Robotic and Imaging Biomarkers of Sensorimotor Dysfunction in Hemiparetic Children after Perinatal Stroke
Abstract
Perinatal ischemic stroke results from focal cerebral arterial or venous occlusion and usually causes lifelong disability. Perinatal stroke is the leading cause of hemiparetic cerebral palsy, and may result in impairment in both sensory and motor function. A major limitation in assessing sensory and motor function following stroke is a lack of objective, sensitive measurement tools which are required to advance personalized therapeutic strategies. In this study, we used a novel robotic exoskeleton (KINARM) to assess sensory and motor function in hemiparetic children with perinatal stroke. Using diffusion tensor imaging, we further sought to better understand changes in sensorimotor pathway microstructure following perinatal stroke and their relationship with behaviour. We studied 50 children with perinatal stroke (arterial or venous) and 150 typically developing children aged 6 to 19 years. Children with perinatal stroke demonstrated diverse impairments in both sensory and motor function relative to controls. Mean group differences were greater for arterial strokes compared to venous. Proprioceptive deficits included dysfunction in both robotic position-matching and kinesthesia tasks that correlated poorly with beside sensory tests. Both stroke groups demonstrated impaired motor reaching in the contralesional limb, with greater deficits in the arterial group. The ipsilesional, “unaffected” arm of arterial cases also often showed impairments. Robotic sensory and motor performance was often associated with the structural connectivity of the corresponding lesioned tract as measured by diffusion tensor imaging. Our findings contribute to a better understanding of how sensory and motor systems develop following unilateral perinatal injury and how these relate to clinical function. We add new components to emerging developmental plasticity models of perinatal stroke including detailed functional outcomes of both upper extremities and measures of structural connectivity in related major tracts. Such knowledge can inform emerging neuromodulation trials towards personalized neurorehabilitation and improved outcomes for hemiparetic children.
Description
Keywords
Neuroscience, Rehabilitation and Therapy
Citation
Kuczynski, A. (2017). Robotic and Imaging Biomarkers of Sensorimotor Dysfunction in Hemiparetic Children after Perinatal Stroke (Doctoral thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca. doi:10.11575/PRISM/27674