Motor learning in children with hemiplegic cerebral palsy and the role of sensation in short-term motor training of goal-directed reaching

摘要

Aim: Our aim was to determine if improved upper limb kinematics in children with cerebral palsy (CP) during a reach-to-grasp task could be retained and transferred to a similar task. We also characterized the relationship between sensation and motor learning. Method: We used a prospective, single-participant research design with 16 children (seven males, nine females; mean/median age 8.6/9y; age range 6-11y) with spastic hemiparesis (Manual Ability Classification System levels II-IV). Children were randomly allocated to one of two groups: (1) task-oriented training with or (2) without trunk restraint. The intervention consisted of three 1-hour sessions per week for 5 weeks (total 15h). Evaluations consisted of sensory modalities (tactile threshold, touch, proprioception, stereognosis) and upper limb kinematics during reach-to-grasp of an object located near and far from the body (five assessments: three pre-intervention, immediately post-intervention and 3mo post-intervention). Results: Motor improvements could be retained 3 months after the intervention and transferred to a similar task in children with CP. Proprioception and tactile thresholds were associated with retention of improvements in endpoint velocity (F2,13=4.832, p=0.027). Interpretation: Practice of activities aimed at improving upper limb kinematics led to better learning and retention of movement patterns in children with CP. Our results underline the importance of sensation for motor learning in children with CP.