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Effect of sensory and motor connectivity on hand function in pediatric hemiplegia.
We tested the hypothesis that somatosensory system injury would more strongly affect movement than motor system injury in children with unilateral cerebral palsy (USCP). This hypothesis was based on how somatosensory and corticospinal circuits adapt to injury during development: while the motor system can maintain connections to the impaired hand from the uninjured hemisphere, this doesn't occur in the somatosensory system. As a corollary, cortical injury strongly impairs sensory function, so we hypothesized that cortical lesions would impair hand function more than subcortical lesions.
Twenty-four children with unilateral CP had physiological and anatomical measures of the motor and somatosensory systems and lesion classification. Motor physiology was performed with transcranial magnetic stimulation and somatosensory physiology with vibration-evoked EEG potentials. Tractography of the corticospinal tract and the medial lemniscus were performed with diffusion tensor imaging, and lesions were classified by MRI. Anatomical and physiological results were correlated with measures of hand function using two independent statistical methods.
Children with disruptions in the somatosensory connectivity, and cortical lesions had the most severe upper extremity impairments, particularly somatosensory function. Motor system connectivity was significantly correlated with bimanual function, but not unimanual function or somatosensory function.
Both sensory and motor connectivity impact hand function in children with USCP. Somatosensory connectivity could be an important target for recovery of hand function in children with USCP.