Less-Affected Hand Function in Children With Hemiparetic Unilateral Cerebral Palsy: A Comparison Study With Typically Developing Peers

• Published in: Neurorehabilitation and neural repair Vol. 31; no. 10-11; pp. 965 - 976
• Main Authors: Rich, Tonya L., Menk, Jeremiah S., Rudser, Kyle D., Feyma, Timothy, Gillick, Bernadette T.
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA SAGE Publications 01-10-2017
• Subjects: Adolescent; Cerebral Palsy - pathology; Cerebral Palsy - physiopathology; Cerebral Palsy - rehabilitation; Child; Cross-Sectional Studies; Evoked Potentials, Motor - physiology; Female; Functional Laterality - physiology; Hand - physiopathology; Hand Strength - physiology; Humans; Male; Motor Cortex - physiology; Motor Skills - physiology; Transcranial Magnetic Stimulation; cerebral palsy; rehabilitation; children; stroke; neuroplasticity; noninvasive brain stimulation
• DOI: 10.1177/1545968317739997
• EISSN: 1552-6844
• ISSN: 1545-9683

Background. Neurorehabilitation interventions in children with unilateral cerebral palsy (UCP) target motor abilities in daily life yet deficits in hand skills persist. Limitations in the less-affected hand may affect overall bimanual hand skills. Objective. To compare hand function, by timed motor performance on the Jebsen-Taylor Test of Hand Function (JTTHF) and grip strength of children with UCP to children with typical development (CTD), aged 8 to 18 years old. Exploratory analyses compared hand function measures with regard to neurophysiological outcomes measured by transcranial magnetic stimulation and between group comparisons of hemispheric motor threshold. Methods. Baseline hand skills were evaluated in 47 children (21 UCP; 26 CTD). Single-pulse transcranial magnetic stimulation testing assessed corticospinal tract and motor threshold. Results. The mean difference of the less-affected hand of children with UCP to the dominant hand of CTD on the JTTHF was 21.4 seconds (95% CI = 9.32-33.46, P = .001). The mean difference in grip strength was −30.8 N (95% CI = −61.9 to 0.31, P = .052). Resting motor thresholds between groups were not significant, but age was significantly associated with resting motor threshold (P < .001; P = .001). Children with UCP ipsilateral pattern of motor representation demonstrated greater mean differences between hands than children with contralateral pattern of motor representation (P < .001). All results were adjusted for age and sex. Conclusions. The less-affected hand in children with UCP underperformed the dominant hand of CTD. Limitations were greater in children with UCP ipsilateral motor pattern. Rehabilitation in the less-affected hand may be warranted. Bilateral hand function in future studies may help identify the optimal rehabilitation and neuromodulatory intervention.