Neurodevelopmental profiles of children with unilateral cerebral palsy associated with middle cerebral artery and periventricular venous infarctions.
Darcy Fehlings, Pradeep Krishnan, Renee-Marie Ragguett and 6 others
PMID 33521966WHAT IT FOUND
Children with unilateral cerebral palsy caused by middle cerebral artery infarction had significantly worse hand function, sensation, and cognition than those with periventricular venous infarction.
Therapists should screen for sensory and cognitive barriers in this group before starting upper limb training.
Key findings
01Children with middle cerebral artery infarctions were significantly more likely to have seizures, visual field deficits, and decreased light touch sensation compared to those with periventricular venous infarctions.
02Upper limb function was notably poorer in the middle cerebral artery group, with children performing significantly fewer independent activities of daily living and using both hands less often than the periventricular venous infarction group.
03Cognitive scores were lower in children with middle cerebral artery infarctions compared to those with periventricular venous infarctions, although behavioural deficits were present in one-third of the total cohort regardless of injury type.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
Neuroimaging was clinically ordered rather than protocolised, meaning scans were taken at varying ages. 75 children (23.4% of those identified) were excluded because they had no clinical neuroimaging available, which may introduce selection bias. Lesion size was not accounted for in the analysis, despite being a known factor affecting outcomes. Missing data occurred because young children or those with cognitive disabilities could not complete all assessments, though imputation analyses supported the primary findings. Different measurement tools were used for hand usage in children under versus over 6 years of age, which reduced the power to detect differences in this specific variable across the whole cohort.
Declared interests
The study was funded by the Ontario Brain Institute. No other conflicts of interest were declared in the provided text.
The easy way to misread this
Do not assume that all children with unilateral cerebral palsy have the same rehabilitation needs based on motor impairment alone. This study shows that the underlying brain injury subtype significantly dictates sensory, cognitive, and bimanual functional outcomes, requiring different therapeutic approaches for upper limb training.