USCP Unilateral spastic cerebral palsyCompromised action performance is one of the most characteristic features of children with unilateral spastic cerebral palsy (USCP). Current rehabilitation efforts predominantly aim to improve the capacity and performance of the affected arm. Recent evidence, however, suggests that compromised motor planning may also negatively affect performance of activities of daily living. In this paper we will first discuss the recent evidence for this motor planning deficit, followed by studies on motor imagery in this population. Motor imagery is an experimental approach in which the contents of the motor plan become overt. Converging evidence indicates a compromised motor imagery ability in USCP. As the neural structures of both motor planning and motor imagery overlap, rehabilitation by motor imagery training may alleviate motor problems in USCP. Increasing evidence for this approach exists in older adults with stroke. We conclude this review with recommendations on such a training approach for children with USCP.

Over the last two decades, the number of studies on motor imagery in children has witnessed a large expansion. Most studies used the hand laterality judgment paradigm or the mental chronometry paradigm to examine motor imagery ability. The main objective of the current review is to collate these studies to provide a more comprehensive insight in children’s motor imagery development and its age of onset. Motor imagery is a form of motor cognition and aligns with forward (or predictive) models of motor control. Studying age-related differences in motor imagery ability in children therefore provides insight in underlying processes of motor development during childhood. Another motivation for studying age-related differences in motor imagery is that in order to effectively apply motor imagery training in children (with motor impairments), it is pertinent to first establish the age at which children are actually able to perform motor imagery. Overall, performance in the imagery tasks develops between 5 and 12 years of age. The age of motor imagery onset, however, remains equivocal, as some studies indicate that children of 5 to 7 years old can already enlist motor imagery in an implicit motor imagery task, whereas other studies using explicit instructions revealed that children do not use motor imagery before the age of 10. From the findings of the current study, we can conclude that motor imagery training is potentially a feasible method for pediatric rehabilitation in children from 5 years on. We suggest that younger children are most likely to benefit from motor imagery training that is presented in an implicit way. Action observation training might be a beneficial adjunct to implicit motor imagery training. From 10 years of age, more explicit forms of motor imagery training can be effectively used.

A commonly used paradigm to study motor imagery is the hand laterality judgment task. The present study aimed to determine which strategies young children employ to successfully perform this task. Children of 5 to 8 years old (N = 92) judged laterality of back and palm view hand pictures in different rotation angles. Response accuracy and response duration were registered. Response durations of the trials with a correct judgment were fitted to a-priori defined predictive sinusoid models, representing different strategies to successfully perform the hand laterality judgment task. The first model predicted systematic changes in response duration as a function of rotation angle of the displayed hand. The second model predicted that response durations are affected by biomechanical constraints of hand rotation. If observed data could be best described by the first model, this would argue for a mental imagery strategy that does not involve motor processes to solve the task. The second model reflects a motor imagery strategy to solve the task. In line with previous research, we showed an age-related increase in response accuracy and decrease in response duration in children. Observed data for both back and palm view showed that motor imagery strategies were used to perform hand laterality judgments, but that not all the children use these strategies (appropriately) at all times. A direct comparison of response duration patterns across age sheds new light on age-related differences in the strategies employed to solve the task. Importantly, the employment of the motor imagery strategy for successful task performance did not change with age.

Introduction: Motor planning is important for daily functioning. Deficits in motor planning can result in slow, inefficient, and clumsy motor behavior and are linked to disruptions in performance of activities of daily living in children with cerebral palsy (CP). However, the evidence in CP is primarily based on cross-sectional data. Method: Data are presented on the development of motor planning in children with CP using a longitudinal design with three measurement occasions, each separated by 1 year. Twenty-two children with CP (9 boys, 13 girls; age in years;months, M = 7;1, SD = 1;2) and 22 age-matched controls (10 boys, 12 girls, M = 7;1, SD = 1;3) participated. Children performed a bar transport task in which some conditions ("critical angles") required participants to sacrifice initial posture comfort in order to achieve end-state comfort. Performance on critical trials was analyzed using linear growth curve modeling. Results: In general, children with CP showed poor end-state planning for critical angles. Importantly, unlike in controls, motor planning ability did not improve across the three measurement occasions in children with CP. Conclusion: These longitudinal results show that motor planning issues in CP do not resolve with development over childhood. Strategies to enhance motor planning are suggested for intervention.

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All 3 tasks can be used to measure aspects of action planning but outcomes vary. Therefore, we recommend combining these tasks in assessments of individual children to obtain a good indication of action planning development.

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