Bilateral reaching deficits after unilateral perinatal ischemic stroke: a population-based case-control study.
Andrea M Kuczynski, Adam Kirton, Jennifer A Semrau and 1 others
PMID 30115093WHAT IT FOUND
Children with arterial perinatal stroke showed reaching deficits in both arms, especially the weaker side.
Children with venous infarction showed fewer deficits. The better arm can be impaired, so hand function assessment should look beyond the paretic side.
Key findings
01Children with AIS showed impairments in all 10 reaching parameters with the contralesional arm reaching out and back, while children with PVI showed impairments in 8 of 10 parameters reaching out and 6 parameters reaching back.
02Children with AIS showed impairments in 7 reaching parameters reaching out and 6 parameters reaching back with the ipsilesional arm, while children with PVI showed only reduced initial speed ratio reaching out and no difference reaching back.
03In AIS, contralesional reaching measures correlated with clinical motor scores, while PVI reaching measures did not show significant correlations with clinical scores.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
No treatment was tested, so the study cannot say whether therapy improves function. The sample excluded children with severe hemiparesis, severe spasticity, multifocal stroke, other neurological disorders, or recent upper limb therapy, so findings may not apply to those children. Age effects were cross-sectional, not longitudinal, so this does not track how motor control changes in the same child over time. The reaching task did not assess range of motion or force exertion. Participants with missing clinical data were removed from correlations, which may affect clinical score analyses.
Declared interests
Funding came from Alberta Children's Hospital Foundation, Alberta Innovates - Health Solutions, Hotchkiss Brain Institute, and Cerebral Palsy International Research Foundation. The article does not report author conflicts of interest.
The easy way to misread this
Do not conclude that therapy targeting the ipsilesional arm improves function. This study measured reaching deficits in children who were not receiving a new treatment, and it excluded children with severe hemiparesis or recent therapy.