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Corticoreticular tract lesion in children with developmental delay presenting with gait dysfunction and trunk
Yong Min Kwon1, Jessica Rose2, Ae Ryoung Kim1
1Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daemyungdong, Namku, Taegu, Republic of Korea.
Insights
The corticoreticular tract (CRT) is crucial for gait and posture. Disruption in the CRT, not the corticospinal tract, correlates with trunk instability in pediatric patients, as shown by diffusion tensor tractography.
Area of Science:
- Neuroscience
- Developmental Pediatrics
- Biomedical Engineering
Background:
- The corticoreticular tract (CRT) plays a role in motor control, including walking and postural stability.
- Gait dysfunction and trunk instability are common in pediatric patients with developmental delays.
- Diffusion tensor tractography (DTT) is a neuroimaging technique used to visualize white matter tracts.
Purpose of the Study:
- To investigate the relationship between the corticoreticular tract (CRT) and gait dysfunction, specifically trunk instability, in pediatric patients.
- To compare CRT integrity in patients with bilateral versus unilateral trunk instability and typically developed children.
- To assess the correlation between CRT status and functional motor assessments.
Main Methods:
- Recruited 30 pediatric patients with delayed development (15 with bilateral trunk instability - Group A, 15 with unilateral trunk instability - Group B) and 15 typically developed (TD) children.
- Utilized diffusion tensor tractography (DTT) to measure fractional anisotropy, apparent diffusion coefficient, fiber number, and tract integrity of the CRT and corticospinal tract.
- Assessed functional status using the Growth Motor Function Classification System and Functional Ambulation Category scales.
Main Results:
- Corticospinal tract integrity did not differ significantly across groups.
- Both CRTs were disrupted in Group A (bilateral instability).
- CRT disruption occurred in hemispheres contralateral to clinical manifestations in Group B (unilateral instability).
- Fractional anisotropy and fiber numbers were decreased in both CRTs in Group A compared to TD.
- Decreases in fractional anisotropy and fiber numbers were more pronounced on the ipsilateral side in Group B compared to the contralateral side, relative to TD.
- CRT status showed strong correlations with functional evaluation data and clinical manifestations, unlike corticospinal tract status.
Conclusions:
- Corticoreticular tract (CRT) integrity is clinically significant for gait function and trunk stability in pediatric patients.
- Diffusion tensor tractography (DTT) is a valuable tool for assessing CRT status in pediatric patients with gait dysfunction.
- Findings highlight the CRT's critical role in pediatric motor control, differentiating its involvement in bilateral versus unilateral trunk instability.
Abstract:
The corticoreticular tract (CRT) is known to be involved in walking and postural control. Using diffusion tensor tractography (DTT), we investigated the relationship between the CRT and gait dysfunction, including trunk instability, in pediatric patients. Thirty patients with delayed development and 15 age-matched, typically-developed (TD) children were recruited. Fifteen patients with gait dysfunction (bilateral trunk instability) were included in the group A, and the other 15 patients with gait dysfunction (unilateral trunk instability) were included in the group B. The Growth Motor Function Classification System, Functional Ambulation Category scale, and Functional Ambulation Category scale were used for measurement of functional state. Fractional anisotropy, apparent diffusion coefficient, fiber number, and tract integrity of the CRT and corticospinal tract were measured. Diffusion parameters or integrity of corticospinal tract were not significantly different in the three study groups. However, CRT results revealed that both CRTs were disrupted in the group A, whereas CRT disruption in the hemispheres contralateral to clinical manifestations was observed in the group B. Fractional anisotropy values and fiber numbers in both CRTs were decreased in the group A than in the group TD. The extents of decreases of fractional anisotropy values and fiber numbers on the ipsilateral side relative to those on the contralateral side were greater in the group B than in the group TD. Functional evaluation data and clinical manifestations were found to show strong correlations with CRT status, rather than with corticospinal tract status. These findings suggest that CRT status appears to be clinically important for gait function and trunk stability in pediatric patients and DTT can help assess CRT status in pediatric patients with gait dysfunction.
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