Helena Mäenpää

Electrostimulation at sensory level improves function of the upper extremities in children with cerebral palsy: a pilot study

The aim of this study was to evaluate the effect of electrical stimulation (ES) on the function of the upper extremities in children with cerebral palsy (CP). The participants were 12 children (seven females and five males) with spastic hemiplegia (mean age 5 years 7 months, SD 3 years 9 months). Indications were weak wrist dorsiflexion and elbow extension. The ES was given at sensory level (20–40 minutes) on the infraspinatus muscle and on the wrist dorsiflexors during 12 regularly scheduled physical and occupational therapy sessions (during 4–5 weeks). The Goal Attainment Scale, the Zancolli classification of hand function, muscle testing according to Daniels and Worthington, and King hypertonicity scale were used for evaluation. Assessments were made twice before (between 4 weeks) and twice after (between 12 weeks) the stimulation period except the King hypertonicity scale, which was used once before and 3 months after the stimulation period. Active elbow extension, wrist dorsiflexion, and forearm supination with the elbow flexed and extended improved when the results of assessments before ES were compared with those made immediately before (p < 0.001) and three months after (p < 0.01) this treatment. Results of this pilot uncontrolled study suggest that ES at sensory level can be used as an adjunct to physiotherapy and/or occupational therapy in children with spastic hemiplegia. These results will be used as basis for further research.

Bilateral alterations in somatosensory cortical processing in hemiplegic cerebral palsy

Aim  In individuals with cerebral palsy (CP), cerebral insults during early development may induce profound reorganization of the motor representation. This study determined the extent of alterations in cortical somatosensory functions in adolescents with hemiplegic CP with subcortical brain lesions.

Reactivity of sensorimotor oscillations is altered in children with hemiplegic cerebral palsy: A magnetoencephalographic study

Cerebral palsy (CP) is characterized by difficulty in control of movement and posture due to brain damage during early development. In addition, tactile discrimination deficits are prevalent in CP. To study the function of somatosensory and motor systems in CP, we compared the reactivity of sensorimotor cortical oscillations to median nerve stimulation in 12 hemiplegic CP children vs. 12 typically developing children using magnetoencephalography. We also determined the primary cortical somatosensory and motor representation areas of the affected hand in the CP children using somatosensory‐evoked magnetic fields and navigated transcranial magnetic stimulation, respectively. We hypothesized that the reactivity of the sensorimotor oscillations in alpha (10 Hz) and beta (20 Hz) bands would be altered in CP and that the beta‐band reactivity would depend on the individual pattern of motor representation. Accordingly, in children with CP, suppression and rebound of both oscillations after stimulation of the contralateral hand were smaller in the lesioned than intact hemisphere. Furthermore, in two of the three children with CP having ipsilateral motor representation, the beta‐ but not alpha‐band modulations were absent in both hemispheres after affected hand stimulation suggesting abnormal sensorimotor network interactions in these individuals. The results are consistent with widespread alterations in information processing in the sensorimotor system and complement current understanding of sensorimotor network development after early brain insults. Precise knowledge of the functional sensorimotor network organization may be useful in tailoring individual rehabilitation for people with CP. Hum Brain Mapp 35:4105–4117, 2014.

Does microcurrent stimulation increase the range of movement of ankle dorsiflexion in children with cerebral palsy

Aim: To determine whether microcurrent stimulation (MENS) increases the range of motion (ROM) of the ankle joint in children with cerebral palsy. Design: Twelve children with spastic hemiplegia (age range 4.5 to 16 years) with moderate myocontracture of the triceps surae, received MENS for 1 h five times a week for 4 weeks. An equally long baseline period was preceded. The assessments were: active and passive ROM of ankle dorsiflexion, popliteal flexion and ankle dorsiflexion in maximal flexion of knees in standing position while maintaining the heels in contact with the floor, one foot standing and hopping on one foot. Results: After the treatment with MENS, the passive ROM of ankle dorsiflexion with both knees flexed and extended (p < 0.001) increased significantly. Increases were also observed in popliteal flexion (p < 0.001) and ankle dorsiflexion (p = 0.0012) during maximal flexion of the knees in a standing position. The ROM of active dorsiflexion with the knee flexed (p < 0.05) and one foot standing (p < 0.05) also improved. Children and parents found this treatment easy to carry out. Conclusions: MENS relieves myocontracture and can enhance conventional rehabilitation programmes for children with cerebral palsy.

Multiprofessional evaluation in clinical practice: establishing a core set of outcome measures for children with cerebral palsy

To develop a national consensus on outcome measures that define functional ability in children with cerebral palsy (CP) according to the International Classification of Functioning, Disability and Health (ICF) framework.

