Understanding bimanual motor control in children with unilateral cerebral palsy

Abstract

In daily life, we perform a lot of activities without consciously thinking about it, like buttoning a shirt or using cutlery. During childhood, these activities are still challenging, but due to practice and experience typically developing children (TDC) learn how to use both hands in a controlled manner. These activities all require bimanual motor control, a complex interplay of neurological processes and motor output mechanisms, which results in the ability to perform fast and accurate movements (bimanual dexterity) as well as synchronizing the spatial and temporal components of both hands in order to achieve the same goal (bimanual coordination). Nevertheless, this process can be hampered in case of a brain lesion occurring in developmental stages of the brain which is the case in children with unilateral cerebral palsy (uCP). Children with uCP exhibit sensorimotor impairments on one side of the body, primarily in the upper limb which significantly affects their daily activities. Up till now, research mainly focuses on the functional hand use which investigates the efficacy of the non-dominant hand, or more-impaired hand, during bimanual tasks. Although these clinical assessments provide valuable information, they do not assess the precise control between both hands during a bimanual task. In contrast, objective, innovative methods like 3D motion analysis and robotics, have been brought forward as possible assessment methods to quantify bimanual motor control. However, research using this state-of-the-art technology in children with uCP is still very limited. Consequently, also the understanding of the underlying neural mechanisms of bimanual motor control is still very much unexplored. Bimanual motor control depends on two white matter pathways: the corpus callosum (CC), connecting the brain hemispheres, and the corticospinal tract (CST), linking the cortex to the spinal cord. However, the structural properties of these neural pathways can be diminished in children with uCP, potentially impacting their bimanual motor control. Therefore, the main scope of this doctoral manuscript is to enhance our understanding of bimanual motor control in children with uCP and identify its neural correlates, with the use of state-of-the-art technology. These new insights, can ultimately contribute to optimizing the treatment of bimanual motor control in children with uCP, aiming to enhance their independence during daily life activities.