Sensorimotor behavior in children born preterm and adolescents with Cerebral Palsy : Side preference, movement organization, and training

Sammanfattning: Preterm birth (< 37 complete gestation weeks, GWs) is the single most prominent risk factor for the development of cerebral palsy (CP). This is due to the immature physiological state of the preterm born infant which increases the risk of brain lesions. In CP, prominent sensorimotor, cognitive, and perceptual deviations are manifested with varying degrees of functional impairment. Although most children born preterm (PT) do not develop CP, sensorimotor and cognitive deficits are frequently reported in the absence of major disability. To date, few studies have focused on detailed kinematic analysis of upper-body goal-directed movements and how aspects of movement organization and control are related to hand preference, intellectual function, gestational age, and sex within groups of prematurely born children. Further, studies evaluating effects of sensorimotor training in persons with CP is needed and of importance as positive effects on movement performance may increase individual autonomy as a consequence.To investigate the prevalence of non-right hand preference within children born preterm (PT) in comparison to children born fullterm (FT), a meta-analysis and literature review were performed (study I). It was shown that children born PT had increased rates of non-right handedness (NRH) corresponding to 22% compared to 12% in the FT group (odds ratio 2.12). In study II, hand preference and side specific movement performance in children born PT (. 35 GWs) compared to an age matched group of children born FT were investigated. All included participants were 4-8 years of age without major disability. Movement performance was studied through detailed kinematic registrations of the head, arm, and hand during a goal-directed task and hand preference through observations of the hand used when manipulating different objects. On a group level, the children born PT, specifically those born < 33 GWs, showed an increased rate of NRH, weaker strength of hand preference, and a lack of side specificity in terms of movement kinematics. In general, the children born < 33 GWs also displayed poorer movement organization and control as expressed by longer durations, less smooth and longer distances of the movement trajectories. These findings imply that preterm birth has long term effects on sensorimoror organization and function, possibly reflecting a developmental delay and/or a persistent effect that may be associated with the increased risk of deviations in brain development.In study III, associations between movement performance, assessed with the same task as in study II, and intellectual function (Wechsler Intelligence Scale for Children, 4th ed; WISC-IV) were studied. This study included a subsample of the children from study II at 6-8 years of age. The results showed a link between movement organization and general intellectual functioning (IQ), when controlling for effects of GA and sex, for the PT born but not the FT born children. These findings suggest shared neural underpinnings and interrelated development of motor and intellectual functions.In study IV, kinematic analysis of upper-body movements and subjective experience of change in upper-body function were applied before and after a period of synchronized metronome training (SMT) in adolescents with varying degree of CP to study the effects of this type of training. The SMT method applied entailed elements of movement timing and rhythmic activation coupled with feedback and was hypothesized to train sensorimotor integration. It was found that SMT did improve, to varying degrees, the organization and control of movements in adolescents with CP. The participants with more severe forms of CP reported substantial effects in daily living activities. The observed effects of SMT warrant further study of specific effects on movement planning, biomechanical constraints, and attention.The relation between hand preference and movement performance, movement performance and intellectual function, and aspects related to the SMT method applied in study IV are discussed. Specifically, the lack of side specific movement organization within the group of children born PT is discussed from perspectives of motor learning, plasticity, and genetics. The relations between movement performance and intellectual functions are considered and ideas for how this association could be tested are given. With relation to study IV, the functions trained by the specific SMT method applied and the accessibility of individuals with different degree of CP is discussed. Methodological considerations and ideas for future research approaches within these areas are presented.