP) have traditionally been targeted with motor execution treatment models, such as modified Constraint-Induced Movement Therapy (mCIMT). However, new approaches based on a neurophysiological model such as Action-Observation Training (AOT) may provide new opportunities for enhanced motor learning. The aim of this study is to describe a randomised controlled trial (RCT) protocol investigating the effects of an intensive treatment model, combining mCIMT and AOT compared to mCIMT alone on UL function in children with uCP. Additionally, the role of neurological factors as potential biomarkers of treatment response will be analysed., Methods: An evaluator-blinded RCT will be conducted in 42 children aged between 6 and 12 years. Before randomization, children will be stratified according to their House Functional Classification Scale, age and type of corticospinal tract wiring. A 2-week day-camp will be set up in which children receive intensive mCIMT therapy for 6 hours a day on 9 out of 11 consecutive days (54 h) including AOT or control condition (15 h). During AOT, these children watch video sequences showing goal-directed actions and subsequently execute the observed actions with the more impaired UL. The control group performs the same actions after watching computer games without human motion. The primary outcome measure will be the Assisting Hand Assessment. Secondary outcomes comprise clinical assessments across body function, activity and participation level of the International Classification of Function, Disability and Health. Furthermore, to quantitatively evaluate UL movement patterns, a three-dimensional motion analysis will be conducted. UL function will be assessed at baseline, immediately before and after intervention and at 6 months follow up. Brain imaging comprising structural and functional connectivity measures as well as Transcranial Magnetic Stimulation (TMS) to evaluate corticospinal tract wiring will be acquired before the intervention., Discussion: This paper describes the methodology of an RCT with two main objectives: (1) to evaluate the added value of AOT to mCIMT on UL outcome in children with uCP and (2) to investigate the role of neurological factors as potential biomarkers of treatment response., Trial Registration: NCT03256357 registered on 21st August 2017 (retrospectively registered).
- Published
- 2018
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23. Age-related changes in upper limb motion during typical development.
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Simon-Martinez C, Dos Santos GL, Jaspers E, Vanderschueren R, Mailleux L, Klingels K, Ortibus E, Desloovere K, and Feys H
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- Adolescent, Biomechanical Phenomena, Child, Child, Preschool, Female, Humans, Male, Range of Motion, Articular, Spatio-Temporal Analysis, Upper Extremity physiology, Movement physiology, Upper Extremity growth & development
- Abstract
Background and Aim: Understanding the maturation of upper limb (UL) movement characteristics in typically developing (TD) children is key to explore UL deficits in those with neurodevelopmental disorders. Three-dimensional motion analysis (3DMA) offers a reliable tool to comprehensively evaluate UL motion. However, studies thus far mainly focused on specific pre-defined parameters extracted from kinematic waveforms. Here, we investigated age-related differences in UL movement characteristics over the entire movement cycle in TD children., Participants and Methods: We assessed the non-dominant UL of 60 TD children (mean age 10y3m±3y1m) using 3DMA during eight tasks: reaching (forwards (RF), upwards (RU), sideways (RS)), reach-to-grasp (sphere (RGS), vertical cylinder (RGV)) and activities-of-daily-living mimicking tasks (hand-to-head (HTH), hand-to-mouth (HTM), hand-to-shoulder (HTS)). We investigated differences between four age-groups (5-7y, 8-10y, 11-12y, 13-15y) in: (1) spatiotemporal parameters (movement duration, peak velocity, time-to-peak velocity and trajectory straightness), and (2) 12 UL joint angles, using Statistical Parametric Mapping (SPM)., Results: We found that the 5-7y children moved with lower peak velocity and less straight trajectories compared to the 11-12y group (peak velocity: RS, HTS, p<0.01; trajectory: RU, RS, RGV, HTS, p<0.01) and the 13-15y group (peak velocity: RF, RS, RGS, RGV, HTH, HTS, p<0.01; trajectory, all tasks, p<0.01). The 5-7y children showed increased scapular protraction compared to older children (8-10y and 11-12y, HTS), as well as increased scapular medial rotation compared to the 13-15y group (RGS). During RU, the 5-7y children moved more towards the frontal plane (shoulder), unlike the 13-15y group. Lastly, the 5-7y group used less elbow flexion than older children (11-12y and 13-15y) during HTH and HTS., Discussion and Conclusion: In conclusion, our results point toward a maturation in UL movement characteristics up to age 11-12y, when UL motion seemed to reach a plateau. The reference values provided in this study will help to further optimize the interpretation of UL deficits in children with neurodevelopmental disorders., Competing Interests: The authors have declared that no competing interests exist.
