title: Impaired Voluntary Movement Control and Its Rehabilitation in Cerebral Palsy.
abstract: Cerebral palsy is caused by early damage to the developing brain, as the most common pediatric neurological disorder. Hemiplegia (unilateral spastic cerebral palsy) is the most common subtype, and the resulting impairments, lateralized to one body side, especially affect the upper extremity, limiting daily function. This chapter first describes the pathophysiology and mechanisms underlying impaired upper extremity control of cerebral palsy. It will be shown that the severity of impaired hand function closely relates to the integrity of the corticospinal tract innervating the affected hand. It will also shown that the developing corticospinal tract can reorganize its connectivity depending on the timing and location of CNS injury, which also has implications for the severity of hand impairments and rehabilitation. The mechanisms underlying impaired motor function will be highlighted, including deficits in movement execution and planning and sensorimotor integration. It will be shown that despite having unimanual hand impairments, bimanual movement control deficits and mirror movements also impact function. Evidence for motor learning-based therapies including Constraint-Induced Movement Therapy and Bimanual Training, and the possible pathophysiological predictors of treatment outcome and plasticity will be described. Finally, future directions for rehabilitations will be presented.
authors.affiliation: Department of Biobehavioral Sciences, Teachers College, Columbia University, 525 West 120th Street, New York, New York, Box 93, 10027, USA. ag275@columbia.edu.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Gordon
mesh_terms: D002547:Cerebral Palsy / Q000503:physiopathology / Q000534:rehabilitation*; D007839:Functional Laterality / Q000502:physiology; D006801:Humans; D009068:Movement / Q000502:physiology*; D026741:Physical Therapy Modalities; D011597:Psychomotor Performance / Q000502:physiology*; D016896:Treatment Outcome
keywords: Bimanual; Constraint-induced movement therapy; Corticospinal pathways (CST); Hand function; Jense-Taylor test; Mirror movements; Motor planning; Object-release coordination; Sensorimotor integration; Stereognosis; Thalamocortical