Sensory-motor network functional connectivity in children with unilateral cerebral palsy secondary to perinatal stroke

Abstract

BackgroundPerinatal stroke is the most common cause of unilateral cerebral palsy. Mechanisms of post-stroke developmental plasticity in children are poorly understood. To better understand the relationship between functional connectivity and disability, we used resting-state fMRI to compare sensorimotor connectivity with clinical dysfunction.MethodsSchool-aged children with periventricular venous infarction (PVI) and unilateral cerebral palsy were compared to controls. Resting-state BOLD signal was acquired on 3 T MRI and analyzed using CONN in SPM12. Functional connectivity was computed between S1, M1, supplementary motor area (SMA), and thalamus of the left/non-lesioned and right/lesioned hemisphere. Primary outcome was connectivity expressed as a Fisher-transformed correlation coefficient. Motor function was measured using the Assisting Hand Assessment (AHA), and Melbourne Assessment (MA). Proprioceptive function was measured using a robotic position matching task (VarXY).ResultsParticipants included 15 PVI and 21 controls. AHA and MA in stroke patients were negatively correlated with connectivity (increased connectivity = poorer performance). Position sense was inversely correlated with connectivity (increased connectivity = improved performance) between the non-lesioned S1 and thalamus/SMA. In controls, VarXY was positively correlated with connectivity between the thalamus and bilateral sensorimotor regions.ConclusionsResting state fMRI measures of sensorimotor connectivity are associated with clinical sensorimotor function in children with unilateral cerebral palsy secondary to PVI. Greater insight into understanding reorganization of brain networks following perinatal stroke may facilitate personalized rehabilitation.

Structural and functional connectivity of motor circuits after perinatal stroke: A machine learning study

“…We have also shown evidence of topographical re-organization of task-related SMA activations in children after perinatal AIS but did not find associated differences in activation strength, extent, or correlation with motor function ( Baker et al, 2020 ). In children with PVI, we have also demonstrated correlations between inter-hemispheric SMA FC at rest and performance on specialized sensory tasks using a proprioceptive robot ( Woodward et al, 2019 ). Given that the SMA areas lie relatively anterior and on the medial surface of the brain, they are often spared after middle cerebral artery infarction, and SMA recruitment may be an ideal compensatory mechanism after stroke.…”

“…Connectivity between S1 and M1 were either ranked as quite low or not included. This could be because the AHA and BBTA tasks have both sensory and motor components, making it difficult to tease out the relative contributions of each component unless utilizing specialized, purely sensory tasks such as those performed previously using robotics ( Kuczynski et al, 2016 , Kuczynski et al, 2017 , Woodward et al, 2019 ). Another possibility is that contributions of motor and sensory areas were highly correlated ( i.e.…”

“…We and others have previously shown that various modalities of magnetic resonance imaging (MRI) can be used to explore how brain structure and function change as children with AIS and PVI ( Hodge et al, 2017 , Kuczynski et al, 2018 , Saunders et al, 2019 ) or just PVI ( Woodward et al, 2019 ) grow and adapt after their injury. The power of neuroimaging within this context lies in its ability to identify different but complementary biomarkers associated with clinical function.…”

Tools and Techniques Used With Robotic Devices to Quantify Upper-Limb Function in Typically Developing Children: A Systematic Review

“…Thirteen articles compared robotic measures of performance to clinical outcome measures. 10,11,[13][14][15][16][17][18][19][20][21][22]27 The definitions and descriptions of each robotic and clinical outcome measure can be found in their respective articles.…”

“…While studies with smaller sample sizes can 13,22,23 Kinarm Exoskeleton Robot Lab Kinarm 2D workspace with 2 DOF. Twelve 10,12,[15][16][17][18][19][20][21]24,26,27 PHANToM 3D Systems 3D workspace with 6 DOF. Two 9,25 REAPlan Axinesis Rehabilitation Technologies 2D workspace with 2 DOF.…”