Alison Crichton1,2, Michael Ditchfield3, Stellamay Gwini4,5, Margaret Wallen6, Megan Thorley7, Jenny Bracken8, Adrienne Harvey9, Catherine Elliott10, Iona Novak11, Brian Hoare1,2,12. 1. Victorian Paediatric Rehabilitation Service, Monash Children's Hospital, Clayton, Victoria, Australia. 2. Department of Paediatrics, Monash University, Clayton, Victoria, Australia. 3. Department of Diagnostic Imaging, Monash Children's Hospital, Clayton, Victoria, Australia. 4. School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia. 5. Barwon Health, University Hospital Geelong, Geelong, Victoria, Australia. 6. School of Allied Health, Australian Catholic University, North Sydney, New South Wales, Australia. 7. Queensland Paediatric Rehabilitation Service, Lady Cilento Children's Hospital, South Brisbane, Queensland, Australia. 8. Department of Diagnostic Imaging, Royal Children's Hospital, Parkville, Victoria, Australia. 9. Developmental Disability and Rehabilitation Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia. 10. School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Bentley, Western Australia, Australia. 11. Cerebral Palsy Alliance, Child and Adolescent Health, The University of Sydney, Frenchs Forest, New South Wales, Australia. 12. School of Occupational Therapy, La Trobe University, Bundoora, Victoria, Australia.
Abstract
AIM: To examine the association between brain magnetic resonance imaging (MRI) characteristics and executive function and bimanual performance in children with unilateral cerebral palsy (CP). METHOD: Clinical MRI brain scans were classified as: (1) predominant pathological pattern (normal, white matter injury [WMI]; grey matter injury; focal vascular insults [FVI]; malformations; or miscellaneous); and (2) focal lesions (frontal, basal ganglia, and/or thalamus). Assessments included: (1) bimanual performance; (2) unimanual dexterity; and (3) executive function tasks (information processing, attention control, cognitive flexibility, and goal setting) and behavioural ratings (parent). RESULTS: From 131 recruited children, 60 were ineligible for analysis, leaving 71 children (47 males, 24 females) in the final sample (mean age 9y [SD 2y], 6y-12y 8mo). Brain MRIs were WMI (69%) and FVI (31%); and frontal (59%), thalamic (45%), basal ganglia (37%), and basal ganglia plus thalamic (21%). Bimanual performance was lower in FVI versus WMI (p<0.003), and with frontal (p=0.36), basal ganglia (p=0.032), and thalamic/basal ganglia lesions (p=0.013). Other than information processing, executive function tasks were not associated with predominant pattern. Frontal lesions predicted attention control (p=0.049) and cognitive flexibility (p=0.009) but not goal setting, information processing, or behavioural ratings. INTERPRETATION: Clinical brain MRI predicts cognitive and motor outcomes when focal lesions and predominate lesion patterns are considered. What this paper adds Early brain magnetic resonance imaging (MRI) predicts bimanual performance and cognitive outcomes. Brain MRI may identify children requiring targeted interventions. Basal ganglia with/without thalamic lesions predicted bimanual performance. Frontal lesions were associated with attention control and cognitive flexibility. Brain MRI predominant patterns predicted motor, not cognitive outcomes, other than information processing.
AIM: To examine the association between brain magnetic resonance imaging (MRI) characteristics and executive function and bimanual performance in children with unilateral cerebral palsy (CP). METHOD: Clinical MRI brain scans were classified as: (1) predominant pathological pattern (normal, white matter injury [WMI]; grey matter injury; focal vascular insults [FVI]; malformations; or miscellaneous); and (2) focal lesions (frontal, basal ganglia, and/or thalamus). Assessments included: (1) bimanual performance; (2) unimanual dexterity; and (3) executive function tasks (information processing, attention control, cognitive flexibility, and goal setting) and behavioural ratings (parent). RESULTS: From 131 recruited children, 60 were ineligible for analysis, leaving 71 children (47 males, 24 females) in the final sample (mean age 9y [SD 2y], 6y-12y 8mo). Brain MRIs were WMI (69%) and FVI (31%); and frontal (59%), thalamic (45%), basal ganglia (37%), and basal ganglia plus thalamic (21%). Bimanual performance was lower in FVI versus WMI (p<0.003), and with frontal (p=0.36), basal ganglia (p=0.032), and thalamic/basal ganglia lesions (p=0.013). Other than information processing, executive function tasks were not associated with predominant pattern. Frontal lesions predicted attention control (p=0.049) and cognitive flexibility (p=0.009) but not goal setting, information processing, or behavioural ratings. INTERPRETATION: Clinical brain MRI predicts cognitive and motor outcomes when focal lesions and predominate lesion patterns are considered. What this paper adds Early brain magnetic resonance imaging (MRI) predicts bimanual performance and cognitive outcomes. Brain MRI may identify children requiring targeted interventions. Basal ganglia with/without thalamic lesions predicted bimanual performance. Frontal lesions were associated with attention control and cognitive flexibility. Brain MRI predominant patterns predicted motor, not cognitive outcomes, other than information processing.
Authors: Rashelle M Hoffman; Michael P Trevarrow; Hannah R Bergwell; Christine M Embury; Elizabeth Heinrichs-Graham; Tony W Wilson; Max J Kurz Journal: Clin Neurophysiol Date: 2021-02-11 Impact factor: 3.708