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Poitras I, Dukelow SP, Campeau-Lecours A, Mercier C. Robotic assessment of bilateral and unilateral upper limb functions in adults with cerebral palsy. J Neuroeng Rehabil 2024; 21:144. [PMID: 39169408 PMCID: PMC11340066 DOI: 10.1186/s12984-024-01415-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 07/04/2024] [Indexed: 08/23/2024] Open
Abstract
BACKGROUND Children with unilateral cerebral palsy (CP) exhibit motor impairments predominantly on one side of the body, while also having ipsilesional and bilateral impairments. These impairments are known to persist through adulthood, but their extent have not been described in adults with CP. This study's aim is to characterize bilateral and unilateral upper limbs impairments in adults with CP. METHODS Nineteen adults with CP (34.3 years old ± 11.5) performed three robotic assessments in the Kinarm Exoskeleton Lab, including two bilateral tasks (Object Hit [asymmetric independent goals task] and Ball on Bar [symmetric common goal task]) and one unilateral task (Visually Guided Reaching, performed with the more affected arm [MA] and less affected arm [LA]). Individual results were compared to sex, age and handedness matched normative data, describing the proportion of participants exhibiting impairments in each task-specific variable (e.g., Hand speed), each performance category (e.g., Feedforward control) and in global task performance. Associations were assessed using Spearman correlation coefficients between: 1: the results of the MA and LA of each limb in the unilateral task; and 2: the results of each limb in the unilateral vs. the bilateral tasks. RESULTS The majority of participants exhibited impairments in bilateral tasks (84%). The bilateral performance categories (i.e., Bimanual) identifying bilateral coordination impairments were impaired in the majority of participants (Object Hit: 57.8%; Ball on Bar: 31.6%). Most of the participants were impaired when performing a unilateral task with their MA arm (63%) and a smaller proportion with their LA arm (31%). The Feedforward control was the unilateral performance category showing the highest proportion of impaired participants while displaying the strongest relationship between the MA and LA arms impairments (rs = 0.93). Feedback control was the unilateral performance category most often associated with impairments in bilateral tasks (6 out of 8 performance categories). CONCLUSIONS Adults with CP experienced more impairment in bilateral tasks while still having substantial impairments in unilateral tasks. They frequently display Feedforward control impairments combined with a higher reliance on Feedback control during both bilateral and unilateral tasks, leading to poorer motor performance.
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Affiliation(s)
- I Poitras
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, Quebec, Canada
- School of Rehabilitation Sciences, Laval University, Quebec City, Quebec, Canada
| | - S P Dukelow
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - A Campeau-Lecours
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, Quebec, Canada
- Department of Mechanical Engineering, Laval University, Quebec City, Quebec, Canada
| | - C Mercier
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec City, Quebec, Canada.
- School of Rehabilitation Sciences, Laval University, Quebec City, Quebec, Canada.
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Rozaire J, Paquin C, Henry L, Agopyan H, Bard-Pondarré R, Naaim A, Duprey S, Chaleat-Valayer E. A systematic review of instrumented assessments for upper limb function in cerebral palsy: current limitations and future directions. J Neuroeng Rehabil 2024; 21:56. [PMID: 38622731 PMCID: PMC11020208 DOI: 10.1186/s12984-024-01353-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 04/03/2024] [Indexed: 04/17/2024] Open
Abstract
INTRODUCTION Recently, interest in quantifying upper limb function in cerebral palsy has grown. However, the lack of reference tasks and protocols, have hindered the development of quantified movement analysis in clinical practice. This study aimed to evaluate existing instrumented assessments of upper limb function in cerebral palsy, with a focus on their clinical applicability, to identify reasons for the lack of adoption and provide recommendations for improving clinical relevance and utility. METHODS A systematic review was conducted by a multidisciplinary team of researchers and clinicians (Prospero CRD42023402382). PubMed and Web of Science databases were searched using relevant keywords and inclusion/exclusion criteria. RESULTS A total of 657 articles were initially identified, and after the selection process, 76 records were included for analysis comprising a total of 1293 patients with cerebral palsy. The quality assessment of the reviewed studies revealed a moderate overall quality, with deficiencies in sample size justification and participant information. Optoelectronic motion capture systems were predominantly used in the studies (N = 57/76). The population mainly consisted of individuals with spastic cerebral palsy (834/1293) with unilateral impairment (N = 1092/1293). Patients with severe functional impairment (MACS IV and V) were underrepresented with 3.4% of the 754 patients for whom the information was provided. Thirty-nine tasks were used across the articles. Most articles focused on unimanual activities (N = 66/76) and reach or reach and grasp (N = 51/76). Bimanual cooperative tasks only represented 3 tasks present in 4 articles. A total of 140 different parameters were identified across articles. Task duration was the most frequently used parameter and 23% of the parameters were used in only one article. CONCLUSION Further research is necessary before incorporating quantified motion analysis into clinical practice. Existing protocols focus on extensively studied populations and rely on costly equipment, limiting their practicality. Standardized unimanual tasks provide limited insights into everyday arm use. Balancing methodological requirements and performance evaluation flexibility is a challenge. Exploring the correlation between outcome parameters and therapeutic guidance could facilitate the integration of quantified movement assessment into treatment pathways.