- Published
- 2018
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24. Gait deviations in Duchenne muscular dystrophy-Part 2. Statistical non-parametric mapping to analyze gait deviations in children with Duchenne muscular dystrophy.
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Goudriaan M, Van den Hauwe M, Simon-Martinez C, Huenaerts C, Molenaers G, Goemans N, and Desloovere K
- Subjects
- Adolescent, Biomechanical Phenomena, Child, Child, Preschool, Databases, Factual, Female, Humans, Kinetics, Male, Muscle, Skeletal physiopathology, Range of Motion, Articular physiology, Gait physiology, Gait Disorders, Neurologic etiology, Muscle Weakness complications, Muscular Dystrophy, Duchenne complications
- Abstract
Background: Prolonged ambulation is considered important in children with Duchenne muscular dystrophy (DMD). However, previous studies analyzing DMD gait were sensitive to false positive outcomes, caused by uncorrected multiple comparisons, regional focus bias, and inter-component covariance bias. Also, while muscle weakness is often suggested to be the main cause for the altered gait pattern in DMD, this was never verified., Research Question: Our research question was twofold: 1) are we able to confirm the sagittal kinematic and kinetic gait alterations described in a previous review with statistical non-parametric mapping (SnPM)? And 2) are these gait deviations related to lower limb weakness?, Methods: We compared gait kinematics and kinetics of 15 children with DMD and 15 typical developing (TD) children (5-17 years), with a two sample Hotelling's T
2 test and post-hoc two-tailed, two-sample t-test. We used canonical correlation analyses to study the relationship between weakness and altered gait parameters. For all analyses, α-level was corrected for multiple comparisons, resulting in α = 0.005., Results: We only found one of the previously reported kinematic deviations: the children with DMD had an increased knee flexion angle during swing (p = 0.0006). Observed gait deviations that were not reported in the review were an increased hip flexion angle during stance (p = 0.0009) and swing (p = 0.0001), altered combined knee and ankle torques (p = 0.0002), and decreased power absorption during stance (p = 0.0001). No relationships between weakness and these gait deviations were found., Significance: We were not able to replicate the gait deviations in DMD previously reported in literature, thus DMD gait remains undefined. Further, weakness does not seem to be linearly related to altered gait features. The progressive nature of the disease requires larger study populations and longitudinal analyses to gain more insight into DMD gait and its underlying causes., (Copyright © 2018 Elsevier B.V. All rights reserved.)- Published
- 2018
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25. GriFT: A Device for Quantifying Physiological and Pathological Mirror Movements in Children.
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Jaspers E, Klingels K, Simon-Martinez C, Feys H, Woolley DG, and Wenderoth N
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- Adolescent, Cerebral Palsy physiopathology, Child, Child, Preschool, Equipment Design, Female, Humans, Male, Movement Disorders physiopathology, ROC Curve, Sensitivity and Specificity, Hand Strength physiology, Monitoring, Physiologic instrumentation, Movement Disorders diagnosis, Signal Processing, Computer-Assisted
- Abstract
Goal: Mirror movements (MM) occur during unilateral actions and manifest as involuntary muscle activity of the passive limb, "mirroring" voluntary actions executed by the contralateral homologous body part. They are a normal motor feature in young children that gradually disappears. In children suffering from neurological disorders, e.g., unilateral cerebral palsy, MMs have been proposed to yield relevant information for diagnosis and therapy. However, in clinical practice, MM are typically assessed using an ordinal rating scale. Here, we introduce the grip force tracking (GriFT) device, a portable system to quantitatively assess MM during repetitive unimanual squeezing while playing a computer game., Methods: The GriFT device consists of two handles, each equipped with two compressive force sensors (range 0-23 kg, F
z 1000 Hz). Children complete three trials of unimanual squeezing, whereby the visual display on the screen determines the squeezing rhythm (0.67 Hz at 15% maximum voluntary contraction, force-level adjusted per hand). MMs are characterized based on frequency, amplitude, and temporal features (synchronization, timing)., Results: MM differed significantly between children with different clinical MM scores. MM frequency and amplitude were most discriminative. Categorization of physiological MM proved highly sensitive (89%-97%)., Conclusion: We demonstrated feasibility and validity of the GriFT device in a large cohort of typically developing children (N = 174, age 5-15 years), and its clinical applicability in children with unilateral cerebral palsy with various levels of hand function., Significance: The quantification of MM is a promising tool to further investigate and categorize MM in children with unilateral cerebral palsy.- Published
- 2018
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26. Structural Brain Damage and Upper Limb Kinematics in Children with Unilateral Cerebral Palsy.
