A neurocognitive perspective on developmental disregard in children with hemiplegic cerebral palsy

Houwink, Annemieke; Aarts, Pauline; Geurts, Alexander C. H.; Steenbergen, Bert

doi:10.1016/j.ridd.2011.07.012

Cited by 63 publications

(75 citation statements)

References 35 publications

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“…New neurocognitive rehabilitation options are now being developed and validated. 10 Adulthood. In adults, interventions shift more toward compensation for deficits and targeted interventions for specific impairments.…”

Section: Variations In Clinical Practice and Thementioning

confidence: 99%

Report of a workshop on research gaps in the treatment of cerebral palsy

et al. 2016

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Cerebral palsy (CP) is heterogeneous in etiology and manifestations, making research into relevant therapies difficult and limiting the generalizability of the results. We report here on the NIH CP symposium, where stakeholders from academic, clinical, regulatory, and advocacy backgrounds discussed the major challenges and needs for moving forward with clinical research in CP, and outlined priorities and action items. New information is constantly generated through research into pathogenesis and etiology. Clinical research and new therapeutic approaches need to keep pace, through large data registry integration and new research designs. Development of standardized data collection, increasing academic focus on CP research, and iterative approaches to treatment throughout the patients' lives, have all been identified as areas of focus. The workshop identified critical gaps and areas of focus to increase the evidence base for therapeutic approaches to determine which treatments work best for which patients in the near future. These include consolidation and optimization of databases and registries, updates to the research methodology, and better integration of resources and stakeholders. DEFINING THE PROBLEM Cerebral palsy (CP) is a group of neurologic disorders of motor control with onset early in development and persistence throughout the lifespan. CP is the most common cause of motor disability in childhood, with an incidence of 2 to 3 per 1,000 live births, occurring 20 to 30 times more frequently in premature or low-birth-weight infants.1 These disturbances of movement and posture cause activity limitations.2 Those activity limitations resulting from spinal or neuromuscular disorders are excluded from the diagnosis. Various etiologies can cause the CP clinical spectrum but all have a disruption of motor control in common. In addition to prematurity, other known etiologies include developmental defects of the brain, perinatal stroke, hypoxia, shock, and fetal or neonatal inflammation/infection. However, CP may also occur in low-risk children for whom there is no obvious etiology or risk factor. CP is often accompanied by comorbidities such as seizures, communication deficits, hearing and vision deficits, and intellectual disability. There is a wide spectrum of functional outcomes from normal educational, career, and social activities to complete disability and dependence.An upper age limit for acquired pathology in the brain leading to CP is not absolute, but the onset of symptoms and the diagnosis are generally expected to occur by the age of 2. Given the heterogeneity in terms of etiology, pathology, clinical manifestations, and progression, it is best to consider CP as a collection of conditions rather than one uniform entity for developing treatment guidelines or conducting research on potential therapies.To address pressing research challenges, the National Institute of Neurological Disorders and Stroke (NINDS) organized a workshop with the main goal of discussing research needed to determine best ...

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Section: Variations In Clinical Practice and Thementioning

confidence: 99%

Report of a workshop on research gaps in the treatment of cerebral palsy

et al. 2016

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“…Houwink et al (2011) suggested that attentional deficits and a lack of automatization may be related to limb disuse and disregard, but these observations also suggest that body representation may be impaired in children with HCP. If present, impairments in body representation could hinder physical therapy and other rehabilitative efforts in these individuals.…”

Section: Introductionmentioning

confidence: 99%

“…The term "developmental disregard" has been proposed to characterize a "failure to use the potential motor functions and capacities of the affected arm and hand for spontaneous use in daily life" (Houwink, Aarts, Geurts, & Steenbergen, 2011, p. 2158. In bimanual tasks, these children frequently fail to engage the hemiparetic limb as support for the healthy limb, a behavior that is similar to motor neglect (Punt & Riddoch, 2006).…”

Section: Introductionmentioning

confidence: 99%

Evaluation of body representation in children with hemiplegic cerebral palsy: Toward the development of a neuropsychological test battery.

Fontes¹,

Moura²,

Haase³

2014

Psychology & Neuroscience

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Clinical observations indicate that many children with hemiplegic cerebral palsy (HCP) exhibit a lack of use or disregard of the affected upper limb. The aim of the present study was to develop, adapt, and verify the psychometric properties of a neuropsychological battery to assess body perception and representation disturbances in children with HCP. Three groups of children participated in this study, who took part in different phases of the validation process: one group of typically developing children (TD; n = 30; aged 4-6 years) and two groups of HCP children (HCP1: n = 12, aged 5-10 years; HCP2: n = 49, aged 5-13 years). Because no cognitive-neuropsychological model of body representation has been specifically developed for children, the tasks were designed based on a cognitive-neuropsychological model developed for adults. The chosen model comprises three levels of body representation: body schema, body structural description, and body image. The following steps were adopted in developing the instrument: development and choice of the tasks, selection and preparation of stimuli, adequacy and improvement of the instrument, semantic analysis of items, internal consistency, and feasibility and acceptability of application for TD and HCP children. The final set of tasks and items was chosen to balance the levels of difficulty and internal consistency. We concluded that the final battery was adequate and can be used to assess body representation disturbances in children with HCP.

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“…Patients with hemiplegic CP often help their affected limb while performing daily tasks by compensatory use of their unaffected limb. 4,5 Even though CP cannot be cured, motor control skills in these children can be improved through repetitive task-specific treatments targeting an increased involvement of the affected limb. 6 Constraint-induced movement therapy (CIMT) is one such common treatment for children with upper limb hemiplegia.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of cortical plasticity in children with cerebral palsy undergoing constraint-induced movement therapy based on functional near-infrared spectroscopy

et al. 2015

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Abstract. Sensorimotor cortex plasticity induced by constraint-induced movement therapy (CIMT) in six children (10.2 AE 2.1 years old) with hemiplegic cerebral palsy was assessed by functional near-infrared spectroscopy (fNIRS). The activation laterality index and time-to-peak/duration during a finger-tapping task and the resting-state functional connectivity were quantified before, immediately after, and 6 months after CIMT. These fNIRS-based metrics were used to help explain changes in clinical scores of manual performance obtained concurrently with imaging time points. Five age-matched healthy children (9.8 AE 1.3 years old) were also imaged to provide comparative activation metrics for normal controls. Interestingly, the activation time-to-peak/duration for all sensorimotor centers displayed significant normalization immediately after CIMT that persisted 6 months later. In contrast to this improved localized activation response, the laterality index and resting-state connectivity metrics that depended on communication between sensorimotor centers improved immediately after CIMT, but relapsed 6 months later. In addition, for the subjects measured in this work, there was either a trade-off between improving unimanual versus bimanual performance when sensorimotor activation patterns normalized after CIMT, or an improvement occurred in both unimanual and bimanual performance but at the cost of very abnormal plastic changes in sensorimotor activity. © The Authors. Published by SPIE under a Creative Commons Attribution 3.0 Unported License. Distribution or reproduction of this work in whole or in part requires full attribution of the original publication, including its DOI.

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A neurocognitive perspective on developmental disregard in children with hemiplegic cerebral palsy

Cited by 63 publications

References 35 publications

Report of a workshop on research gaps in the treatment of cerebral palsy

Report of a workshop on research gaps in the treatment of cerebral palsy

Evaluation of body representation in children with hemiplegic cerebral palsy: Toward the development of a neuropsychological test battery.

Evaluation of cortical plasticity in children with cerebral palsy undergoing constraint-induced movement therapy based on functional near-infrared spectroscopy

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