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i want cut short it to 20 to 30 refernec which are main say my study is cross sectional BEHAVIORAL ASSESMENT OF INTERHEMISPHERIC CONNECTION IN SCHOOL AGED CHILDREN USING TASK-BASED MEASURES: A CROSS-SECTIONAL OBSERVATIONAL STUDY REFERENCE: 1. Gazzaniga MS. Cerebral specialization and interhemispheric communication: Does the corpus callosum enable the human condition? Brain. 2000;123(7):1293-1326. 2. Aboitiz F, Scheibel AB, Fisher RS, Zaidel E. Fiber composition of the human corpus callosum. Brain Res. 1992;598(1-2):143-153. 3. Sperry RW. Hemisphere deconnection and unity in conscious awareness. Am Psychol. 1968;23(10):723-733. 4. Hofer S, Frahm J. Topography of the human corpus callosum revisited: Comprehensive fiber tractography using diffusion tensor magnetic resonance imaging. Neuroimage. 2006;32(3):989-994. 5. Giedd JN, Blumenthal J, Jeffries NO, Rajapakse JC, Vaituzis AC, Liu H, et al. Development of the human corpus callosum during childhood and adolescence: a longitudinal MRI study. Prog Neuropsychopharmacol Biol Psychiatry. 1999;23(4):571-588. 6. Reuter EM, Voelcker-Rehage C, Vieluf S, Godde B. Behavioural measures of interhemispheric communication in children and adolescents: a systematic review. Dev Neuropsychol. 2020;45(3):123-145. 7. Banich MT. The missing link: the role of interhemispheric interaction in attentional processing. Brain Cogn. 1998;36(2):128-157. 8. Chicoine AJ, Proteau L, Bherer L. Intermanual transfer of learned visuomotor sequences in children and adults. Dev Sci. 2000;3(1):55-68. 9. Lassonde M, Sauerwein HC, Chicoine AJ, Geoffroy G. Absence of disconnexion syndrome in callosal agenesis and early callosotomy: brain reorganization or lack of structural specificity during ontogeny? Neuropsychologia. 1991;29(6):481-495. 10. Fagard J. The development of bimanual coordination. In: Swinnen SP, Massion J, Heuer H, Casaer P, editors. Interlimb Coordination: Neural, Dynamical, and Cognitive Constraints. San Diego: Academic Press; 1994. p. 391-414. 11. Corbetta D, Thelen E. The developmental origins of bimanual coordination: a dynamic perspective. J Exp Psychol Hum Percept Perform. 1996;22(2):502-522. 12. Gooijers J, Swinnen SP. Interactions between brain structure and behaviour: the corpus callosum and bimanual coordination. Neurosci Biobehav Rev. 2014;43:1-19. 13. Mayston MJ, Harrison LM, Stephens JA. A neurophysiological study of mirror movements in adults and children. Ann Neurol. 1999;45(5):583-594. 14. Cincotta M, Ziemann U. Neurophysiology of unimanual motor control and mirror movements. Clin Neurophysiol. 2008;119(4):744-762. 15. Bloom JS, Hynd GW. The role of the corpus callosum in interhemispheric transfer of information: excitation or inhibition? Neuropsychol Rev. 2005;15(2):59-71. 16. Roland JL, Snyder AZ, Hacker CD, Miezin FM, Petersen SE, Raichle ME, et al. On the role of the corpus callosum in interhemispheric functional connectivity in humans. Proc Natl Acad Sci U S A. 2017;114(50):13278-13283. 17. Westerhausen R, Hugdahl K. The corpus callosum in dichotic listening studies of hemispheric asymmetry: a review of clinical and experimental evidence. Neurosci Biobehav Rev. 2010;32(5):1044-1054. 18. Beeman MJ, Chiarello C. Complementary right- and left-hemisphere language comprehension. Curr Dir Psychol Sci. 1998;7(1):2-8. 