Assessment of bilateral motor skills and visuospatial attention in children with perinatal stroke using a robotic
Rachel L Hawe1, Andrea M Kuczynski2, Adam Kirton3,4,5
1Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada. Rachel.hawe@ucalgary.ca.
Insights
Children with hemiparetic cerebral palsy from perinatal stroke show bilateral motor and visuospatial deficits, impacting both affected and unaffected limbs. These impairments highlight the need for integrated clinical assessments and interventions.
Area of Science:
- Neuroscience
- Developmental Pediatrics
- Rehabilitation Medicine
Background:
- Hemiparetic cerebral palsy (CP) often involves motor deficits, but visuospatial attention impairments can also hinder participation in daily activities.
- Perinatal stroke is a leading cause of hemiparetic CP, affecting sensorimotor control and potentially visuospatial skills.
Purpose of the Study:
- To assess bilateral sensorimotor control and visuospatial skills in children with hemiparetic CP due to perinatal stroke using a robotic task.
- To investigate if performance deficits are related to motor behavior and clinical visuospatial assessments.
Main Methods:
- A bilateral object hitting task using the KINARM Exoskeleton Robot was administered to 49 children with hemiparetic CP and 155 typically developing (TD) children.
- Performance was quantified across 13 parameters, with normative ranges established from TD children. Comparisons were made between TD, arterial ischemic stroke (AIS), and periventricular venous infarct (PVI) groups.
Main Results:
- Children with perinatal stroke exhibited deficits in hitting balls with both affected and unaffected arms compared to TD peers.
- Arterial ischemic stroke (AIS) group showed greater impairments than the periventricular venous infarct (PVI) group.
- Clinical assessment of visuospatial attention (Behavioral Inattention Test) explained 21-32% of the variance in unaffected hand performance.
Conclusions:
- Children with perinatal stroke-induced hemiparetic CP present complex bilateral deficits involving both motor skills and visuospatial attention.
- Clinical evaluations and interventions should consider the interaction between motor and visuospatial functions for comprehensive care.
Background:
While motor deficits are the hallmark of hemiparetic cerebral palsy, children may also experience impairments in visuospatial attention that interfere with participation in complex activities, including sports or driving. In this study, we used a robotic object hitting task to assess bilateral sensorimotor control and visuospatial skills in children with hemiparesis due to perinatal arterial ischemic stroke (AIS) or periventricular venous infarct (PVI). We hypothesized that performance would be impaired bilaterally and be related to motor behavior and clinical assessment of visuospatial attention.
Methods:
Forty-nine children with perinatal stroke and hemiparetic cerebral palsy and 155 typically developing (TD) children participated in the study. Participants performed a bilateral object hitting task using the KINARM Exoskeleton Robot, in which they used virtual paddles at their fingertips to hit balls that fell from the top of the screen with increasing speed and frequency over 2.3 min. We quantified performance across 13 parameters including number of balls hit with each hand, movement speed and area, biases between hands, and spatial biases. We determined normative ranges of performance accounting for age by fitting 95% prediction bands to the TD children. We compared parameters between TD, AIS, and PVI groups using ANCOVAs accounting for age effects. Lastly, we performed regression analysis between robotic and clinical measures.
Results:
The majority of children with perinatal stroke hit fewer balls with their affected arm compared to their typically developing peers. We also found deficits with the ipsilesional ("unaffected") arm. Children with AIS had greater impairments than PVI. Despite hitting fewer balls, we only identified 18% of children as impaired in hand speed or movement area. Performance on the Behavioral Inattention Test accounted for 21-32% of the variance in number of balls hit with the unaffected hand.
Conclusions:
Children with perinatal stroke-induced hemiparetic cerebral palsy may have complex bilateral deficits reflecting a combination of impairments in motor skill and visuospatial attention. Clinical assessments and interventions should address the interplay between motor and visuospatial skills.
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