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Neurorehabil Neural Repair. 2014 Jan;28(1):24-35. doi: 10.1177/1545968313497829. Epub 2013 Aug 1.

Motor impairments related to brain injury timing in early hemiparesis. Part II: abnormal upper extremity joint torque synergies.

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  • 11Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA.

Abstract

BACKGROUND:

Extensive neuromotor development occurs early in human life, and the timing of brain injury may affect the resulting motor impairment. In Part I of this series, it was demonstrated that the distribution of weakness in the upper extremity depended on the timing of brain injury in individuals with childhood-onset hemiparesis.

OBJECTIVE:

The goal of this study was to characterize how timing of brain injury affects joint torque synergies, or losses of independent joint control.

METHOD:

Twenty-four individuals with hemiparesis were divided into 3 groups based on the timing of their injury: before birth (PRE-natal, n = 8), around the time of birth (PERI-natal, n = 8), and after 6 months of age (POST-natal, n = 8). Individuals with hemiparesis and 8 typically developing peers participated in maximal isometric shoulder, elbow, wrist, and finger torque generation tasks while their efforts were recorded by a multiple degree-of-freedom load cell. Motor output in 4 joints of the upper extremity was concurrently measured during 8 primary torque generation tasks to quantify joint torque synergies.

RESULTS:

There were a number of significant coupling patterns identified in individuals with hemiparesis that differed from the typically developing group. POST-natal differences were most noted in the coupling of shoulder abductors with elbow, wrist, and finger flexors, while the PRE-natal group demonstrated significant distal joint coupling with elbow flexion.

CONCLUSION:

The torque synergies measured provide indirect evidence for the use of bulbospinal pathways in the POST-natal group, while those with earlier injury may use relatively preserved ipsilateral corticospinal motor pathways.

KEYWORDS:

cerebral palsy; childhood hemiparesis; childhood hemiplegia; independent joint control; selective motor control

PMID:
23911972
[PubMed - indexed for MEDLINE]
PMCID:
PMC3974905
Free PMC Article
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