Abstract
BACKGROUND AND PURPOSE: Selective voluntary motor control is an important factor influencing gross motor function, interjoint coordination, and the outcome of hamstring-lengthening surgery in spastic cerebral palsy. Using DTI, we investigated whether selective voluntary motor control would show strong correlations with WM motor tract microstructure and whether selective voluntary motor control is more sensitive to global WM impairment than gross motor function.
MATERIALS AND METHODS: Children with spastic bilateral cerebral palsy born preterm and typically developing children were recruited. The Selective Control Assessment of the Lower Extremity (SCALE) and Gross Motor Function Measure (GMFM) were assessed in participants with cerebral palsy. Participants underwent brain MR imaging to collect DWI data. Tract-Based Spatial Statistics was used to analyze the WM for between-group differences and correlations with SCALE and GMFM. ROI analyses compared motor regions.
RESULTS: Twelve children with cerebral palsy (mean age, 11.5 years) and 12 typically developing children (mean age, 10.3 years) participated. Altered DTI outcomes were found throughout the whole brain for the cerebral palsy group. SCALE, developed to evaluate selective voluntary motor control in cerebral palsy, showed significant positive correlations with fractional anisotropy in more WM voxels throughout the whole brain and for motor regions, including the corticospinal tract and corpus callosum, compared with GMFM. A significant negative correlation between radial diffusivity and SCALE, but not GMFM, was found within the corpus callosum.
CONCLUSIONS: SCALE was a more sensitive clinical correlate of motor and whole-brain WM tract impairment in children with spastic bilateral cerebral palsy, suggesting greater anisotropy and myelination in these regions for those with higher selective voluntary motor control.
ABBREVIATIONS:
- AD
- axial diffusivity
- CC
- corpus callosum
- CerPed
- cerebral peduncle
- CP
- cerebral palsy
- CST
- corticospinal tract
- FA
- fractional anisotropy
- GMFCS
- Gross Motor Function Classification System
- GMFM
- Gross Motor Function Measure
- MD
- mean diffusivity
- PLIC
- posterior limb of the internal capsule
- RD
- radial diffusivity
- SCALE
- Selective Control Assessment of the Lower Extremity
- SCR
- superior corona radiata
- SVMC
- selective voluntary motor control
- TDC
- typically developing children
Footnotes
MR imaging data acquisition and gait assessments were funded by donations and grants from the UCLA Children’s Discovery and Innovation Institute; Shapiro Family Foundation; United Cerebral Palsy of Los Angeles, Santa Barbara and Ventura Counties; Waters Foundation; California Community Foundation; Lena Longo Foundation; and UCLA Brain Mapping Center. No funders were involved in the preparation of this article.
Paper previously presented, in part, at: Annual Meeting of the American Academy for Cerebral Palsy and Developmental Medicine, September 18–21, 2019; Anaheim, California.
Disclosures: Eileen G. Fowler—RELATED: Grant: UCLA Children’s Discovery and Innovation Institute, Comments: This internal university grant provided funding for the MR images. Also, our institution received donations from individuals that supported salaries.* Joyce Matsumoto—RELATED: Grant: UCLA Children’s Discovery and Innovation Institute, Comments: Grant awarded to fund research MR images.* *Money paid to the institution.
- © 2021 by American Journal of Neuroradiology