Hand function in relation to brain lesions and corticomotor-projection pattern in children with unilateral cerebral palsy
Hand function in relation to brain lesions and corticomotor-projection pattern in children with unilateral cerebral palsy
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DOI：
10.1111/j.1469-8749.2009.03496.x
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发表时间：
2010-02-01
影响因子：
3.8
通讯作者：
Eliasson, Ann-Christin
中科院分区：
文献类型：
--
作者：
Holmstrom, Linda;Vollmer, Brigitte;Eliasson, Ann-Christin
目的探讨单侧脑性瘫痪（CP）患儿的手功能、脑损害和皮质运动投射之间的关系。方法本研究包括17名单侧CP患儿（男9名，女8名;平均年龄11.4 [SD 2.4]，范围7- 16岁），粗大运动功能分类系统I级和手动能力分类系统I级或II级。手功能评估采用箱块试验和辅助手评估（AHA）。常规结构磁共振图像进行视觉评估的类型，位置和脑病变的程度。单脉冲经颅磁刺激（TMS）提供的信息组织corticomotor projections.RESULTS最有利的手功能被认为是在儿童谁有白质损伤的不成熟与轻度白质损失和对侧运动预测。同侧投射的儿童功能受损最严重。然而，在该亚组中观察到一系列能力（AHA 29-59%）。运动投射模式似乎受到病变范围和位置的影响，但不受病变类型的影响。解释结合结构磁共振图像和TMS的信息可以提高预测手功能。在所有的运动投射模式中，手的功能变化很大。虽然同侧运动投射组的手功能受损最严重，但该组中的一些儿童具有相当好的能力。这些信息对于治疗计划非常重要。
AIM To investigate relationships between hand function, brain lesions, and corticomotor projections in children with unilateral cerebral palsy (CP).METHOD The study included 17 children (nine males, eight females; mean age 11.4 [SD 2.4] range 7-16y), with unilateral CP at Gross Motor Function Classification System level I and Manual Ability Classification System level I or II. Hand function was assessed with the Box and Blocks test and Assisting Hand Assessment (AHA). Conventional structural magnetic resonance images were assessed visually for type, location, and extent of brain lesions. Single-pulse transcranial magnetic stimulation (TMS) provided information on organization of corticomotor projections.RESULTS The most favourable hand function was seen in children who had white-matter damage of immaturity with mild white-matter loss and contralateral motor projections. Children with ipsilateral projections had the most impaired function. Nevertheless, in this subgroup a range of ability was seen (AHA 29-59%). Motor-projection patterns appeared to be influenced by lesion extent and location, but not by lesion type.INTERPRETATION Combining information from structural magnetic resonance images and TMS can improve prediction of hand function. A wide variation in hand function was seen within all motor-projection patterns. Although the most impaired hand function was seen in the ipsilateral motor-projection group, some children in this group had fairly good ability. Such information is important for treatment planning.