Calgary Pediatric Stroke Program, Alberta Children's Hospital, Calgary, Alberta, Canada.
Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada.
Dev Med Child Neurol. 2019 Aug;61(8):943-949. doi: 10.1111/dmcn.14155. Epub 2019 Jan 28.
We aimed to determine if the mirror movements that often result in children with unilateral cerebral palsy (CP) after perinatal stroke represent a clinical biomarker of developmental plasticity.
This was a prospective, controlled cohort study. Mirror movements in children with unilateral CP from a population-based cohort were compared to those of typically developing controls. The population with stroke was assessed further via electromyography (EMG), motor function, and corticospinal organization investigations. Mirror movements were quantified (0-5) bidirectionally. EMG mirror movements were quantified during voluntary contraction. Motor function was quantified by validated measures including the Assisting Hand Assessment (AHA). Corticospinal organization was categorized as ipsilateral or contralateral using transcranial magnetic stimulation (TMS). The relationships between mirror movements, function, and corticospinal organization were assessed (t-tests, Pearson rank correlation coefficients).
Ninety-two participants were scored (55 males, 37 females, mean [SD] 12y [5y 6mo], range 4-17y), 63 with complete motor outcomes and 39 with TMS data. EMG ratios correlated with clinical mirror movements (r=0.562, p=0.008). Mild mirror activity in controls declined with age (r=-0.459, p<0.001). Mirroring was stronger with tasks performed by the affected hand (p<0.001). Mirror movements correlated with AHA scores (r=-0.255, p=0.04) and poor motor outcome (p<0.001). Unaffected hand mirror activity was higher in children with ipsilateral corticospinal tract arrangements (p<0.001).
Clinical mirror movements correlate with disability and corticospinal organization in children with unilateral CP with perinatal stroke. This simple bedside biomarker could facilitate patient selection for personalized rehabilitation.
Mirror movements are a clinical indicator of corticospinal organization in children with unilateral cerebral palsy with perinatal stroke. Mirroring is strongest in children with ipsilateral corticospinal tract reorganization. The concept of a 'directionality factor' to mirror movements highlights additional, clinically relevant functional correlations.
我们旨在确定围产期卒中后经常导致单侧脑瘫（CP）儿童出现的镜像运动是否代表发育可塑性的临床生物标志物。
这是一项前瞻性、对照队列研究。将人群中单侧 CP 儿童的镜像运动与典型发育对照者进行比较。对卒中人群进行肌电图（EMG）、运动功能和皮质脊髓组织研究进一步评估。双向定量镜像运动（0-5 级）。在自愿收缩期间定量 EMG 镜像运动。通过 Assisting Hand Assessment（AHA）等经过验证的测量方法量化运动功能。使用经颅磁刺激（TMS）将皮质脊髓组织分类为同侧或对侧。评估镜像运动、功能和皮质脊髓组织之间的关系（t 检验，Pearson 等级相关系数）。
共对 92 名参与者进行评分（55 名男性，37 名女性，平均[标准差]12 岁[5 岁 6 个月]，范围 4-17 岁），63 名有完整运动结果，39 名有 TMS 数据。EMG 比值与临床镜像运动相关（r=0.562，p=0.008）。对照组轻度镜像活动随年龄增长而下降（r=-0.459，p<0.001）。受影响手完成的任务镜像更强（p<0.001）。镜像运动与 AHA 评分相关（r=-0.255，p=0.04），与运动功能不良相关（p<0.001）。同侧皮质脊髓束排列的儿童非优势手镜像活动更高（p<0.001）。
围产期卒中后单侧 CP 儿童的临床镜像运动与残疾和皮质脊髓组织相关。这种简单的床边生物标志物可以促进为患者选择个性化康复。
镜像运动是围产期卒中后单侧脑瘫儿童皮质脊髓组织的临床指标。镜像运动在同侧皮质脊髓束重组的儿童中最强。镜像运动的“方向性因素”概念突出了其他具有临床相关性的功能相关性。
