Linking corticospinal tract activation and upper-limb motor control in adults with cerebral palsy.
Saihari S Dukkipati, Sarah J Walker, Michael P Trevarrow and 3 others
PMID 37679938WHAT IT FOUND
Adults with cerebral palsy had smaller wrist flexor corticospinal responses at high stimulation levels than typical adults.
Among adults with cerebral palsy, smaller responses were associated with poorer manual dexterity, selective motor control, and self-reported upper-limb tasks.
Key findings
01Adults with cerebral palsy had smaller wrist flexor CMEP amplitudes than typical adults at 90mA and 95mA stimulation.
02Among adults with cerebral palsy, larger maximum CMEP amplitude was positively related to more blocks moved, more pegs placed, higher selective motor control scores, and higher scores on a self-reported upper-extremity function scale.
03Adults with cerebral palsy moved 37.07 blocks and placed 6.27 pegs, compared with 70.38 blocks and 15.39 pegs in typical adults.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
Only 15 adults with cerebral palsy and 18 typical adults were studied, so the findings may not generalise widely. Controls were a convenience sample and were not matched to the cerebral palsy group, although group ages were not significantly different. The study measured associations at one time point and did not test whether reduced corticospinal activation causes poorer function or whether treatment can change it. Only the more affected hand was tested in adults with cerebral palsy, and each dexterity test was attempted once. One adult with cerebral palsy had botulinum neurotoxin A in the tested wrist flexor muscle in the year before the study. At higher stimulation levels, responses could be contaminated by indirect activation of spinal pathways, although the setup tried to limit this. The study protocol was not registered in a database.
The easy way to misread this
Do not conclude that lower corticospinal activation caused poorer hand function or that strength training will improve it. The study included 15 adults with cerebral palsy, used cross-sectional comparisons and correlations, and did not test a treatment.