19. Sacco K, Cauda F, Cerliani L, Mate D, Duca S, Geminiani GC. Reorganization of the motor system in left-handers: the role of bimanual coordination. Neuropsychologia. 2006;44(8):1434-1442 20. Larsen N, Craig BT, Hilderley AJ, Carlson HL, Minns RA, Lebel C, et al. Frontal interhemispheric structural connectivity, attention, and executive function in children with perinatal stroke. Brain Behav. 2022;12(1):e02411. 21. Kosslyn SM, Koenig O, Barrett A, Cave CB, Tang J, Gabrieli JDE. Evidence for two types of spatial representations: hemispheric specialization for categorical and coordinate relations. J Exp Psychol Hum Percept Perform. 1989;15(4):723-735. 22. Parlatini V, Itahashi T, Lee Y, Liu S, Nguyen HT, Aoki YY, et al. White matter alterations in Attention-Deficit/Hyperactivity Disorder (ADHD): a systematic review of 129 diffusion imaging studies with meta-analysis. Mol Psychiatry. 2023;28:4697-4710. 23. Booth R, Wallace GL, Happé F. Connectivity and the corpus callosum in autism spectrum conditions: insights from comparison of autism and callosal agenesis. Prog Brain Res. 2011;189:209-218. 24. Westerhausen R, Groth-Marnat G, Hugdahl K, Ek J, Lundervold AJ, Lundervold A. Structural and functional development of the corpus callosum: a longitudinal MRI study of shape-based analysis and interhemispheric transfer in children aged 6–8 years. Neuropsychologia. 2011;49(12):3377-3389. 25. Hugdahl K. Dichotic listening: probing temporal lobe functional integrity. Brain Cogn. 2003;53(2):101-106. 26. Huttenlocher PR, Dabholkar AS. Regional differences in synaptogenesis in human cerebral cortex. J Comp Neurol. 1997;387(2):167-178. 27. Innocenti GM, Price DJ. Exuberance in the development of cortical networks. Nat Rev Neurosci. 2005;6(12):955-965. 28. Corballis MC. Left brain, right brain: facts and fantasies. PLoS Biol. 2014;12:e1001767. 29. Knecht S, Dräger B, Deppe M, Bobe L, Lohmann H, Flöel A, et al. Handedness and hemispheric language dominance in healthy humans. Brain. 2000;123:2512-2518. 30. Oldfield RC. The assessment and analysis of handedness: the Edinburgh Inventory. Neuropsychologia. 1971;9:97-113. 31. Szaflarski JP, Binder JR, Possing ET, McKiernan KA, Ward BD, Hammeke TA. Language lateralization in left-handed and ambidextrous people: an fMRI study. Neurology. 2002;59:238-244. 32. Cai Q, Van der Haegen L, Brysbaert M. Complementary hemispheric specialization for language production and visuospatial attention. Proc Natl Acad Sci U S A. 2013;110:E322-E330 33. Fabri M, Polonara G. Functional topography of human corpus callosum: an fMRI mapping study. Neural Plast. 2013;2013:251308. 34. Poffenberger AT. Reaction time to retinal stimulation with special reference to the time lost in conduction through nerve centres. Arch Psychol. 1912;23:1-73. 35. Marzi CA, Bisiacchi P, Nicoletti R. Is interhemispheric transfer of visuomotor information asymmetric? Evidence from a meta-analysis. Neuropsychologia. 1991;29(12):1163-1177. 36. Barnea A, Rassis A, Zaidel E. Effect of age on interhemispheric coordination. Dev Neuropsychol. 2005;28(1):533-546. 37. Delvenne JF, Castronovo J, Demeyere N, Riddoch JM. Bilateral field advantage in visual enumeration. PLoS One. 2011;6(3):e17743. 38. Salamy A. Commissural transmission: maturational changes in humans. Science. 1978;200(4348):1409-1411. 39. Serrien DJ, Ivry RB, Swinnen SP. Dynamics of hemispheric specialisation and integration in the context of motor control. Nat Rev Neurosci. 