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Abstract
The purpose of this dissertation was to examine the influence of motor control impairments and aberrant prefrontal cortex (PFC) activity on upper limb dysfunction in children with cerebral palsy (CP) during goal-directed actions. A multimodal framework combined robotic assessments with mobile functional neuroimaging using functional near-infrared spectroscopy (fNIRS) to investigate brain–behavior relationships during naturalistic, time-constrained reaching and interception tasks. The first aim was to determine whether children with CP displayed impaired motor performance and planning during stationary target reaching and moving target interception, and to assess if deficits varied across time constraints. Children with CP exhibited task- and limb-specific impairments in reaching accuracy, trajectory planning, and response preparedness, with deficits more pronounced in the non-preferred arm and under stricter time restrictions. The second aim was to assess relationships between robotic metrics and established clinical measures of manual ability. Results indicated robotic metrics recorded under high time pressure were directly and moderately related to manual ability in children with CP. The third aim was to determine PFC activity during time-constrained reaching and assess its relationship to reaching accuracy. An atypical pattern of suppressed PFC activity was observed in CP, with increased PFC recruitment moderate-strongly related to improved motor accuracy, with relationships more pronounced across temporal constraints for the ipsilateral PFC. The fourth aim was to determine PFC activity patterns during time-constrained interception, and to assess their relationship to robotic metrics of interception planning and performance. Children with CP exhibited atypical patterns of suppressed contralateral PFC activity and ipsilateral PFC dominance with the non-preferred arm, with greater contralateral activity and higher ipsilateral dominance both related to faster responses in this group.These findings provide compelling evidence that children with CP exhibit persistent, limb-specific, and context-dependent impairments in motor planning and execution, that are influenced by altered cortical activation patterns. Robotic metrics sensitively reflect functional capacity, while PFC activity offers a potential biomarker for adaptive versus maladaptive compensatory strategies. These results lay the empirical groundwork for the development of individualized interventions that are informed by personalized profiles of motor behavior and brain function.