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Affiliation(s)
- Julie Rozaire
- Service de Médecine Physique et de Réadaptation, Centre Médico-Chirurgical de Réadaptation des Massues Croix-Rouge française, Hôpital de Jour, Lyon, France
- LBMC UMR_T9406, Univ Lyon, Univ Gustave Eiffel, Université Claude Bernard Lyon 1, Lyon, France
| | - Clémence Paquin
- LBMC UMR_T9406, Univ Lyon, Univ Gustave Eiffel, Université Claude Bernard Lyon 1, Lyon, France
- Texisense, Torcy, France
| | - Lauren Henry
- LBMC UMR_T9406, Univ Lyon, Univ Gustave Eiffel, Université Claude Bernard Lyon 1, Lyon, France
| | - Hovannes Agopyan
- Service de Médecine Physique et de Réadaptation, Centre Médico-Chirurgical de Réadaptation des Massues Croix-Rouge française, Hôpital de Jour, Lyon, France
| | - Rachel Bard-Pondarré
- Service de Médecine Physique et de Réadaptation, Centre Médico-Chirurgical de Réadaptation des Massues Croix-Rouge française, Hôpital de Jour, Lyon, France
| | - Alexandre Naaim
- LBMC UMR_T9406, Univ Lyon, Univ Gustave Eiffel, Université Claude Bernard Lyon 1, Lyon, France.
| | - Sonia Duprey
- LBMC UMR_T9406, Univ Lyon, Univ Gustave Eiffel, Université Claude Bernard Lyon 1, Lyon, France
| | - Emmanuelle Chaleat-Valayer
- Service de Médecine Physique et de Réadaptation, Centre Médico-Chirurgical de Réadaptation des Massues Croix-Rouge française, Hôpital de Jour, Lyon, France
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Cacioppo M, Loos A, Lempereur M, Brochard S. Bimanual movements in children with cerebral palsy: a systematic review of instrumented assessments. J Neuroeng Rehabil 2023; 20:26. [PMID: 36849971 PMCID: PMC9972766 DOI: 10.1186/s12984-023-01150-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 02/14/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Assessment of bimanual movements, which are frequently impaired in children with cerebral palsy, is highly challenging in clinical practice. Instrumented measures have been developed to evaluate and help to understand impaired upper limb movement during bimanual tasks in these children. The aim of this review was to report instrumented measurement tools (3D motion analysis, sensors, etc.) used for bimanual task movement analysis, and the metrological properties of the measures in children with cerebral palsy. METHODS A systematic review was conducted (Prospero CRD42022308517). PubMed, Web of Science, Cochrane and Scopus databases were searched with relevant keywords and inclusion/exclusion criteria. Article quality and biomechanical methods were evaluated with a customized scale and metrological properties with the COSMIN checklist. RESULTS In total, 452 children, mostly with unilateral cerebral palsy, mean age 10.9 (SD 3.2) years, underwent quantitative bimanual assessments in the 31 included studies (mean quality score 22/32 points [SD 4.7]). The tools used were 3D motion analysis (n = 26), accelerometers (n = 2), and other instruments (cube, digitizer, etc.) (n = 3). Children performed 1-5 bimanual tasks in laboratory settings, mostly activities of daily living or game scenarios. Analyses focused mostly on spatiotemporal variables, 6 of which were specifically developed for bilateral measures (task completion time, goal synchronization, movement overlap time, interlimb coupling, continuous relative phase and asynchrony). These instrumented measurements had moderate to good discriminant and convergent validity, but reliability and responsiveness assessments were lacking. CONCLUSIONS A large number of quantitative bimanual assessments involving different tools, bimanual tasks and specific variables developed to evaluate bimanual function were found. Development of other relevant variables and validation of these tools are needed to further determine their usefulness, both as research outcomes and to guide therapies in clinical practice. Future research, involving younger children and real-life assessments, will improve our understanding of bimanual function in children with cerebral palsy.
