Mailleux Lisa, Simon-Martinez Cristina, Klingels Katrijn, Jaspers Ellen, Desloovere Kaat, Demaerel Philippe, Fiori Simona, Guzzetta Andrea, Ortibus Els, Feys Hilde
Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.
BIOMED, Rehabilitation Research Center (REVAL), Hasselt University, Diepenbeek, Belgium.
Front Hum Neurosci. 2017 Dec 12;11:607. doi: 10.3389/fnhum.2017.00607. eCollection 2017.
In children with unilateral cerebral palsy (uCP) virtually nothing is known on the relation between structural brain damage and upper limb (UL) kinematics quantified with three-dimensional movement analysis (3DMA). This explorative study aimed to (1) investigate differences in UL kinematics between children with different lesion timings, i.e., periventricular white matter (PWM) vs. cortical and deep gray matter (CDGM) lesions and (2) to explore the relation between UL kinematics and lesion location and extent within each lesion timing group. Forty-eight children (age 10.4 ± 2.7 year; 29 boys; 21 right-sided; 33 PWM; 15 CDGM) underwent an UL 3DMA during a reach-to-grasp task. Spatiotemporal parameters [movement duration, (timing of) maximum velocity, trajectory straightness], the Arm Profile Score (APS) and Arm Variable Scores (AVS) were extracted. The APS and AVS refer to the total amount of movement pathology and movement deviations of the wrist, elbow, shoulder, scapula and trunk respectively. Brain lesion location and extent were scored based on FLAIR-images using a semi-quantitative MRI-scale. Children with CDGM lesions showed more aberrant spatiotemporal parameters ( < 0.03) and more movement pathology (APS, = 0.003) compared to the PWM group, mostly characterized by increased wrist flexion ( = 0.01). In the CDGM group, moderate to high correlations were found between lesion location and extent and duration, timing of maximum velocity and trajectory straightness ( = 0.53-0.90). Lesion location and extent were further moderately correlated with distal UL movement pathology (wrist flexion/extension, elbow pronation/supination, elbow flexion/extension; = 0.50-0.65) and with the APS ( = 0.51-0.63). In the PWM group, only a few and low correlations were observed, mostly between damage to the PLIC and higher AVS of elbow flexion/extension, shoulder elevation and trunk rotation ( = 0.35-0.42). Regression analysis revealed damage to the temporal lobe with lesion timing as interactor (27%, = 0.002) and the posterior limb of the internal capsule (PLIC) (7%, = 0.04) as the strongest predictors, explaining 34% of the variance in APS. UL kinematic deviations are more influenced by lesion location and extent in children with later (CDGM) versus earlier lesions (PWM), except for proximal movement pathology. Damage to the PLIC is a significant predictor for UL movement pathology irrespective of lesion timing.
对于单侧脑瘫（uCP）儿童，关于脑结构损伤与通过三维运动分析（3DMA）量化的上肢（UL）运动学之间的关系几乎一无所知。这项探索性研究旨在：（1）调查不同损伤时间的儿童（即脑室周围白质（PWM）损伤与皮质和深部灰质（CDGM）损伤）之间上肢运动学的差异；（2）探讨每个损伤时间组内上肢运动学与损伤位置和范围之间的关系。48名儿童（年龄10.4±2.7岁；29名男孩；21名右侧；33名PWM损伤；15名CDGM损伤）在进行伸手抓握任务时接受了上肢3DMA检查。提取了时空参数[运动持续时间、最大速度（时间）、轨迹直线度]、手臂轮廓评分（APS）和手臂变量评分（AVS）。APS和AVS分别指运动病理学总量以及手腕、肘部、肩部、肩胛骨和躯干的运动偏差。基于液体衰减反转恢复（FLAIR）图像，使用半定量MRI量表对脑损伤的位置和范围进行评分。与PWM组相比，CDGM损伤的儿童表现出更多异常的时空参数（<0.03）和更多的运动病理学表现（APS，=0.003），主要表现为手腕屈曲增加（=0.01）。在CDGM组中，发现损伤位置和范围与持续时间、最大速度时间和轨迹直线度之间存在中度至高相关性（=0.53 - 0.90）。损伤位置和范围与上肢远端运动病理学（手腕屈伸、肘部旋前/旋后、肘部屈伸；=0.50 - 0.65）以及APS（=0.51 - 0.63）进一步存在中度相关性。在PWM组中，仅观察到少数且相关性较低，主要是在PLIC损伤与肘部屈伸、肩部抬高和躯干旋转的较高AVS之间（=0.35 - 0.42）。回归分析显示，以损伤时间作为交互因子时，颞叶损伤（27%，=0.002）和内囊后肢（PLIC）损伤（7%，=0.04）是最强的预测因子，解释了APS中34%的方差。与早期损伤（PWM）的儿童相比，晚期（CDGM）损伤儿童的上肢运动学偏差受损伤位置和范围的影响更大，但近端运动病理学除外。无论损伤时间如何，PLIC损伤都是上肢运动病理学的重要预测因子。
