The study can lead to effective strategies for the rehabilitation of children with arthrogryposis

HSE researchers have joined researchers at the Turner Pediatric Orthopedics Research Institute to study how the brains of children with arthrogryposis control elbow flexion after a muscle transplant. They found that such patients had more motor neuron activity, which meant that starting a new movement required more effort from the brain. The report “Feasibility and Challenges of Magnetoencephalography Experiments in Children with Multiplex Congenita Arthrogryposis” was published in Limits in pediatrics.

The study is part of a grant from the Russian Science Foundation, led by Iro Jaaskelainen, academic director of the International Laboratory of Social Neurobiology.

Arthrogryposis is a congenital disease of the musculoskeletal system that causes deformity of the limbs, underdeveloped joints and muscles and limited movement. One in every 10,000 newborns is born with multiplex congenital arthritis (AMC). The disease does not progress with age and does not affect the child’s cognitive abilities.

It is important for people with arthrogryposis to restore the ability to bend the elbow, which can help the individual take care of themselves. This is facilitated by the transplantation of muscles capable of controlling the folding of the elbow. In such cases, it is necessary to teach the patient’s brain to control the limb in a way that was not previously possible. The brain does not know this pattern of movement, because it was not previously produced by the individual in his daily activities.

The study of brain activity associated with elbow flexion allows the development of effective methods for the rehabilitation of people with arthrogryposis after muscle transplantation. Such studies have rarely been performed in children, despite the fact that from year to year the age of each patient undergoing autotransplant surgery decreases and more information is needed on the brain activity of young patients with AMC, which may differ significantly from this of adults.

To bridge this gap, researchers at the HSE Institute for Cognitive Neuroscience studied sensorimotor function in children with AMC compared with healthy age and adult controls. They invited four children with AMC and five healthy children aged 5-10 to the joint MSUPE-HSE MEG Center, equipped with a unique 306-channel magnetoencephalography (MEG). Three of the four children with arthrogryposis have previously undergone a muscle transplant to restore elbow flexion.

The participants in the experiment were asked to sit at a table and bring their hand to their mouths after hearing a voice command from a researcher imitating the process of eating. Meanwhile, their brain activity is recorded using MEG. Each participant was asked to perform 80 movements – 40 with each hand.

The combined MRI-MEG analysis of the sources of brain activity showed that in arthrogryposis patients who underwent muscle transplantation, bilateral cortical activation accompanying arm movement was predominant compared to contralateral activation in healthy controls. Also, in patients with AMC, cortical sensorimotor activity is less limited to physiologically significant areas of the sensorimotor cortex than in healthy children and adults.

Meanwhile, AMC movements are less precise and slower than healthy control groups.

Bilateral cortical activity can be explained by the relative difficulty of initiating movement in children with movement disorders: patients with AMC with arthrogryposis may need to engage more motor neurons in this task. “

Evgeniy Blagoveshchenski, co-author of the study and senior research associate, HSE Institute for Cognitive Neuroscience

The dynamics of brain activity in patients with AMC are different from those in healthy control groups: brain responses to movement extend over a longer period of time. The slower the patient’s movement, the more extensive the model of generalized activity that accompanies him. This is probably due to the involvement of a complex compensatory mechanism in the process of bending the elbow.

According to the researchers, because starting movement is the most difficult for children with arthrogryposis after muscle transplantation, possible rehabilitation strategies may include non-invasive brain stimulation, which would facilitate their starting movement.


National Research University Higher School of Economics

Reference in the magazine:

Golosheykin, S.A., et al. (2021) Feasibility and challenges in performing magnetoencephalography experiments in children with Arthrogryposis Multiplex Congenita. Limits in pediatrics.

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