Upper Limb Function in Pediatric Onset Motor Disorder Conditions

a. Bilateral Sensorimotor Coordination in Children with Hemiparetic Cerebral Palsy

In neurological conditions where one limb is more impaired than the other, rehabilitation typically focuses on the affected limb to the exclusion of the other less or unaffected limb. However, there are both theoretical and neurophysiological arguments to suggest that the use of bilateral tasks may actually improve limb function in conditions characterized by unilateral learned disuse. Our understanding of the problems specific to bilateral limb control in asymmetric conditions such as cerebral palsy, is remarkably poor. Further, it is not known whether proprioceptive impairment may contribute to the motor deficits observed in this population and how these impairments correlate with each other. Proprioceptive ability is quantified using an upper limb matching paradigm and forward reaching unilateral and bilateral movements are analyzed in 3-D space.
  • Proprioceptive Acuity in Children with Mild Spastic Hemiparesis
    2004 Society for Neuroscience: Abstract  &  Poster
  • Proprioceptive Acuity and Multi-joint Coordination in Hemiplegic Cerebral Palsy
    2005 American Congress of Rehabilitation Medicine: Abstract  &  Poster
  • Sensorimotor Coordination in Children with Hemiplegic Cerebral Palsy
    2005 American Academy of Physical Medicine and Rehabilitation: Abstract  &  Poster


b. Upper Limb Function in Congenital Brachial Plexus Palsy

Congenital brachial plexus palsy (CBPP) arises from injury to the brachial plexus as a result of compression or traction of the anterior shoulder during delivery. While recovery occurs in most individuals, muscle weakness may persist to varying degrees. Typically, this condition presents as an asymmetric motor deficit with only one arm being affected. From a motor control perspective, very little is known how this condition impacts motor coordination - does muscle weakness manifest itself through simply motor slowing or are there also deficits in, for example, multijoint coordination, particularly during bimanual tasks? Will bilateral movement facilitate unilateral impairment which might, in turn, be an effective rehabilitative technique in this population? In addition to examining motor performance in CBPP, we are also examining proprioceptive ability in order to determine whether a long-term reduction in limb usage due to muscle weakness impacts not only motor output but utilization of sensory feedback as well.
(Funded by UM Mott Children's Hospital)
  • Bilateral Upper Limb Coordination in Children with Brachial Plexus Injury
    2003 Society for Neuroscience: Abstract  &  Poster
  • Upper Limb Coordination in Children with Congenital Brachial Plexus Palsy
    2005 American Congress of Rehabilitation Medicine: Abstract  &  Poster


c. Effectiveness of Upper Limb Training in Children with Hemipalesic Cerebral Palsy

In collaboration with Dr. Edward Hurvitz, Dept.of Physical Medicine and Rehabilitation, we have recently completed a study investigating the effectiveness of a home-based upper limb training program in improving motor function in children with spastic hemiplegia. Six-week training involved either a traditional (30 min, three times a week) or intensive (30 min, twice daily, five days a week) programs in which student trainers worked one-on-one with the child in either a home or school setting. Using programs designed by an occupational therapist, children were encouraged to perform task-oriented movements using the affected arm and hand both unilaterally and bilaterally. Laboratory-based, quantitative assessments of upper limb function were performed prior to training, and at three, six, and nine weeks post baseline. Results indicate that intensive training (as described above) can lead to improved control of arm trajectory and hand function during forward reaching by as early as three weeks. A more traditional approach may also improve trajectory control but appears to take up to six weeks before improvement is seen.
(funded by the National Institute on Disability and Rehabilitation Research)
  • Effects of Task-Based Motor Training on Upper Limb Function in Hemiplegic Cerevral Palsy
    2005 American Congress of Rehabilitation Medicine: Abstract  &  Slide Presentation

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