Graduation Date

Fall 12-16-2016

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Programs

Medical Sciences Interdepartmental Area

First Advisor

Dr. Max J. Kurz

Second Advisor

Dr. Regina T. Harbourne

Abstract

The primary purpose of this investigation was to describe and quantify action-planning deficits during goal-directed movements in children with hemiplegic cerebral palsy (HCP). Three specific topics were addressed: brain activation, kinematics, and the use of visual input. First, we assessed prefrontal cortex (PFC) activation during complex goal-directed actions in children with HCP. The outcome suggested that children with HCP have higher PFC activation than age matched typically developing (TD) children during action planning, potentially due to the difficulty in allocating attentional resources for simultaneously processing the cognitive (i.e., attention, memory, information processing) and motor demands of the goal-directed task. Reduced task performance paralleled the increased cortical activation. Secondly, we explored the kinematics of action planning and execution of goal-directed action of children with HCP. We found that children with HCP lack forward planning capacity of sequential action, which further impacts the ability to execute action. Thirdly, we explored anticipatory visual patterns and the temporal coupling between eye and hand in children with HCP. The outcomes from this study indicate delays in anticipatory vision and impaired visuomotor coordination, potential factors responsible for the delay in motor performance in children with HCP. Moreover, we observed increased visual monitoring of the moving arm, a potential compensatory mechanism for impaired proprioception of the arm.

A secondary purpose was to evaluate whether hand arm bimanual intensive therapy (HABIT) improves action planning and subsequent action execution deficits, and improves PFC activation. After completion of 50-hours of HABIT program, children with HCP displayed reduction in PFC activation. The reduction in cortical activation was accompanied by clinically relevant improvements in bimanual coordination, affected hand function, and motor task performance. Altogether this investigation provides novel information about the action planning and subsequent action execution deficits and the influence of therapeutic interventions in reducing these deficits to optimize learning motor skills in children with HCP.

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