Soleus H-Reflex and Its Modulation With Vibration in Idiopathic Toe Walkers and Typically Developing Children

Idiopathic toe walking is a relatively common developmental condition often leading to secondary problems such as pain and muscle contractures in the lower extremities. The cause of idiopathic toe walking is unknown, which hinders the development of treatment strategies. To test whether children with idiopathic toe walking have functional alterations in their spinal motor circuits, we studied the properties of the soleus H-reflex and its modulation with vibration in 26 idiopathic toe walkers and 16 typically developing children. At the group level, the H-reflex properties did not differ, but at the individual level, in 7 of 25 idiopathic toe walkers, some of the H-reflex parameters fell out of normal limits of typically developing children. However, the H-reflex was suppressed by vibration to the Achilles tendon similarly in both the idiopathic toe walkers and typically developing children. In conclusion, idiopathic toe walking in some children can be associated with functional alterations in their spinal motor circuits.

P 093 - Comparison of three bipedal tasks to quantify contribution of proprioception to postural stability in healhty children and adolescents

Static postural sway can be quantified as variation in bodys center of force (COF) position across time using a plantar pressure plate. We aimed to compare capability of three clinically feasible bipedal tasks to extract the contribution of proprioception to postural stability. We measured the postural sway of 24 healthy volunteers (age range 10.2-17.6 years) with a plantar-pressure plate with three different standing tasks: (1) normal standing, (2) normal standing on soft foam, and (3) feet together standing. Each task was repeated eyes closed to emphasize the contribution of proprioception on maintaining the postural stability. The effect of closing the eyes varied among the tasks, and was greatest in the feet together standing task, possibly due to greater proprioceptive demands in the more difficult tasks. It appears that standing feet together is a potential task for quantifying contribution of proprioception to postural stability.

P 042 - Gait complexity quantified using inertial measurement units in children with cerebral palsy

Children with cerebral palsy (CP) have gait impairments, and their gait is affected by concurrent tasks. We used inertial measurement units (IMU) to quantify CP-related gait complexity alterations, and identify effects of dual tasks on gait variability from 12 children with CP and 23 typically developed (TD) controls. The data were collected for normal and dual-tasks (motor; carrying a tray, cognitive; word naming) during walking. Step duration and adjusted multiscale entropy (MSE) index were computed. In overall, children with CP had shorter step duration and greater gait complexity than TD. Gait complexity was higher in vertical direction during the cognitive than normal and motor tasks in children with CP. In TD, the gait complexity was not significantly affected by dual-tasking, although, step duration was longer for the cognitive than normal and motor tasks in both groups. As expected, gait kinematics and complexity differed between single- and dual-tasking in children with CP. The present results indicate that IMUs may provide a low-cost tool to quantify gait complexity.

OP28 – 2809: Structural MRI, transcranial magnetic stimulation, magnetoencephalography and DTI tractography findings in relation to sensorimotor outcome after perinatal stroke

Objective Despite the frequency and importance of sensorimotor deficits after perinatal stroke (PS), the correlation between brain damage and severity of hemiparesis remains unclear. We aimed to investigate inter-relations between stroke topography, (re)organization of motor and sensory pathways, and clinical grade of hemiparesis in children with PS. Methods Seven children (3 boys; age 12–18 years) with mild to profound upper limb impairment (MACS I-V) after left-sided PS were enrolled. 3T structural MRI scans were reviewed to define vascular origin and extent of the infarction. Information about gestational age, delivery, and type of presentation, were collected from patient records. Navigated transcranial magnetic stimulation (nTMS) was used to map cortical hand muscle representations. The integrity of thalamocortical pathways was evaluated with somatosensory evoked magnetic fields to electrical median nerve stimulation and tractography based on regions of interest defined by neuroradiologist. Asymmetry of tract volume (TV), tract mean fractional anisotropy and mean diffusivity (MD) were estimated. Somatosensory responses were assessed by Semmes-Weinstein monofilaments. Results In two children with unilateral truncal middle cerebral artery (MCA) infarctions, moderate to severe hemiparesis (MACS II-III; sensory deficits in one) was associated with ipsilateral motor and contralateral somatosensory representation of the paretic hand. In a child with proximal MCA stroke, profound hemiplegia with sensory impairment (MACS V) was found in relation to purely contralateral motor and somatosensory projections, distinguished by decreased ipsilesional thalamocortical TV and increased MD in comparison to other subjects. While MEG showed contralateral somatosensory representation in four children with periventricular venous infarctions, who had less severe hemiparesis (MACS I-II, no sensory deficits), nTMS revealed bilateral motor representation. Conclusion Distinct (re)organization patterns after different subtypes of PS are demonstrated by modern neuroimaging techniques, which complement structural MRI in the prediction of severity of hemiparesis after PS.