title: Hand function assessment in the first years of life in unilateral cerebral palsy: Correlation with neuroimaging and cortico-spinal reorganization.
abstract: OBJECTIVE
  The purpose of the present study was to correlate early hand function assessment during the first years of life with neuroimaging findings and the different patterns of cortico-motor reorganization in children with unilateral cerebral palsy (UCP).
  
  
  METHODS
  We conducted a long prospective observational study, in which 17 children with UCP (8 left-sided hemiplegia; Manual Ability Classification System level 1-3) were first assessed at a mean age of 24 months (range 18-28), and followed up by means of the Besta Scale, a new standardized protocol assessing both unimanual and bimanual hand function. They also underwent Melbourne Assessment of Unilateral Upper Limb Function (MUUL) and single-pulse Transcranial Magnetic Stimulation (TMS) at a mean age of 10 years 5 months (range 9 y 1 m-12 y 8 m). Brain MRIs of all the 17 children were independently assessed and scored by two blinded observers, according to a defined protocol. Possible correlations between hand function at first assessment, neuroimaging and TMS data were analyzed.
  
  
  RESULTS
  Early hand function impairment significantly correlated with the extension of brain damage (ρ = -0.531, p = 0.028), number of involved areas (ρ = -0.608, p = 0.010), presence of radiological signs of cortico-spinal degeneration (ρ = -0.628, p = 0.007), and basal ganglia involvement (ρ = -0.485, p = 0.049). Additionally, higher hand function scores (i.e. better hand function) at first assessment significantly correlated with contralateral cortico-spinal projections, while lower scores significantly correlated with either mixed or ipsilateral cortico-spinal projections to the affected hand (χ(2)(2) = 11.418, p = 0.003; post-hoc tests: contralateral TMS group versus ipsilateral: Z = -2.943, p = 0.002 and contralateral TMS group versus mixed: Z = -2.775, p = 0.006).
  
  
  CONCLUSIONS
  To our knowledge, this is the first study correlating hand function assessment in the first years of life, and its evolution over time, with neuroimaging and cortico-spinal projection patterns in children with UCP. These findings could contribute to an improved prediction of prognosis and a better delineation of therapeutic interventions in young children with UCP.
authors.affiliation: Developmental Neurology Unit, "Carlo Besta" Neurological Institute Foundation, Via Celoria 11, 20133 Milan, Italy. Electronic address: giovanni.baranello@istituto-besta.it.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Baranello
authors.affiliation: Department of Neurophysiology-Epilepsy Centre, "Carlo Besta" Neurological Institute Foundation, Via Celoria 11, 20133 Milan, Italy. Electronic address: rossi.d@istituto-besta.it.
authors.forename: Davide
authors.initials: D
authors.lastname: Rossi Sebastiano
authors.affiliation: Developmental Neurology Unit, "Carlo Besta" Neurological Institute Foundation, Via Celoria 11, 20133 Milan, Italy. Electronic address: epagliano@istituto-besta.it.
authors.forename: Emanuela
authors.initials: E
authors.lastname: Pagliano
authors.affiliation: Department of Neurophysiology-Epilepsy Centre, "Carlo Besta" Neurological Institute Foundation, Via Celoria 11, 20133 Milan, Italy. Electronic address: visani.e@istituto-besta.it.
authors.forename: Elisa
authors.initials: E
authors.lastname: Visani
authors.affiliation: Department of Neurophysiology-Epilepsy Centre, "Carlo Besta" Neurological Institute Foundation, Via Celoria 11, 20133 Milan, Italy. Electronic address: claudia.ciano@istituto-besta.it.
authors.forename: Claudia
authors.initials: C
authors.lastname: Ciano
authors.affiliation: Developmental Neurology Unit, "Carlo Besta" Neurological Institute Foundation, Via Celoria 11, 20133 Milan, Italy. Electronic address: tnpeends@istituto-besta.it.
authors.forename: Adriana
authors.initials: A
authors.lastname: Fumarola
authors.affiliation: Developmental Neurology Unit, "Carlo Besta" Neurological Institute Foundation, Via Celoria 11, 20133 Milan, Italy. Electronic address: mariateresa.arnoldi@gmail.com.
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Arnoldi
authors.affiliation: Developmental Neurology Unit, "Carlo Besta" Neurological Institute Foundation, Via Celoria 11, 20133 Milan, Italy. Electronic address: alice.corlatti@alice.it.
authors.forename: Alice
authors.initials: A
authors.lastname: Corlatti
authors.affiliation: Developmental Neurology Unit, "Carlo Besta" Neurological Institute Foundation, Via Celoria 11, 20133 Milan, Italy. Electronic address: maria.foscan@live.it.
authors.forename: Maria
authors.initials: M
authors.lastname: Foscan
authors.affiliation: Developmental Neurology Unit, "Carlo Besta" Neurological Institute Foundation, Via Celoria 11, 20133 Milan, Italy. Electronic address: alessia_marchi@yahoo.it.
authors.forename: Alessia
authors.initials: A
authors.lastname: Marchi
authors.affiliation: Neuroradiology Unit, "Carlo Besta" Neurological Institute Foundation, Via Celoria 11, 20133 Milan, Italy. Electronic address: alessandra.erbetta@istituto-besta.it.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Erbetta
authors.affiliation: Developmental Neurology Unit, "Carlo Besta" Neurological Institute Foundation, Via Celoria 11, 20133 Milan, Italy. Electronic address: driva@istituto-besta.it.
authors.forename: Daria
authors.initials: D
authors.lastname: Riva
mesh_terms: D002547:Cerebral Palsy / Q000150:complications* / Q000473:pathology* / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006225:Hand / Q000503:physiopathology; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D009048:Motor Skills; D059906:Neuroimaging / Q000379:methods*; D011446:Prospective Studies; D011712:Pyramidal Tracts / Q000473:pathology* / Q000503:physiopathology; D050781:Transcranial Magnetic Stimulation
keywords: Brain lesions; Cortico-spinal projections; Hand function assessment; TMS; Unilateral cerebral palsy