Mimouni-Bloch Aviva, Shaklai Sharon, Levin Moran, Ingber Moria, Karolitsky Tanya, Grunbaum Sigal, Friedman Jason
Pediatric Neurology and Development Unit, Loewenstein Rehabilitation Medical Center, Ra'anana, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel.
Front Hum Neurosci. 2023 Jan 23;17:1083304. doi: 10.3389/fnhum.2023.1083304. eCollection 2023.
The ability to coordinate finger forces to dexterously perform tasks develops in children as they grow older. Following brain injury, either developmental (as in cerebral palsy-CP) or acquired (as in traumatic brain injury-TBI), this developmental trajectory will likely be impaired. In this study, we compared finger coordination in a group of children aged 4-12 with CP and TBI to a group of typically developing children using an isometric pressing task. As expected, deficits were observed in functional tests (Jebsen Taylor test of hand function, Box and Block test) for both groups, and children in both groups performed the pressing task less well than the control group. However, differing results were observed between the CP and TBI groups when using the uncontrolled manifold hypothesis to look at the synergy index. This index measures the relative amount of "good" (does not affect the outcome measure) and "bad" (does affect the outcome measure) variability, where in this case the outcome measure is the total force produced by the fingers. While children with CP were more variable in their performance, their synergy index was not significantly different from typically developing children, suggesting the development of compensatory strategies. In contrast, the children following TBI showed performance that got worse as a function of age (i.e., the older children with TBI performed worse than the younger children with TBI). These differences between the groups may be a result of different areas of brain injury typically observed in CP and TBI, and the different amount of time that has passed since the injury.
随着年龄的增长，儿童协调手指力量以灵巧地执行任务的能力逐渐发展。在经历脑损伤后，无论是发育性的（如脑瘫-CP）还是后天获得性的（如创伤性脑损伤-TBI），这种发育轨迹都可能受到损害。在本研究中，我们使用等长按压任务，将一组4至12岁的脑瘫和创伤性脑损伤儿童的手指协调性与一组发育正常的儿童进行了比较。正如预期的那样，两组在功能测试（Jebsen Taylor手功能测试、箱块测试）中均观察到缺陷，且两组儿童在按压任务中的表现均不如对照组。然而，在使用非受控流形假设来观察协同指数时，脑瘫组和创伤性脑损伤组之间出现了不同的结果。该指数衡量“好”（不影响结果测量）和“坏”（影响结果测量）变异性的相对量，在这种情况下，结果测量是手指产生的总力。虽然脑瘫儿童的表现更具变异性，但其协同指数与发育正常的儿童并无显著差异，这表明他们发展出了代偿策略。相比之下，创伤性脑损伤后的儿童表现出随着年龄增长而变差的情况（即年龄较大的创伤性脑损伤儿童比年龄较小的创伤性脑损伤儿童表现更差）。两组之间的这些差异可能是由于脑瘫和创伤性脑损伤中通常观察到的不同脑损伤区域，以及损伤后经过的不同时间所致。
