Review Article

The Case for Musical Instrument Training in Cerebral Palsy for Neurorehabilitation

Table 1

Main results of imaging studies regarding alterations in neuronal structure and neuronal activity in CP. CP: cerebral palsy, TD: typically developing, TMS: Transcranial Magentic Resonance Imaging, EMG: Electromyography, fMRI: functional Magentic Resonance Imaging, SEP: Somatosensory Evoked Potential, MEG: magnetic resonance imaging, DTI: Diffusion Tensor Imaging, and ERP: Event-Related Potential.

Study (1st author, year)CP groupControl groupExperimental methodsMain results

Farmer (1991) [38]4 unilateral CP, 2–5 yrs10 age-matched TD childrenTMS, EMG.Projections from ipsilateral cortex to impaired hand in CP.

Cooper (1995) [16]9 hemiplegic, 4.4–18 yrs41 age-matched TD teenagersSEP, hand motor function tests, clinical sensory tests (stereognosis and proprioception).Bilateral sensory deficits in hemiplegic CP. SEP correlated with motor function.

Thickbroom (2001) [30]7 unilateral CP, 17–57 yrsTMS, fMRI.Unaffected hand: contralateral projection. Affected hand: either ipsilateral or bilateral projection. Contralateral projection with passive movement.

Staudt (2004) [44]34 unilateral CP, 5–27 yrsTMS and fMRI during simple hand movements.In 16 patients the paretic hand was controlled via ipsilateral corticospinal projections. Motor dysfunction correlated with timing of brain lesion.

Guzzetta (2007) [22]12 unilateral, 10–28 yrsSEP, structural MRI, functional MRI during sensory stimulation and during hand movement, TMS, motor function test.Perilesional reorganization of somatosensory function in 11 patients. Reorganization of motor function in the ipsilateral hemisphere in 5 individuals → dissociation motor-somatosensory. Correlation between fMRI activation and sensory deficit.

Bleyenheuft (2007) [40]12 unilateral CP, 10–16 yrs12 age-matched teenagersStructural and diffusion MRI.Correlation between corticospinal dysgenesis and upper limb impairment. DTI results correlated with stereognosis and digital and manual dexterities and abilities.

Hoon (2009) [24]21 spastic diplegia, 4 with spastic quadriplegia, 2 with hemiplegia, 1 with ataxic/hypotonic CP, 16 months–13 yrs35 age-matched, TD childrenDTI, perceptual tests of touch, proprioception, tests of strength and spasticity.All children with CP had periventricular white-matter injury. Injury in posterior thalamic radiation and descending corticospinal tracts. Injury on the posterior thalamic pathways correlated with touch threshold, proprioception, motor severity.

Wingert (2010) [31]10 spastic diplegia, 10–34 yrs10 age-matched participantsfMRI during tactile perceptual and discrimination tasks.Relative to controls the CP group showed less extensive cortical activation and lower magnitude of activation in areas associated to somatosensation and motor and attention-relevant cortical areas.

Nevalainen et al. (2012) [45]8 hemiplegic, mean age: 14.5 yrs8 age-matched TD childrenMEG, tests of somatosensory perception and discrimination.Ipsilateral (i.e., ipsilesional) somatosensory representation but altered SEP bilaterally. Altered morphology of median nerve evoked fields.

Rose (2011) [39]16 unilateral CPDiffusion and structural MRI.Reduced volume of ipsilesional precentral gyrus. Decreased ipsilesional corticospinal and corticothalamic pathways in comparison with contralesional ones. Sensorimotor thalamic projections better correlated with paretic hand motor function than corticospinal projections.

Maitre et al. (2012) [28]8 unilateral CP, 5–10 yrsERP to sham or air puff stimulation. Quality of upper extremity skill test. Two-point discrimination test. Measurement of stereognosis and grip strength.No differences in the responses associated with primary sensory cortex between the affected and unaffected hands. Differences in responses from secondary sensory cortex (larger N140 on the unaffected hemisphere). Larger latency of ipsilateral compared to contralateral P300.

Kurz (2014) [26]11 spastic diplegic or hemiplegic CP, 10–18 yrs11 age-matched TD childrenOscillatory activity (MEG) evoked by tactile stimulation of the foot. Measurement of errors during a match-to-target task with the foot.Desynchronization in somatosensory cortices in CP relative to synchronized activity in controls. Degree of synchronization negatively correlated with number of errors in match-to-target task.

Holmefur et al. (2013) [46]32 unilateral CP, 18 months–8 yrsComputerized tomography, structural MRI.Hand function predicted by pattern of damage and white matter damage. Better performance associated with absence of lesions in the thalamus or basal ganglia.

Englander (2013) [42]17 spastic bilateral CP, 1–5 yrsDiffusion MRI.Differences in total white matter connectivity throughout the brain and long-range connectivity between severe and moderate CP, but no differences in short-range connectivity. Reduction in white matter connectivity included sensorimotor and nonsensorimotor regions.

Daly et al. (2015) [43]Upper, lower, or both limbs affected, 20–58 yrs12 age-matched able-bodied adultsEEG: alpha ERD, phase synchrony, phase dynamics during motor imagery.Less ERD and less phase locking over motor cortex in CP.

Pannek (2014) [41]50 unilateral CP, 5–16 yrs17 age-matched TD children and teenagersDiffusion MRI, assisting hand assessment.Pathway integrity and connectivity reduced in CP compared to controls. Positive relationship between performance in bimanual tasks and integrity and connectivity in corticospinal and thalamocortical pathways.

Scheck (2014) [36]72 unilateral CP, 5–17 yrs19 age-matched TD children and teenagersStructural MRI.Reduction in grey matter volume in several subcortical structures in CP compared to controls.

Chinier (2014) [32]20 unilateral CPFunctional MRI of motor imagery task.Reduced activation for patients with right brain damage, with bilateral distribution of activation.

Kurz (2014) [26]9 spastic diplegia, 4 hemiplegia, mean age: 14 yrs 3 months13 age-matched TD childrenMEG during extension of knee joint.Higher beta event-related desynchronization before the onset of movement and lower gamma event-related synchronization at the onset of movement in CP relative to controls.

Kurz (2015) [27]4 spastic diplegia, 2 hemiplegia, 2 quadriplegia, 2 spastic, 12–18 yrs8 aged matched TD teenagersOscillatory activity (MEG) in response to tactile stimulation of the hand.Theta-alpha oscillations intact but increased beta activity in children with CP compared to controls, suggesting altered somatosensory processing.