Advanced Fiber Tracking in Early Acquired Brain Injury Causing Cerebral Palsy

Lennartsson, Finn; Holmström, Linda; Eliasson, A-C; Flodmark, Olof; Forssberg, Hans; Tournier, Jacques‐Donald; Vollmer, Brigitte

doi:10.3174/ajnr.a4072

Cited by 17 publications

(16 citation statements)

References 36 publications

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“…Hoon et al (2002, 2009) found that the severity of injury in the thalamocortical sensory pathways correlated to the severity of deficits in sensorimotor function in children with CP born preterm. Similarly, abnormalities assessed using DTI in preterm infants were seen in both CST and thalamocortical projections to the somatosensory cortex, and both tracts were associated with underlying pathology on conventional MRI (Lennartsson et al, 2015). …”

Section: Brain Injury In Cerebral Palsymentioning

confidence: 99%

Neurologic Correlates of Gait Abnormalities in Cerebral Palsy: Implications for Treatment

Zhou

Butler

Rose

2017

Front. Hum. Neurosci.

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Cerebral palsy (CP) is the most common movement disorder in children. A diagnosis of CP is often made based on abnormal muscle tone or posture, a delay in reaching motor milestones, or the presence of gait abnormalities in young children. Neuroimaging of high-risk neonates and of children diagnosed with CP have identified patterns of neurologic injury associated with CP, however, the neural underpinnings of common gait abnormalities remain largely uncharacterized. Here, we review the nature of the brain injury in CP, as well as the neuromuscular deficits and subsequent gait abnormalities common among children with CP. We first discuss brain injury in terms of mechanism, pattern, and time of injury during the prenatal, perinatal, or postnatal period in preterm and term-born children. Second, we outline neuromuscular deficits of CP with a focus on spastic CP, characterized by muscle weakness, shortened muscle-tendon unit, spasticity, and impaired selective motor control, on both a microscopic and functional level. Third, we examine the influence of neuromuscular deficits on gait abnormalities in CP, while considering emerging information on neural correlates of gait abnormalities and the implications for strategic treatment. This review of the neural basis of gait abnormalities in CP discusses what is known about links between the location and extent of brain injury and the type and severity of CP, in relation to the associated neuromuscular deficits, and subsequent gait abnormalities. Targeted treatment opportunities are identified that may improve functional outcomes for children with CP. By providing this context on the neural basis of gait abnormalities in CP, we hope to highlight areas of further research that can reduce the long-term, debilitating effects of CP.

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Section: Brain Injury In Cerebral Palsymentioning

confidence: 99%

Neurologic Correlates of Gait Abnormalities in Cerebral Palsy: Implications for Treatment

Zhou

Butler

Rose

2017

Front. Hum. Neurosci.

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“…Diffusion tensor imaging (DTI) can evaluate structural connectivity by examining the direction and intensity of water diffusion in white matter tracts to reveal the characteristics of tissue microstructure, facilitating the study of sensory pathways [Lai et al, 2014]. Multiple DTI studies evaluating the corticospinal tract after perinatal stroke [van der Aa et al, 2013;Jaspers et al, 2015;Lennartsson et al, 2015;Roze et al, 2012] have defined imaging biomarkers associated with clinical outcome such as decreased fractional anisotropy (FA) in the lesioned hemisphere. Whether diffusion imaging of sensory pathway structural connectivity carries the same potential has not been determined.…”

Section: Introductionmentioning

confidence: 99%

Sensory tractography and robot‐quantified proprioception in hemiparetic children with perinatal stroke

