Contribution of altered corticospinal microstructure to gait impairment in children with cerebral palsy

Abstract

Objective: Corticospinal tract (CST) injury may lead to motor disorders in children with Cerebral Palsy (CP). However, the precise underlying mechanisms are still ambiguous. We aimed to characterize the CST structure and function in children with CP and determine their contributions to balance and gait impairments.

Method: Twenty-six children with spastic CP participated. Transcranial magnetic stimulation (TMS) and diffusion tensor imaging (DTI) were utilized to characterize CST structure and function. Common clinical measures were used to assess gait speed, endurance and balance, and mobility.

Results: CST structure and function were significantly altered in children with CP. Different abnormal patterns of CST structure were identified as either abnormal appearance of brain hemispheres (Group-1) or semi-normal CST appearance (Group-2). We found significant correlations between the DTI parameters of the more affected CST and gait features only in Group-1.

Conclusion: CST structure and function are abnormal in children with CP and these abnormalities may contribute to balance and gait impairment in some children with CP.

Significance: Our findings may lead to the development of further investigations on the mechanisms underlying gait impairment in children with CP and on decision-making for more effective rehabilitation.

Keywords: Cerebral palsy; Corticospinal tract; Diffusion tensor imaging; Gait impairment; Lower extremity; Spasticity; Transcranial magnetic stimulation.