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Mailleux L, Simon-Martinez C, Klingels K, Jaspers E, Desloovere K, Demaerel P, Fiori S, Guzzetta A, Ortibus E, and Feys H
- Abstract
Background: In children with unilateral cerebral palsy (uCP) virtually nothing is known on the relation between structural brain damage and upper limb (UL) kinematics quantified with three-dimensional movement analysis (3DMA). This explorative study aimed to (1) investigate differences in UL kinematics between children with different lesion timings, i.e., periventricular white matter (PWM) vs. cortical and deep gray matter (CDGM) lesions and (2) to explore the relation between UL kinematics and lesion location and extent within each lesion timing group. Methods: Forty-eight children (age 10.4 ± 2.7 year; 29 boys; 21 right-sided; 33 PWM; 15 CDGM) underwent an UL 3DMA during a reach-to-grasp task. Spatiotemporal parameters [movement duration, (timing of) maximum velocity, trajectory straightness], the Arm Profile Score (APS) and Arm Variable Scores (AVS) were extracted. The APS and AVS refer to the total amount of movement pathology and movement deviations of the wrist, elbow, shoulder, scapula and trunk respectively. Brain lesion location and extent were scored based on FLAIR-images using a semi-quantitative MRI-scale. Results: Children with CDGM lesions showed more aberrant spatiotemporal parameters ( p < 0.03) and more movement pathology (APS, p = 0.003) compared to the PWM group, mostly characterized by increased wrist flexion ( p = 0.01). In the CDGM group, moderate to high correlations were found between lesion location and extent and duration, timing of maximum velocity and trajectory straightness ( r = 0.53-0.90). Lesion location and extent were further moderately correlated with distal UL movement pathology (wrist flexion/extension, elbow pronation/supination, elbow flexion/extension; r = 0.50-0.65) and with the APS ( r = 0.51-0.63). In the PWM group, only a few and low correlations were observed, mostly between damage to the PLIC and higher AVS of elbow flexion/extension, shoulder elevation and trunk rotation ( r = 0.35-0.42). Regression analysis revealed damage to the temporal lobe with lesion timing as interactor (27%, p = 0.002) and the posterior limb of the internal capsule (PLIC) (7%, p = 0.04) as the strongest predictors, explaining 34% of the variance in APS. Conclusion: UL kinematic deviations are more influenced by lesion location and extent in children with later (CDGM) versus earlier lesions (PWM), except for proximal movement pathology. Damage to the PLIC is a significant predictor for UL movement pathology irrespective of lesion timing.
- Published
- 2017
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27. Negative Influence of Motor Impairments on Upper Limb Movement Patterns in Children with Unilateral Cerebral Palsy. A Statistical Parametric Mapping Study.
