Brain lateralization in children with upper-limb reduction deficiency

Jorge M Zuniga, James E Pierce, Christopher Copeland, Claudia Cortes-Reyes, David Salazar, YingYing Wang, K M Arun, Theodore Huppert, Jorge M Zuniga, James E Pierce, Christopher Copeland, Claudia Cortes-Reyes, David Salazar, YingYing Wang, K M Arun, Theodore Huppert

Abstract

Background: The purpose of the current study was to determine the influence of upper-limb prostheses on brain activity and gross dexterity in children with congenital unilateral upper-limb reduction deficiencies (ULD) compared to typically developing children (TD).

Methods: Five children with ULD (3 boys, 2 girls, 8.76 ± 3.37 years of age) and five age- and sex-matched TD children (3 boys, 2 girls, 8.96 ± 3.23 years of age) performed a gross manual dexterity task (Box and Block Test) while measuring brain activity (functional near-infrared spectroscopy; fNIRS).

Results: There were no significant differences (p = 0.948) in gross dexterity performance between the ULD group with prosthesis (7.23 ± 3.37 blocks per minute) and TD group with the prosthetic simulator (7.63 ± 5.61 blocks per minute). However, there was a significant (p = 0.001) difference in Laterality Index (LI) between the ULD group with prosthesis (LI = - 0.2888 ± 0.0205) and TD group with simulator (LI = 0.0504 ± 0.0296) showing in a significant ipsilateral control for the ULD group. Thus, the major finding of the present investigation was that children with ULD, unlike the control group, showed significant activation in the ipsilateral motor cortex on the non-preferred side using a prosthesis during a gross manual dexterity task.

Conclusions: This ipsilateral response may be a compensation strategy in which the existing cortical representations of the non-affected (preferred) side are been used by the affected (non-preferred) side to operate the prosthesis. This study is the first to report altered lateralization in children with ULD while using a prosthesis. Trial registration The clinical trial (ClinicalTrial.gov ID: NCT04110730 and unique protocol ID: IRB # 614-16-FB) was registered on October 1, 2019 ( https://ichgcp.net/clinical-trials-registry/NCT04110730 ) and posted on October 1, 2019. The study start date was January 10, 2020. The first participant was enrolled on January 14, 2020, and the trial is scheduled to be completed by August 23, 2023. The trial was updated January 18, 2020 and is currently recruiting.

Keywords: Brain activation; Pediatric; Prosthesis; Upper-limb deficiency; fNIRS.

Conflict of interest statement

Jorge M. Zuniga, Ph.D. is the designer of the 3D printed prostheses Cyborg Beast.

Figures

Fig. 1
Fig. 1
Description of prostheses and prosthetic simulators. The prosthetic simulators used in the study mimic the design and control mechanism of the prostheses. The partial hand prosthesis simulator allowed typically developing children to rest their existing hand on top of the simulator hand, with the wrist in slight extension. A pushing platform placed above the hand allowed wrist active flexion and passive extension to facilitate actuation of the hand. Similarly, the trans-radial simulators incorporated similar features than the trans-radial prosthesis with the addition of a handle that allowed typically developed children to actuate the device by elbow flexion
Fig. 2.
Fig. 2.
Placement of the functional near-infrared spectroscopy (fNIRS) head set and probe adjustment
Fig. 3
Fig. 3
a Adjustable headgear and channels arrangement. The headset was centered at the vertex (Cz) and lateral channels placed over the C3 and C4 motor cortex landmarks associated with motor activity of the hand and arm movements. Red rectangles show the adjustable Velcro straps used to accommodate different head sizes. b Visualization of headgear after virtual registration to subject brain model. Blue lines indicate placement of the headgear over the brain
Fig. 4
Fig. 4
Functional near-infrared spectroscopy (fNIRS) filtered waveform from the motor cortex of the left hemisphere of the experimental group (Subject 2 in Table 1)
Fig. 5
Fig. 5
Visualization of brain activity patterns from a typically developing (TD) child (Control group ID: 5) and a child with unilateral limb deficiency (ULD; Experimental group ID: 5). The left hemisphere from the children with ULD showed a significant ipsilateral activation
Fig. 6
Fig. 6
Laterality indices of children with upper-limb deficiency (ULD) and typically developing (TD) children during the performance of a functional task with preferred (right) and non-preferred hands (left for TD and affected for ULD)

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