Feedforward control in children with cerebral palsy and association with white matter integrity.

Background: Precise upper limb movements required for daily activities rely on feedback and feedforward control mechanisms. In children with cerebral palsy (CP), damage to white matter tracts impairs motor execution and sensorimotor control. Most studies in CP have focused on motor execution deficits, whereas the relationship between feedforward control alterations and white matter microstructure features has received less attention. Method: This study compared feedforward control during a grasp and lift task in 9 children with CP (diagnosis of hemiplegic CP with mild to moderate upper limb deficits) to 40 typically developing (TD) children aged 8 to 17 years. A secondary objective was to examine associations between feedforward control and the microstructural measures of corticocerebellar and other motor-planning related tracts. All participants completed 13 trials of the grasp and lift task. The CP group also underwent diffusion magnetic resonance imaging (MRI) using a 3-Tesla system to acquire anatomical and diffusion MRI. Results: Results showed feedforward control deficits in the non-dominant hand of children with CP, reflected by reduced peak force rates before sensory feedback was available and a lack of adaptation across trials. Strong correlations were observed between feedforward control and microstructural measures of the corticospinal tract and superior longitudinal fasciculus, but not with the corticocerebellar tracts. Conclusion: These findings suggest that broader sensorimotor processes, beyond feedforward control alone, contribute to force control deficits observed in children with CP.