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Simon-Martinez C, Jaspers E, Mailleux L, Desloovere K, Vanrenterghem J, Ortibus E, Molenaers G, Feys H, and Klingels K
- Abstract
Upper limb three-dimensional movement analysis (UL-3DMA) offers a reliable and valid tool to evaluate movement patterns in children with unilateral cerebral palsy (uCP). However, it remains unknown to what extent the underlying motor impairments explain deviant movement patterns. Such understanding is key to develop efficient rehabilitation programs. Although UL-3DMA has been shown to be a useful tool to assess movement patterns, it results in a multitude of data, challenging the clinical interpretation and consequently its implementation. UL-3DMA reports are often reduced to summary metrics, such as average or peak values per joint. However, these metrics do not take into account the continuous nature of the data or the interdependency between UL joints, and do not provide phase-specific information of the movement pattern. Moreover, summary metrics may not be sensitive enough to estimate the impact of motor impairments. Recently, Statistical Parametric Mapping (SPM) was proposed to overcome these problems. We collected UL-3DMA of 60 children with uCP and 60 typically developing children during eight functional tasks and evaluated the impact of spasticity and muscle weakness on UL movement patterns. SPM vector field analysis was used to analyze movement patterns at the level of five joints (wrist, elbow, shoulder, scapula, and trunk). Children with uCP showed deviant movement patterns in all joints during a large percentage of the movement cycle. Spasticity and muscle weakness negatively impacted on UL movement patterns during all tasks, which resulted in increased wrist flexion, elbow pronation and flexion, increased shoulder external rotation, decreased shoulder elevation with a preference for movement in the frontal plane and increased trunk internal rotation. Scapular position was altered during movement initiation, although scapular movements were not affected by muscle weakness or spasticity. In conclusion, we identified pathological movement patterns in children with uCP and additionally mapped the negative impact of spasticity and muscle weakness on these movement patterns, providing useful insights that will contribute to treatment planning. Last, we also identified a subset of the most relevant tasks for studying UL movements in children with uCP, which will facilitate the interpretation of UL-3DMA data and undoubtedly contribute to its clinical implementation.
- Published
- 2017
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28. How does the interaction of presumed timing, location and extent of the underlying brain lesion relate to upper limb function in children with unilateral cerebral palsy?
- Author
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Mailleux L, Klingels K, Fiori S, Simon-Martinez C, Demaerel P, Locus M, Fosseprez E, Boyd RN, Guzzetta A, Ortibus E, and Feys H
- Subjects
- Adolescent, Age Factors, Cerebral Palsy diagnostic imaging, Child, Child, Preschool, Female, Gray Matter diagnostic imaging, Gray Matter pathology, Hand Strength physiology, Humans, Magnetic Resonance Imaging, Male, Motor Activity physiology, Stereognosis physiology, White Matter diagnostic imaging, White Matter pathology, Cerebral Palsy pathology, Cerebral Palsy physiopathology, Upper Extremity physiopathology
- Abstract
Background: Upper limb (UL) function in children with unilateral cerebral palsy (CP) vary largely depending on presumed timing, location and extent of brain lesions. These factors might exhibit a complex interaction and the combined prognostic value warrants further investigation. This study aimed to map lesion location and extent and assessed whether these differ according to presumed lesion timing and to determine the impact of structural brain damage on UL function within different lesion timing groups., Materials and Methods: Seventy-three children with unilateral CP (mean age 10 years 2 months) were classified according to lesion timing: malformations (N = 2), periventricular white matter (PWM, N = 42) and cortical and deep grey matter (CDGM, N = 29) lesions. Neuroanatomical damage was scored using a semi-quantitative MRI scale. UL function was assessed at body function and activity level., Results: CDGM lesions were more pronounced compared to PWM lesions (p = 0.0003). Neuroanatomical scores were correlated with a higher degree to UL function in the CDGM group (r
s = -0.39 to rs = -0.84) compared to the PWM group (rrb = -0.42 to rs = -0.61). Regression analysis found lesion location and extent to explain 75% and 65% (p < 0.02) respectively, of the variance in AHA performance in the CDGM group, but only 24% and 12% (p < 0.03) in the PWM group., Conclusions: In the CDGM group, lesion location and extent seems to impact more on UL function compared to the PWM group. In children with PWM lesions, other factors like corticospinal tract (re)organization and structural connectivity may play an additional role., (Copyright © 2017 European Paediatric Neurology Society. All rights reserved.)- Published
- 2017
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29. Clinical assessment and three-dimensional movement analysis: An integrated approach for upper limb evaluation in children with unilateral cerebral palsy.
