Cognition and bimanual performance in children with unilateral cerebral palsy: protocol for a multicentre,
Brian Hoare1,2,3, Michael Ditchfield4, Megan Thorley5
1Victorian Paediatric Rehabilitation Service, Monash Children's Hospital, 246 Clayton Rd, Clayton, VIC, 3168, Australia. brianhoare@cpteaching.com.
Insights
Cognitive function significantly impacts bimanual performance in children with unilateral cerebral palsy. This study explores the link between executive function, motor skills, and brain differences in these children.
Area of Science:
- Neuroscience
- Developmental Pediatrics
- Rehabilitation Medicine
Background:
- Motor outcomes in unilateral cerebral palsy are well-documented, but cognitive functioning and its impact on bimanual performance remain poorly understood.
- Bimanual tasks require complex motor and cognitive integration, suggesting impairments in either domain can affect performance.
- Existing research has not fully elucidated the relationship between cognitive abilities and a child's capacity to use both hands for tasks.
Purpose of the Study:
- To investigate the associations between cognitive functioning, specifically executive function, and bimanual performance in children with unilateral cerebral palsy.
- To explore the relationship between bimanual performance, cognitive abilities, and underlying brain neuropathology (lesion type and severity).
- To provide evidence for refining existing upper limb interventions and developing new strategies to enhance both cognitive and motor outcomes.
Main Methods:
- Prospective, cross-sectional, multi-centre observational study involving 131 children (aged 6-12 years) with unilateral cerebral palsy.
- Primary outcomes include the Assisting Hand Assessment (motor), Executive Function (cognitive), and structural MRI for brain lesion location (brain).
- Secondary measures include Box and Blocks, ABILHAND-Kids, Sword Test (motor), and standard neuropsychological intelligence tests (cognitive).
- Generalized linear modelling and structural equation modelling will be used to analyze relationships.
Main Results:
- Anticipated identification of distinct relationships between bimanual performance and executive function.
- Expected association between interrelationships of bimanual performance and cognition with common neuropathology.
- Study aims to quantify the influence of cognitive deficits on motor task execution in this population.
Conclusions:
- This study will clarify how cognitive abilities, particularly executive function, influence bimanual task performance in children with unilateral cerebral palsy.
- Findings are expected to reveal specific links between motor skills, cognitive function, and brain lesion characteristics.
- The results have the potential to inform targeted interventions for improving upper limb function and overall development.
Background:
Motor outcomes of children with unilateral cerebral palsy are clearly documented and well understood, yet few studies describe the cognitive functioning in this population, and the associations between the two is poorly understood. Using two hands together in daily life involves complex motor and cognitive processes. Impairment in either domain may contribute to difficulties with bimanual performance. Research is yet to derive whether, and how, cognition affects a child's ability to use their two hands to perform bimanual tasks.
Methods/Design:
This study will use a prospective, cross-sectional multi-centre observational design. Children (aged 6-12 years) with unilateral cerebral palsy will be recruited from one of five Australian treatment centres. We will examine associations between cognition, bimanual performance and brain neuropathology (lesion type and severity) in a sample of 131 children. The primary outcomes are: Motor - the Assisting Hand Assessment; Cognitive - Executive Function; and Brain - lesion location on structural MRI. Secondary data collected will include: Motor - Box and Blocks, ABILHAND- Kids, Sword Test; Cognitive - standard neuropsychological measures of intelligence. We will use generalized linear modelling and structural equation modelling techniques to investigate relationships between bimanual performance, executive function and brain lesion location.
Discussion:
This large multi-centre study will examine how cognition affects bimanual performance in children with unilateral cerebral palsy. First, it is anticipated that distinct relationships between bimanual performance and cognition (executive function) will be identified. Second, it is anticipated that interrelationships between bimanual performance and cognition will be associated with common underlying neuropathology. Findings have the potential to improve the specificity of existing upper limb interventions by providing more targeted treatments and influence the development of novel methods to improve both cognitive and motor outcomes in children with unilateral cerebral palsy.
Trial Registration:
ACTRN12614000631606 ; Date of retrospective registration 29/05/2014.
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