Adults with cerebral palsy exhibit uncharacteristic cortical oscillations during an adaptive sensorimotor control task.

Prior research has shown that the sensorimotor cortical oscillations are uncharacteristic in persons with cerebral palsy (CP); however, it is unknown if these altered cortical oscillations have an impact on adaptive sensorimotor control. This investigation evaluated the cortical dynamics when the motor action needs to be changed "on-the-fly". Adults with CP and neurotypical controls completed a sensorimotor task that required either proactive or reactive control while undergoing magnetoencephalography (MEG). When compared with the controls, the adults with CP had a weaker beta (18-24 Hz) event-related desynchronization (ERD), post-movement beta rebound (PMBR, 16-20 Hz) and theta (4-6 Hz) event-related synchronization (ERS) in the sensorimotor cortices. In agreement with normative work, the controls exhibited differences in the strength of the sensorimotor gamma (66-84 Hz) ERS during proactive compared to reactive trials, but similar condition-wise changes were not seen in adults with CP. Lastly, the adults with CP who had a stronger theta ERS tended to have better hand dexterity, as indicated by the Box and Blocks Test and Purdue Pegboard Test. These results may suggest that alterations in the theta and gamma cortical oscillations play a role in the altered hand dexterity and uncharacteristic adaptive sensorimotor control noted in adults with CP.

Linking corticospinal tract activation and upper-limb motor control in adults with cerebral palsy.

AIM: To quantify the cervicomedullary motor evoked potentials (CMEPs) at the cervical spinal level in adults with cerebral palsy (CP) and determine if altered CMEPs are linked with upper-extremity motor function in this population. METHOD: This cross-sectional study consisted of a cohort of adults with CP (n = 15; mean age = 33 years 5 months [SD = 11 years 8 months]); Manual Ability Classification System levels I-IV) and neurotypical controls (n = 18; mean age = 30 years 10 months [SD = 10 years 4 months]), who were recruited to participate at an academic medical center. Adults with CP and typical adults (controls) were stimulated at the cervicomedullary junction to assess CMEPs at the cervical spinal cord level. Upper-extremity motor function was quantified using the Box and Blocks and Purdue Pegboard tests, self-reported upper-extremity function (UEF), and assessments of selective motor control. RESULTS: At higher stimulation levels, the contralateral CMEP responses of adults with CP were different from typical adults (p = 0.032). Reduced CMEP was correlated with reduced upper-limb function, including worse performance on the Box and Blocks (rho = 0.625, p = 0.025) and Purdue Pegboard tests (rho = 0.701, p = 0.010), lower self-reported UEF (rho = 0.761, p = 0.009), and overall selective motor control (rho = 0.731, p = 0.007). INTERPRETATION: Changes in the activation of spinal motoneurons through corticospinal pathways may have an important role in the altered upper-extremity motor function of individuals with CP.

Disruption of Sensorimotor Cortical Oscillations by Visual Interference Predicts the Altered Motor Performance of Persons with Cerebral Palsy.

Emerging evidence indicates that aberrations in sensorimotor cortical oscillations likely play a key role in uncharacteristic motor actions seen in cerebral palsy. This interpretation is largely centered on the assumption that the aberrant cortical oscillations primarily reflect the motor aspects, with less consideration of possible higher-order cognitive connections. To directly probe this view, we examined the impact of cognitive interference on the sensorimotor cortical oscillations seen in persons with cerebral palsy using magnetoencephalography. Persons with cerebral palsy (N = 26, 9-47 years old) and controls (N = 46, 11-49 years) underwent magnetoencephalographic imaging while completing an arrow-based version of the Eriksen flanker task. Structural equation modeling was used to evaluate the relationship between the extent of interference generated by the flanker task and the strength of the sensorimotor cortical oscillations and motor performance. Our results indicated that the impact of cognitive interference on beta and gamma oscillations moderated the interference effect on reaction times in persons with cerebral palsy, above and beyond that seen in controls. Overall, these findings suggest that alterations in sensorimotor oscillatory activity in those with cerebral palsy at least partly reflects top-down control influences on the motor system. Thus, suppression of distracting stimuli should be a consideration when evaluating altered motor actions in cerebral palsy.

Spinal cord H-reflex post-activation depression is linked with hand motor control in adults with cerebral palsy.

OBJECTIVE: Cerebral palsy (CP) is associated with upper extremity motor impairments that are largely assumed to arise from alterations in the supraspinal networks. The objective of this study was to determine if post-activation depression of the spinal H-reflexes is altered in adults with CP and connected with altered upper extremity function. METHODS: The post-activation depression of the flexor carpi radialis (FCR) H-reflex of adults with CP and healthy adults (HA) controls were assessed by 1) a 1 Hz continuous single-pulse stimulus train and 2) 0.11 Hz / 1 Hz paired-pulse stimuli. Secondarily, we measured the maximum key grip force and the box and blocks assessment of manual dexterity. RESULTS: Our results revealed that adults with CP had reduced post-activation depression of the FCR H-reflex during the stimulus train and the paired pulse protocol. A greater reduction in H-reflex post-activation depression was connected to lower manual dexterity and weaker grip forces. CONCLUSIONS: Our results indicate that the post-activation depression of the upper extremity spinal H-reflex pathways is altered in adults with CP and possibly linked with their uncharacteristic upper extremity motor performance. Alterations in the spinal networks may also play a significant role in the altered motor control of adults with CP. SIGNIFICANCE: Our results identify spinal H-reflex modulation as a possible locus for hand motor control in CP.