- Author
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Mailleux L, Jaspers E, Ortibus E, Simon-Martinez C, Desloovere K, Molenaers G, Klingels K, and Feys H
- Subjects
- Adolescent, Biomechanical Phenomena, Child, Child, Preschool, Female, Humans, Male, Prospective Studies, Regression Analysis, Arm physiopathology, Cerebral Palsy physiopathology, Movement
- Abstract
Introduction: The clinical application of upper limb (UL) three-dimensional movement analysis (3DMA) in children with unilateral cerebral palsy (uCP) remains challenging, despite its benefits compared to conventional clinical scales. Moreover, knowledge on UL movement pathology and how this relates to clinical parameters remains scarce. Therefore, we investigated UL kinematics across different manual ability classification system (MACS) levels and explored the relation between clinical and kinematic parameters in children with uCP., Patients and Methods: Fifty children (MACS: I = 15, II = 26, III = 9) underwent an UL evaluation of sensorimotor impairments (grip force, muscle strength, muscle tone, two-point discrimination, stereognosis), bimanual performance (Assisting Hand Assessment, AHA), unimanual capacity (Melbourne Assessment 2, MA2) and UL-3DMA during hand-to-head, hand-to-mouth and reach-to-grasp tasks. Global parameters (Arm Profile Score (APS), duration, (timing of) maximum velocity, trajectory straightness) and joint specific parameters (angles at task endpoint, ROM and Arm Variable Scores (AVS)) were extracted. The APS and AVS refer respectively to the total amount of movement pathology and movement deviations of wrist, elbow, shoulder, scapula and trunk., Results: Longer movement durations and increased APS were found with higher MACS-levels (p<0.001). Increased APS was also associated with more severe sensorimotor impairments (r = -0.30-(-0.73)) and with lower AHA and MA2-scores (r = -0.50-(-0.86)). For the joint specific parameters, stronger movement deviations distally were significantly associated with increased muscle weakness (r = -0.32-(-0.74)) and muscle tone (r = 0.33-(-0.61)); proximal movement deviations correlated only with muscle weakness (r = -0.35-0.59). Regression analysis exposed grip force as the most important predictor for the variability in APS (p<0.002)., Conclusion: We found increased movement pathology with increasing MACS-levels and demonstrated the adverse impact of especially muscle weakness. The lower correlations suggest that 3DMA provides additional information regarding UL motor function, particularly for the proximal joints. Integrating both methods seems clinically meaningful to obtain a comprehensive representation of all aspects of a child's UL functioning.
- Published
- 2017
- Full Text
- View/download PDF
30. Multi-contact functional electrical stimulation for hand opening: electrophysiologically driven identification of the optimal stimulation site.
- Author
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De Marchis C, Santos Monteiro T, Simon-Martinez C, Conforto S, and Gharabaghi A
- Subjects
- Biomechanical Phenomena, Electrodes, Humans, Male, Electric Stimulation Therapy methods, Electromyography methods, Hand physiology, Movement physiology, Muscle, Skeletal physiology, Neurological Rehabilitation methods
- Abstract
Background: Functional Electrical Stimulation (FES) is increasingly applied in neurorehabilitation. Particularly, the use of electrode arrays may allow for selective muscle recruitment. However, detecting the best electrode configuration constitutes still a challenge., Methods: A multi-contact set-up with thirty electrodes was applied for combined FES and electromyography (EMG) recording of the forearm. A search procedure scanned all electrode configurations by applying single, sub-threshold stimulation pulses while recording M-waves of the extensor digitorum communis (EDC), extensor carpi radialis (ECR) and extensor carpi ulnaris (ECU) muscles. The electrode contacts with the best electrophysiological response were then selected for stimulation with FES bursts while capturing finger/wrist extension and radial/ulnar deviation with a kinematic glove., Results: The stimulation electrodes chosen on the basis of M-waves of the EDC/ECR/ECU muscles were able to effectively elicit the respective finger/wrist movements for the targeted extension and/or deviation with high specificity in two different hand postures., Conclusions: A subset of functionally relevant stimulation electrodes could be selected fast, automatic and non-painful from a multi-contact array on the basis of muscle responses to subthreshold stimulation pulses. The selectivity of muscle recruitment predicted the kinematic pattern. This electrophysiologically driven approach would thus allow for an operator-independent positioning of the electrode array in neurorehabilitation.
- Published
- 2016
- Full Text
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