2006;7(2):160-166. 40. Marzi CA. The Poffenberger paradigm: a tool to study interhemispheric transmission time. Neuropsychol Rev. 1999;9(3):157-169. 41. Reed CL, Caselli RJ, Farah MJ. Tactile agnosia: underlying impairment and implications for normal tactile object recognition. Brain. 1996;119(3):875-888. 42. Geffen GM, Jones DL, Geffen LB. Interhemispheric transfer of information and manual asymmetries in tactile naming. Neuropsychologia. 1994;32(4):429-440. 43. Benton AL, Hamsher KD, Varney NR, Spreen O. Contributions to Neuropsychological Assessment. New York: Oxford University Press; 1983. 44. Innocenti GM. General organization of callosal connections in the cerebral cortex. In: Jones EG, Peters A, editors. Cerebral Cortex. Vol. 5. New York: Plenum Press; 1986. p. 291-353. 45. Temple CM, Jeeves MA. Interhemispheric transfer in children with agenesis of the corpus callosum. Brain Lang. 1989;37(4):548-564. 46. Swinnen SP. Intermanual coordination: from behavioural principles to neural-network interactions. Nat Rev Neurosci. 2002;3(5):348-359. 47. Wahl M, Lauterbach-Soon B, Hattingen E, Jung P, Singer O, Volz S, et al. Human motor corpus callosum: topography, somatotopy, and link between microstructure and function. J Neurosci. 2007;27(45):12132-12138. 48. Wolff PH, Hurwitz I, Moss HA. Serial organization of motor skills in children: development of bimanual coordination. Dev Med Child Neurol. 1983;25:378-387. 49. Muetzel RL, Collins PF, Mueller BA, Schissel AM, Lim KO, Luciana M. The development of corpus callosum microstructure and associations with bimanual task performance in healthy adolescents. Neuroimage. 2008;39(4):1918-1925. 50. Parlatini V, Itahashi T, Lee Y, Liu S, Nguyen HT, Aoki YY, et al. White matter alterations in Attention-Deficit/Hyperactivity Disorder (ADHD): a systematic review and meta-analysis. Mol Psychiatry. 2023;28:4697-4710. 51. Kennerley SW, Diedrichsen J, Hazeltine E, Semjen A, Ivry RB. Callosotomy patients exhibit temporal uncoupling during continuous bimanual movements. Nat Neurosci. 2002;5(4):376-381. 52. Uehara K, Morishita T, Kubota S, Funase K. Interhemispheric interactions during bimanual coordination: a review. Front Hum Neurosci. 2014;8:951. 53. Wahl M, Lauterbach-Soon B, Hattingen E, Jung P, Singer O, Volz S, et al. Human motor corpus callosum: topography, somatotopy, and link between microstructure and function. J Neurosci. 2007;27(45):12132-12138. 54. Tiffin J, Asher EJ. The Purdue Pegboard: norms and studies of reliability and validity. J Appl Psychol. 1948;32(3):234-247. 55. Kelso JAS. Phase transitions and critical behavior in human bimanual coordination. Am J Physiol. 1984;246:R1000-R1004. 56. Mayston MJ. Mirror movements in children: developmental and pathological aspects. Dev Med Child Neurol. 2001;43(9):583-588. 57. Weinstein M, Green D, Geva R, Schertz M. Interhemispheric and intrahemispheric connectivity and manual performance in children with unilateral cerebral palsy. Neurorehabil Neural Repair. 2014;28(6):509-518. 58. Henderson SE, Sugden DA, Barnett AL. Movement Assessment Battery for Children-2 (MABC-2). 2nd ed. London: Pearson Assessment; 2007. 59. Gooijers J, Caeyenberghs K, Sisti HM, Geurts M, Heitger MH, Leemans A, et al. Diffusion tensor imaging metrics of corpus callosum microstructure are associated with bimanual coordination performance. Hum Brain Mapp. 2013;34(5):1261-1275.

