Tactile function in the upper limb of children with unilateral cerebral palsy

Megan Auld (2011). Tactile function in the upper limb of children with unilateral cerebral palsy PhD Thesis, School of Health & Rehabilitation Sciences, The University of Queensland.

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Author Megan Auld
Thesis Title Tactile function in the upper limb of children with unilateral cerebral palsy
School, Centre or Institute School of Health & Rehabilitation Sciences
Institution The University of Queensland
Publication date 2011-06
Thesis type PhD Thesis
Supervisor Dr Leanne Johnston
Professor Roslyn Boyd
Professor G. Lorimer Moseley
Total pages 270
Total colour pages 2
Total black and white pages 268
Language eng
Subjects 11 Medical and Health Sciences
Abstract/Summary Tactile deficits have been reported in children with unilateral cerebral palsy (UCP), however the nature and severity of these deficits and the impact that they have on motor function is not well understood. The purpose of this thesis was to examine the profile of tactile function in children with UCP using a systematic assessment framework and to determine if there are any potential relationships between tactile function and upper limb motor function. This thesis involved three parts. Part 1 involved two studies that aimed to develop a tactile assessment framework. Study 1 was a systematic review of tactile assessments used in cerebral palsy based on a framework for tactile assessment, developed in the background of the thesis. The framework consists of tactile registration and perception. Study 2 was an examination of the reproducibility of these tactile assessments in both children with UCP and typically developing children (TDC). Studies 1 and 2 yielded a reliable tactile test battery consisting of: Semmes Weinstein Monofilaments (registration), single point localisation, two-point discrimination and double simultaneous (spatial perception), stereognosis (haptic recognition), AsTex® (texture perception) and temporal order judgement (temporal perception). Part 2 involved two studies that aimed to investigate tactile function in children with UCP and TDC. Study 3 investigated tactile registration and spatial and textural perception in 52 children with UCP (median age=12 years; range 8-17 years; 29 male; 23 left UCP; GMFCS I=34; II=18; MACS I=36; II=16) and 34 TDC (median age=9 years; range 5-17 years; 20 male; 9 left handed). It was hypothesised that children with UCP would have poorer tactile function in both hands compared to either hand of TDC. In children with UCP, it was hypothesised that (a) the impaired limb would perform worse than the unimpaired limb, and (b) there would be a correlation between the severity of registration and perception deficits. It was also hypothesised that three patterns of tactile function would be observed in children with UCP: (i) primary impairment in tactile registration – i.e. deficits in registration and perception, (ii) primary impairments in tactile perception – i.e. deficits in perception only, and (iii) no registration or perception impairment. In addition, in line with the adult literature, we hypothesised that those children with right-sided brain lesions (left UCP predominantly) would demonstrate more difficulties with spatial tactile perception than those with right UCP (predominantly left brain lesions). The results from Study 3 indicated that both hands of children with UCP had poorer performance than either hand of TDC. It was also established that children who had deficits on tactile registration testing also all had deficits on tactile perception testing. The profile of deficits revealed that 40% of children with UCP had both registration and perception deficits, 37% had perceptual deficits alone, and 23% had normal tactile function. There was a trend in this study for children with left UCP to have poorer tactile performance, particularly in spatial tactile perception tests. Study 4 investigated temporo-spatial aspects of tactile function, using a temporal order judgement (TOJ) task to test the hypotheses that, (i) children with UCP would demonstrate poorer temporo-spatial function(according to performance on TOJs) than TDC, (ii) children with left UCP would demonstrate poorer performance on the spatial aspect of TOJs than children with right UCP. Results confirmed hypotheses that children with UCP had worse performance than TDC on TOJ and those with left UCP demonstrated poorer performance on the spatial aspects of this task compared to those with right UCP. Part 3 involved one study that aimed to investigate the relationship between tactile function and upper limb motor function in children with UCP. Study 5 investigated the relationships between tactile function and unimanual and bimanual function using the Melbourne Unilateral Upper Limb Assessment, the Jebsen-Taylor Test of Hand Function and the Assisting Hand Assessment. It was hypothesised that poorer tactile function would be related to poorer unimanual capacity, bimanual performance and higher classification of motor ability according to the Manual Abilities Classification Scale (MACS). Results confirmed hypotheses that the presence of tactile impairments in registration or perception were associated with poorer unimanual capacity and bimanual performance and higher classification of motor ability according to the MACS. In terms of relative contribution, regression analysis demonstrated that stereognosis, a motor-assisted tactile assessment, accounted for over 30% of the variance in both unimanual capacity and bimanual performance. When only motor-free tactile tests were added to the model, it was found that single point localisation, a measure of unilateral spatial tactile perception, accounted for 30% of the variance in unimanual capacity. Further, double simultaneous, a measure of bilateral spatial tactile perception accounted for 30% of the variance in bimanual performance. These results confirm that unilateral and bilateral tactile function should be assessed in order to fully explain the source and nature of unilateral and bilateral motor impairment in children with UCP. In Part 1 of this thesis a comprehensive and reliable tactile assessment framework for children with UCP was established. In Part 2, the profile of tactile deficits in children with right and left UCP was described, demonstrating that over three quarters of children with UCP have a tactile impairment. Part 3 confirmed that there is a strong relationship between the presence of tactile impairments and unimanual and bimanual dysfunction. It is important to test tactile dysfunction in order to fully understand motor dysfunction. This thesis provides the platform for future studies to determine appropriate treatments for tactile deficits in children with UCP, which also have implications for upper limb motor function.
Keyword tactile, unilateral cerebral palsy, hemiplegia, registration, perception, sensation, children, upper limb
Additional Notes 30, 31

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Created: Thu, 02 Feb 2012, 17:12:47 EST by Mrs Megan Auld on behalf of Library - Information Access Service