Relationship between sensorimotor cortical activation as assessed by functional near infrared spectroscopy and lower extremity motor coordination in bilateral cerebral palsy

BACKGROUND: Evaluation of task-evoked cortical responses during movement has been limited in individuals with bilateral cerebral palsy (CP), despite documented alterations in brain structure/function and deficits in motor control. OBJECTIVE: To systematically evaluate cortical activity associated with lower extremity tasks, and relate activation parameters to clinical measures in CP. METHODS: 28 ambulatory participants (14 with bilateral CP and 14 with typical development) completed five motor tasks (non-dominant ankle dorsiflexion, hip flexion and leg cycling as well as bilateral dorsiflexion and cycling) in a block design while their sensorimotor cortex was monitored using functional near infrared spectroscopy (fNIRS), in addition to laboratory and clinical measures of performance. RESULTS: Main effects for group and task were found for extent of fNIRS activation (number of active channels; p < 0.001 and p = 0.010, respectively), magnitude of activation (sum of beta values; p < 0.001 for both), and number of active muscles (p = 0.001 and p < 0.001, respectively), but no group by task interactions. Collectively, subgroups with CP and especially those with greater impairments, showed higher extent and magnitude of cortical sensorimotor activation as well as higher amounts of concurrent activity in muscles not required for task performance. Magnitude of fNIRS activation during non-dominant dorsiflexion correlated with validated measures of selective control (r = −0.60, p = 0.03), as well as mobility and daily activity (r = −0.55, p = 0.04 and r = −0.52, p = 0.05, respectively) and self-reported gait function (r = −0.68, p = 0.01) in those with CP. CONCLUSIONS: The association between higher activity in the sensorimotor cortex and decreased selectivity in cortical organization suggests a potential neural mechanism of motor deficits and target for intervention.