Original ArticleDelayed Finger Tapping and Cognitive Responses in Preterm-Born Male Teenagers With Mild Spastic Diplegia
Introduction
Cerebral palsy (CP), primarily a motor disorder, is often accompanied by disturbances of sensation, cognition, communication, perception, behavior, and seizure disorders.1 It is prevalent in the world. Spastic diplegia is a subgroup of CP found in both preterm and term infants.2 The Gross Motor Function Classification System (GMFCS) was developed by Palisano et al.3, 4 to provide an objective classification of the patterns of gross motor disability in CP patients. According to the study of Reid et al.,5 GMFCS level Ⅰ and Ⅱ was defined as mild CP. Preterm male teenagers with mild spastic diplegia (MSD) at GMFCS level Ⅰ or Ⅱ were included in the present study.
Finger tapping is an elementary fine motor function. The finger-tapping test is widely used to examine fine motor performance in patients with cerebral disorders.6, 7, 8, 9 So far, only a few studies10, 11 have investigated the finger-tapping ability on a keyboard in patients with spastic hemiplegia. In the study of Steenbergen et al.,10 the tapping performance on a keyboard was examined in four adolescents with spastic hemiplegia. The tapping speed, tapping regularity, and tapping errors were examined within a time window. It was shown that the “good” hand outperformed the impaired hand at nearly all measures in the four fingers. In the study of Roon et al.,11 the tapping ability was examined in nine adolescents with spastic hemiplegia. The impaired hand tapped slower and more irregularly and exerted less force. The deficit in the two studies was that a control group was not included for comparison. The main disorder in spastic diplegia is dysfunction in the lower limbs; so the fine motor function of the upper limb is often neglected. There is a lack of study results to accurately measure the fine finger motor function quantitatively in spastic diplegia.
Existing literature on cognitive function in CP patients is mostly limited to the assessment of discrimination and/or short-term memory toward digits,12, 13 letters of an alphabet,14 words,13 and simple graphs.15, 16 Among the most fundamental cognitive processes are categorization and old/new recognition.17 However, very few studies have investigated these cognitive functions in CP patients.
Periventricular leukomalacia (PVL) is the main neuropathology in preterm-born children with spastic diplegia.18 It was presumed that the preterm spastic diplegia–related brain damage would disrupt fine finger movement, categorization, and recognition functions. To address the hypothesis, we examined the index finger's tapping ability, categorization, and old/new recognition functions toward animal/plant and boy/girl face pictures in preterm-born male teenagers with MSD.
Section snippets
Participants
All participants were asked to fill in the Oldfield's Edinburgh Handedness Inventory.19 Only right-handed participants were included in this study. There is increasing evidence for early sexual dimorphism of the brain, and recent diffusion tension imaging findings revealed sex differences in the white matter structures of the adult brain.20 Therefore, we only chose male adolescents as our participants in this study.
Fifteen teenager patients (Table) with MSD (mean age, 14 years 7 months;
Finger-tapping tests
In the test of left digit tapping one key persistently, the RT of the patients was around 130 ms longer (t′ = 5.342; P < 0.001) than that of the controls. In the test of right digit tapping one key persistently, the RT of the patients was about 60 ms longer (t′ = 5.905; P < 0.001) than that of the controls. In the test of left digit tapping two keys alternately, the RT of the patients was approximately 200 ms longer (t′ = 4.292; P = 0.001) than that of the controls. In the test of right digit
Discussion
Brain injury patterns in CP vary and mainly depend on gestational age.26 By gestational age, children were grouped into ≤34 weeks and >34 weeks based on the evidence that children with CP born ≤34 weeks were considered most likely to have periventricular white matter injury.27 Preterm spastic diplegia is the result of PVL.28 Only spastic diplegia patients with a gestational age between 30 to 34 weeks were included in this study. So the patients included in this study may have similar brain
Conclusions
These findings demonstrate delayed fine finger motor and cognitive responses in preterm-born male teenagers with MSD. The experimental paradigm is sensitive in studying the motor and cognitive functions between patients and healthy controls. Better understanding of the basic behavioral status of CP patients may be beneficial to design proper rehabilitative measures. Further experimental study is underway in electroencephalography and event-related potential mapping of fine finger tapping and
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