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Atypical brain development and early brain injury have profound and long lasting impact on the development, skill acquisition, and subsequent independence of a child. Heterogeneity is present at the brain level and at the motor level; particularly with respect to phenomena of bilateral activation and mirrored movements (MMs). In this multiple case study we consider the feasibility of using several modalities to explore the relationship between brain structure and/or activity and hand function: Electroencephalography (EEG), both structural and functional Magnetic Resonance Imaging (sMRI, fMRI), diffusion tensor imaging (DTI), transcranial magnetic stimulation (TMS), Electromyography (EMG) and hand function assessments. Methods 15 children with unilateral CP (ages: 9.4 ± 2.5 years) undertook hand function assessments and at least two additional neuroimaging and/or neurophysiological procedures: MRI/DTI/fMRI (n = 13), TMS (n = 11), and/or EEG/EMG (n = 8). During the fMRI scans and EEG measurements, a motor task was performed to study cortical motor control activity during simple hand movements. DTI tractography analysis was used to study the corpus-callosum (CC) and cortico-spinal tracts (CST). TMS was used to study cortico-spinal connectivity pattern. Results Type and range of severity of brain injury was evident across all levels of manual ability with the highest radiological scores corresponded to children poorer manual ability. Evidence of MMs was found in 7 children, mostly detected when moving the affected hand, and not necessarily corresponding to bilateral brain activation. When moving the affected hand, bilateral brain activation was seen in 6/11 children while 3/11 demonstrated unilateral activation in the contralateral hemisphere, and one child demonstrated motor activation predominantly in the supplementary motor area (SMA). TMS revealed three types of connectivity patterns from the cortex to the affected hand: a contralateral (n = 3), an ipsilateral (n = 4) and a mixed (n = 1) connectivity pattern; again without clear association with MMs. No differences were found between children with and without MMs in lesion scores, motor fMRI laterality indices, CST diffusivity values, and upper limb function. In the genu, midbody, and splenium of the CC, higher fractional anisotropy values were found in children with MMs compared to children without MMs. The EEG data indicated a stronger mu-restoration above the contralateral hemisphere in 6/8 children and above the ipsilateral hemisphere in 2/8 children. Conclusion The current results demonstrate benefits from the use of different modalities when studying upper-limb function in children with CP; not least to accommodate to the variations in tolerance and feasibility of implementation of the differing methods. These exposed multiple individual brain-reorganization patterns corresponding to different functional motor abilities. Additional research is warranted to understand the transactional influences of early brain injury, neuroplasticity and developmental and environmental factors on hand function in order to develop targeted interventions. [ABSTRACT FROM AUTHOR]

Older nursing home residents are often characterized by multimorbidity and dependency in activities of daily living. Most exercise studies in this setting aim at residents who are still able to walk despite the huge group of residents that is unable to walk. Thus, little is known about the effectiveness to improve cognitive and motor functions as well as well-being within this target group, e.g., by use of chair-based exercises. The aim of this study was to determine the effects of a 16-week multicomponent chair-based exercise intervention on motor functions, cognition and well-being for nursing home residents who are unable to walk. A two-arm single-blinded multicenter randomized controlled trial integrated N = 52 nursing home residents with a mean age of 81 ± 11 years (63% female), randomly assigned to a training (n = 26, 16 weeks; twice a week; 60 min) or a wait-list control group (n = 26). The intervention followed the F.I.T.T. principles (frequency, intensity, time and type) and was continuously adapted to residents' performance level. The outcomes motor function (hand grip strength, sitting balance, manual dexterity), cognitive performance (cognitive status, working memory) and psychosocial resources (physical and mental well-being (SF12), satisfaction with life (SWLS), depressive symptoms (CES-D)) were assessed at baseline (pre-test) and after 16-weeks (post-treatment). Statistics were performed using ANOVA for repeated measures. The results of the ANOVA showed significant improvements of the intervention group for hand grip strength (Pre: M = 12.67, SD = 5.28; Post: M = 13.86, SD = 4.79; Group × Time: F (1, 17) = 10.816, p =.002, η p 2 = 0.241), manual dexterity (Pre: M = 4.50, SD = 5.17; Post: M = 5.30, SD = 4.25; Group × Time: F (1, 7) = 9.193, p =.008, η p 2 = 0.365), cognition (Pre: M = 10.31, SD = 6.87; Post: M = 11.06, SD = 7.50; Group × Time: F (1, 15) = 12.687, p =.001, η p 2 = 0.284), and depression (Pre: M = 5.19, SD = 5.12; Post: M = 4.38, SD = 4.62; Group × Time: F (1, 14) = 5.135, p =.031, η p 2 = 0.150) while the values of the control group decreased. The multicomponent chair-based intervention over 16 weeks was able to improve motor functions and cognition in nursing home residents who are unable to walk. Other psychological factors remained stable within the intervention group, which can be interpreted as a good result for this target group. All of the investigated parameters showed a significant decrease in the control group. The intervention seemed to cause physiological adaptations even in very old age. Study results encourage to further differentiate the heterogeneous group of nursing home residents concerning mobility aspects and to include chair-based interventions as feasible program to prevent further decline of functional performance and maintain independence in activities of daily living for a better physical and mental well-being. • Despite mobility impairments, nursing home residents have motor, cognitive, and psychosocial resources which should be fostered. • Motor functions, cognitive performance, and well-being were assessed in both study groups at baseline and after 16 weeks (post-treatment). • A chair-based exercise intervention for nursing home residents who are unable to walk improves motor functions and cognition. • Chair-based exercise interventions should be designed with constantly adapted progression. • This study contributes to the scientifically underrepresented group of nursing home residents who are unable to walk. [ABSTRACT FROM AUTHOR]