Motor cortical functional geometry in cerebral palsy and its relationship to disability

T. M. Kesar, L. Sawaki, J. H. Burdette, M. N. Cabrera, K. Kolaski, B. P. Smith, T. M. O'Shea, L. A. Koman, G. F. Wittenberg

Research output: Contribution to journalArticlepeer-review

38 Scopus citations


Objective: To investigate motor cortical map patterns in children with diplegic and hemiplegic cerebral palsy (CP), and the relationships between motor cortical geometry and motor function in CP. Methods: Transcranial magnetic stimulation (TMS) was used to map motor cortical representations of the first dorsal interosseus (FDI) and tibialis anterior (TA) muscles in 13 children with CP (age 9-16. years, 6 males.) The Gross Motor Function Measure (GMFM) and Melbourne upper extremity function were used to quantify motor ability. Results: In the hemiplegic participants (N= 7), the affected (right) FDI cortical representation was mapped on the ipsilateral (N= 4), contralateral (N= 2), or bilateral (N= 1) cortex. Participants with diplegia (N= 6) showed either bilateral (N= 2) or contralateral (N= 4) cortical hand maps. The FDI and TA motor map center-of-gravity mediolateral location ranged from 2-8. cm and 3-6. cm from the midline, respectively. Among diplegics, more lateral FDI representation locations were associated with lower Melbourne scores, i.e. worse hand motor function (Spearman's rho = -0.841, p= 0.036). Conclusions: Abnormalities in TMS-derived motor maps cut across the clinical classifications of hemiplegic and diplegic CP. The lateralization of the upper and lower extremity motor representation demonstrates reorganization after insults to the affected hemispheres of both diplegic and hemiplegic children. Significance: The current study is a step towards defining the relationship between changes in motor maps and functional impairments in CP. These results suggest the need for further work to develop improved classification schemes that integrate clinical, radiologic, and neurophysiologic measures in CP.

Original languageEnglish
Pages (from-to)1383-1390
Number of pages8
JournalClinical Neurophysiology
Issue number7
StatePublished - Jul 2012

Bibliographical note

Funding Information:
The study was funded by USPHS Award R21 HD049019, G.F.W., P.I. The authors also thank Dr. Stuart Binder-Macleod, PT, PhD, FAPTA (University of Delaware) for supporting Dr. Kesar’s participation in this work.


  • Cerebral palsy
  • Motor function
  • Motor mapping
  • Transcranial magnetic stimulation (TMS)

ASJC Scopus subject areas

  • Sensory Systems
  • Neurology
  • Clinical Neurology
  • Physiology (medical)


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