Kuczynski

Carlson

Lebel

et al. 2017

Human Brain Mapping

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Perinatal stroke causes most hemiparetic cerebral palsy, resulting in lifelong disability. We have demonstrated the ability of robots to quantify sensory dysfunction in hemiparetic children but the relationship between such deficits and sensory tract structural connectivity has not been explored. It was aimed to characterize the relationship between the dorsal column medial lemniscus (DCML) pathway connectivity and proprioceptive dysfunction in children with perinatal stroke. Twenty-nine participants (6-19 years old) with MRI-classified, unilateral perinatal ischemic stroke (14 arterial, 15 venous), and upper extremity deficits were recruited from a population-based cohort and compared with 21 healthy controls. Diffusion tensor imaging (DTI) defined DCML tracts and five diffusion properties were quantified: fractional anisotropy (FA), mean, radial, and axial diffusivities (MD, RD, AD), and fiber count. A robotic exoskeleton (KINARM) tested upper limb proprioception in an augmented reality environment. Correlations between robotic measures and sensory tract diffusion parameters were evaluated. Lesioned hemisphere sensory tracts demonstrated lower FA and higher MD, RD, and AD compared with the non-dominant hemisphere of controls. Dominant (contralesional) hemisphere tracts were not different from controls. Both arterial and venous stroke groups demonstrated impairments in proprioception that correlated with lesioned hemisphere DCML tract diffusion properties. Sensory tract connectivity is altered in the lesioned hemisphere of hemiparetic children with perinatal stroke. A correlation between lesioned DCML tract diffusion properties and robotic proprioceptive measures suggests clinical relevance and a possible target for therapeutic intervention. Hum Brain Mapp 38:2424-2440, 2017. © 2017 Wiley Periodicals, Inc.

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“…Fractional anisotropy (FA) is a commonly investigated biomarker of such diffusion and tissue microstructure, where greater values indicate more ordered diffusion along white matter tracts. Several studies in children with hemiparesis have demonstrated that reduced FA, indicative of more random diffusion within the stroke‐affected CST, is associated with poor motor function in the contralateral, affected limbs (van der Aa et al, ; Lennartsson et al, ; Roze et al, ; Yoshida et al, ). More recently, we have investigated the relationship between sensory dysfunction (Kuczynski, Dukelow, Semrau, & Kirton, ; Kuczynski, Semrau, Kirton, & Dukelow, ) and diffusion properties of the dorsal column medial lemniscus sensory pathways in children with perinatal stroke and hemiparetic CP (Kuczynski et al, ).…”

Section: Introductionmentioning

confidence: 99%

Corticospinal tract diffusion properties and robotic visually guided reaching in children with hemiparetic cerebral palsy

Kuczynski

Dukelow

Hodge

et al. 2017

Human Brain Mapping

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Perinatal stroke is the leading cause of hemiparetic cerebral palsy (CP), resulting in life-long disability. In this study, we examined the relationship between robotic upper extremity motor impairment and corticospinal tract (CST) diffusion properties. Thirty-three children with unilateral perinatal ischemic stroke (17 arterial, 16 venous) and hemiparesis were recruited from a population-based research cohort. Bilateral CSTs were defined using diffusion tensor imaging (DTI) and four diffusion metrics were quantified: fractional anisotropy (FA), mean (MD), radial (RD), and axial (AD) diffusivities. Participants completed a visually guided reaching task using the KINARM robot to define 10 movement parameters including movement time and maximum speed. Twenty-six typically developing children underwent the same evaluations. Partial correlations assessed the relationship between robotic reaching and CST diffusion parameters. All diffusion properties of the lesioned CST differed from controls in the arterial group, whereas only FA was reduced in the venous group. Non-lesioned CST diffusion measures were similar between stroke groups and controls. Both stroke groups demonstrated impaired reaching performance. Multiple reaching parameters of the affected limb correlated with lesioned CST diffusion properties. Lower FA and higher MD were associated with greater movement time. Few correlations were observed between non-lesioned CST diffusion and unaffected limb function though FA was associated with reaction time (R = -0.39, p < .01). Diffusion properties of the lesioned CST are altered after perinatal stroke, the degree of which correlates with specific elements of visually guided reaching performance, suggesting specific relevance of CST structural connectivity to clinical motor function in hemiparetic children.

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Advanced Fiber Tracking in Early Acquired Brain Injury Causing Cerebral Palsy

Cited by 17 publications

References 36 publications

Neurologic Correlates of Gait Abnormalities in Cerebral Palsy: Implications for Treatment

Neurologic Correlates of Gait Abnormalities in Cerebral Palsy: Implications for Treatment

Sensory tractography and robot‐quantified proprioception in hemiparetic children with perinatal stroke

Corticospinal tract diffusion properties and robotic visually guided reaching in children with hemiparetic cerebral palsy

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