The human brain is a bilaterally organized structure into two hemispheres, where each hemisphere performs different yet similar functions. Even though each hemisphere operates in its own way, coordination is necessary to ensure smooth functioning in activities such as movement, perception and thought.1. The corpus callosum, which is the largest bundle of white matter in the brain, facilitates communication between the two hemispheres.2. Without such connectivity, each hemisphere functions independently, causing chaos and confusion in behaviour3. It enables the transfer of sensory, motor and cognitive information from left to right hemispheres and vice versa 1. It has about 190 to 250 million myelinated axons, which are like tiny wires that help send messages between the two halves of the brain.2. The corpus callosum consists of several parts, each having a particular function. The rostrum, body, isthmus, and splenium perform certain functions. The genu connects the prefrontal cortices and enables planning and decision-making skills. The body connects motor and premotor areas allowing coordination of the two hands. The splenium, located on the posterior end, connects the areas of sensory, perception, vision and spatial orientation4. This ensures that the information is exchanged between the two brain halves quickly and effectively.1 The corpus callosum develops gradually and starts developing from birth to early adulthood. It develops rapidly at age 3 to 10 years, which is the period when children develop significant progress in their fine motor skills, hand to hand coordination and sensory-motor processing. If this process is disturbed, it may result in hand coordination problems, movement control difficulties and concentration problems.5 The period of ages 6 to 12 is critical in terms of interconnectivity and synchronisation of two hemispheres, according to developmental neuroscience. Evidence for this is also provided in terms of behavioural studies6. The research by Chicoine et al. revealed that children aged 6-7 could not transfer a newly acquired skill from one hand to another similarly to individuals with poor connectivity of the brain’s hemispheres7. On the contrary, children aged 11-12 showed high ability to perform skills from both hands, similarly to healthy adults. Coordination from both hands also dramatically by age8. Mirror movements, which involve uncontrolled movement of one hand affecting the other hand, occur frequently in small children but gradually decrease over the course of this developmental period.9 Brain connectivity between the two hemispheres of the brain serves two principal purposes-one for facilitating the exchange of information between the two hemispheres, while the other prevents any one hemisphere from being hyperactive, allowing the brain to carry out multiple functions efficiently10. In cases of children who are enrolled in schools, brain connectivity plays a vital role in developing various abilities11, including the ability to coordinate movements of both sides of the body simultaneously, which is necessary for writing, painting and physical activities8. ADHD13 and autism spectrum disorder are some of the developmental disorders often associated with brain connectivity.14 A longitudinal study was performed on the development of structural and functional properties of the corpus callosum in children aged 6-8 years24. They used a specific method to look at the shape-based analysis of the mid-sagittal corpus callosum alongside a dichotic consonant-vowel syllable discrimination task as a measure of interhemispheric information transfer 24,25, these authors found that increases in isthmus thickness were paradoxically associated with decreases in transfer efficiency while decreases in isthmus thickness corresponded to improved transfer21 This result was interrupted by authors as an example of a developmental process of synaptic pruning. Synaptic pruning is responsible for increasing the efficiency and speed of interhemispheric communication of the brain hemispheres.26,27 The human brain exhibits functional hemispheric specialisation, with the left hemisphere being dominant for language in most individuals 28. Handedness represents one of the simplest and the most extensively researched approaches to investigate the differences in the functionality of the two brain hemispheres in terms of motor activity 29. The Edinburgh handedness inventory introduced by Oldfield in 1971 is considered to be the primary instrument for measuring the preference to use either hand while performing different routine actions 30. This test generates the Laterality Quotient (LQ) index, which allows classification of people as right-handed, left-handed and ambidextrous30. Handedness is also related to the dominance of the certain hemispheres in performing the language functions 31. While the language processing is located in left brain hemispheres in most cases among the right-handed population, left-handed people may show more variability in this aspect 31. Thus, it is critical to know about the person’s handedness before carrying out any investigation on the inter-hemispheric coordination in order to take into account the individual peculiarities of brain functioning and its lateralisation32 Assessing Interhemispheric communication via behavioural paradigms: In contrast to neuroimaging, behavioural assessment does not require special equipment, cost less involves no harm to the individual and is closer to real life conditions than neuroimaging does33.it allows measuring interhemispheric communication in children33,34. Many of such tests were successfully used on children33,34.