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Evaluation of Gross and Fine Motor Functions in Children With Hemidecortication: Predictors of Outcomes and Timing of Surgery

Department of Rehabilitation Services, The Hospital for Sick Children, chantal.graveline{at}mailhub.sickkids.on.ca

Paul Hwang, MD, MSc

Department of Paediatrics, and Medicine/Neurology The Hospital for Sick Children

Gillian Bone, BScPT

Department of Rehabilitation Services, The Hospital for Sick Children

Carey Shikolka, BScOT

Department of Rehabilitation Services, The Hospital for Sick Children

Shawna Wade, BMROT (C)

Department of Rehabilitation Services, The Hospital for Sick Children

Adrian Crawley, PhD

Department of Medical Imaging the Toronto Hospital, Western Division, Toronto, ON, Canada

David Mikulis, MD

Department of Medical Imaging the Toronto Hospital, Western Division, Toronto, ON, Canada

The purpose of this study is three-fold: First, to determine the levels of gross and fine motor functions in children before and after hemidecortication, using standardized measurement tools; second, to investigate if predictors of these outcomes can be characterized; and third, to explore if both clinical measures and functional magnetic resonance imaging (MRI) potentially can identify optimal timing of surgery. The Gross Motor Function Measure and the Quality of Upper Extremity Skills Test are shown to be comprehensive, standardized outcome measures of movement performance in affected children. Age at surgery and interval between age at seizure onset and age at surgery could be the most reliable predictors of clinical outcomes. Functional MRI studies are valuable in exploring the potential of the cortical reorganization that sustains residual sensorimotor function. The combination of clinical measures with functional MRI is a promising method of inquiry into developmental and plasticity processes. (J Child Neurol 1999;14:304-315).

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