“The Poffenberger test”, introduced in 1912 requires participants to respond with either left or right hand to visual stimuli presented unilaterally to either the left or right hand to visual field35. When someone sees something in their left vision, the brain information usually goes to the right side of the brain. If they use right hand to respond, that means the brain had to send the signal across the corpus callosum. In case if they use left hand then it means that no crossing was necessary36,37. The difference in reaction time for two types of reactions is known as crossed-uncrossed difference (CUD) and serves as an indicator of how fast and efficient is visual and motor brain hemispheres interaction 36. For adults, the average CUD is about 1-2milliseconds 36. For children, these values decrease over time which proves their increasing ability to communicate via brain hemispheres38. The CUD correlates with the anatomy of the corpus callosum, as shown in DTI studies39 In this literature, three complementary behavioural paradigms using non-invasive measures of interhemispheric function have been identified as valid 40. Tactile inter-manual transfer: Tactile inter-manual transfer is the ability to identify or replicate an object that was explored tactually by another hand without visual guidance. This process occurs because touch perception is mediated by the contralateral hemisphere of the brain 41. For inter-manual transfer to be achieved, tactile information should be transmitted between hemispheres via the corpus callosum42. This activity reveals the efficiency of interhemispheric connection of the corpus callosum in relation to tactile function. The most frequently used test to assess this function is the fingertip cross-lateralisation test. During this test, a finger of one hand is stimulated, and a child has to indicate the corresponding finger on another hand. The accuracy obtained in the inter-manual transfer condition relative to the intra-manual comparison reveals the efficiency of the information transfer through the corpus callosum43. As the children grow older, the efficiency of performance increases, which corresponds to the maturation of myelin of the posterior portion of the corpus callosum44. The children with various disorders such as corpus callosum agenesis, brain injury, cerebral palsy and down syndrome fail this task.45 Bimanual tapping; this task includes the use of both hands for tapping simultaneously or alternately46. To ensure coordination in the timing of movements produced by the left and right hands, the midbody of the corpus callosum that connects the two major motor areas and the supplementary motor areas is used46,47. The main method for assessing this coordination is through the analysis of inter-tap asynchrony (ITA), which is the difference in the duration between the matching taps of both hands46. The lower the ITA, the greater the synchronicity of work performed by both hands. Synchronous tapping is easier because it is performed simultaneously by both hands. But alternating tapping requires additional coordination between the hemispheres of the brain and clearly demonstrates of the brain and clearly demonstrates the immaturity of connections between them47. At the age 6 to 7years, children have a high level of ITA and frequent errors in the timing of tapping. At the age of 10- 12 years, their tapping performance approaches that of adults48. Using DTI studies, researchers discovered that high levels of fractional anisotropy within the midbody of the corpus callosum are associated with superior tapping coordination49. Among those who suffer from ADHD, high ITA is evident, just like the results demonstrating underdevelopment of the corpus callosum in children with ADHD50. Bimanual coordination: refers to the process whereby both hands work simultaneously in a well- timed manner51. This function is supported by brain structures such as the corpus callosum including its midbody and splenium, SMA and temporal circuits in the cerebellum52. The two functions of the corpus callosum are to transmit time signals from one hemisphere of the brain to another (excitatory) and prevent one hand from working as the other is performing an unrelated activity(inhibitory)53. In clinical practise, clinicians assess bimanual coordination through tests such as the Purdue pegboard bimanual assembly, box and block test and kinematic drawer- opening tasks54. If both hands perform the same actions, such actions appear earlier in development and do not require assistance from corpus callosum55. However, when each hand performs different actions, the process requires an active contribution from the corpus callosum and appears later in the school years. The mirror movements of one hand without intention are common up until age 7 or 8; however, the continuation of these movements indicates the malfunction of the corpus callosum, which prevents unwanted movements56. DTI research in children suffering from CP proves that the condition of the splenium of the corpus callosum is correlated with the skills of bimanual coordination.57 It means that the brain structure affects this skill significantly57. Bimanual coordination disorders are also one of the symptoms of the Developmental Coordination Disorder (DCD); it is checked as a part of the MABC-2 tests58 Despite the increasing number of studies on the role of interhemispheric connection in child development, there are very few comprehensive behavioural assessments using multiple corpus callosum-based tasks and normative data, particularly for Indian school-aged children, which remain limited58. Therefore, this cross-sectional observational study aimed to profile interhemispheric communication in typically developing children aged 6-12years using the tactile inter-manual transfer, bimanual tapping and bimanual coordination tasks and to establish preliminary criteria that could be used for assessing hemispheric interaction-related problems by physiotherapists59 short cut this to 3 pages and refernce also to 30 as per above given alot the vancouver style

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