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Affiliation(s)
- Marine Cacioppo
- Department of Physical Medicine and Rehabilitation, Brest University Hospital, 2 Avenue Foch, 29200, Brest, France. .,Laboratoire de Traitement de L'information Médicale (LaTIM), Inserm U1101, Université de Bretagne-Occidentale, 29200, Brest, France. .,Pediatric Rehabilitation Department, Fondation ILDYS, 29200, Brest, France.
| | - Anthéa Loos
- Pediatric Rehabilitation Department, University Hospital of Rehabilitation (HU2R), Strasbourg, France
| | - Mathieu Lempereur
- Department of Physical Medicine and Rehabilitation, Brest University Hospital, 2 Avenue Foch, 29200, Brest, France.,Laboratoire de Traitement de L'information Médicale (LaTIM), Inserm U1101, Université de Bretagne-Occidentale, 29200, Brest, France
| | - Sylvain Brochard
- Department of Physical Medicine and Rehabilitation, Brest University Hospital, 2 Avenue Foch, 29200, Brest, France.,Laboratoire de Traitement de L'information Médicale (LaTIM), Inserm U1101, Université de Bretagne-Occidentale, 29200, Brest, France.,Pediatric Rehabilitation Department, Fondation ILDYS, 29200, Brest, France
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Cacioppo M, Marin A, Rauscent H, Le Pabic E, Gaillard F, Brochard S, Garlantezec R, Cretual A, Bonan I. A new child-friendly 3D bimanual protocol to assess upper limb movement in children with unilateral cerebral palsy: Development and validation. J Electromyogr Kinesiol 2020; 55:102481. [PMID: 33091791 DOI: 10.1016/j.jelekin.2020.102481] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 10/05/2020] [Accepted: 10/05/2020] [Indexed: 11/24/2022] Open
Abstract
Unilateral cerebral palsy (uCP) causes upper limb movement disorders that impact on daily activities, especially in bimanual condition. However, a few studies have proposed bimanual tasks for 3D motion analysis. The aim of this study was to validate the new version of a child-friendly, 3D, bimanual protocol for the measurement of joint angles and movement quality variables. Twenty children with uCP and 20 typically developing children (TDC) performed the five-task protocol integrated into a game scenario. Each task specifically targeted one or two upper limb degrees of freedom. Joint angles, smoothness and trajectory straightness were calculated. Elbow extension, supination, wrist extension and adduction amplitudes were reduced; hand trajectories were less smooth and straight in children with uCP compared to TDC. Correlations between the performance-based score and kinematic variables were strong. High within and between-session reliability was found for most joint angle variables and lower reliability was found for smoothness and straightness in most tasks. The results therefore demonstrated the validity and reliability of the new protocol for the objective assessment of bimanual function in children with uCP. The evaluation of both joint angles and movement quality variables should increase understanding of pathological movement patterns and help clinicians to optimize treatment. ClinicalTrials.gov identifier: NCT03888443.
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Affiliation(s)
- Marine Cacioppo
- Department of Physical Medicine and Rehabilitation, Rennes University Hospital, 35033 Rennes, France; Pediatric Rehabilitation Department, Fondation Ildys, Ty Yann, 29200 Brest, France; Laboratoire de Traitement de l'information Médicale (LaTIM), Inserm U1101, Université de Bretagne-Occidentale, 29200 Brest, France; Department of Physical Medicine and Rehabilitation, Brest University Hospital, 29200 Brest, France.
| | - Antoine Marin
- M2S Laboratory (Mouvement Sport Santé), Rennes 2 University - ENS Rennes - UEB, Campus de Ker Lann, 35170 Bruz, France
| | - Hélène Rauscent
- Department of Physical Medicine and Rehabilitation, Rennes University Hospital, 35033 Rennes, France
| | - Estelle Le Pabic
- CIC Inserm 1414, Centre d'Investigations Cliniques, Rennes University Hospital, 35033 Rennes, France
| | - Florence Gaillard
- M2S Laboratory (Mouvement Sport Santé), Rennes 2 University - ENS Rennes - UEB, Campus de Ker Lann, 35170 Bruz, France
| | - Sylvain Brochard
- Pediatric Rehabilitation Department, Fondation Ildys, Ty Yann, 29200 Brest, France; Laboratoire de Traitement de l'information Médicale (LaTIM), Inserm U1101, Université de Bretagne-Occidentale, 29200 Brest, France; Department of Physical Medicine and Rehabilitation, Brest University Hospital, 29200 Brest, France
| | - Ronan Garlantezec
- Department of Public Health, Rennes University Hospital, 35033 Rennes, France
| | - Armel Cretual
- M2S Laboratory (Mouvement Sport Santé), Rennes 2 University - ENS Rennes - UEB, Campus de Ker Lann, 35170 Bruz, France
| | - Isabelle Bonan
- Department of Physical Medicine and Rehabilitation, Rennes University Hospital, 35033 Rennes, France; Unité Empenn (ex-Visages) U1228 INSERM-INRIA, IRISA UMR CNRS 6074, Campus de Beaulieu, 35042 Rennes Cedex, France
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Chen Y, Garcia-Vergara S, Howard A. Number of trials necessary to achieve performance stability in a reaching kinematics movement analysis game. J Hand Ther 2020; 33:371-377.e1. [PMID: 31519383 PMCID: PMC7062588 DOI: 10.1016/j.jht.2019.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 03/30/2019] [Accepted: 04/01/2019] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN A cross-sectional design was used. INTRODUCTION Motion analysis is commonly used to analyze reaching movements of individuals, but how many trials are necessary to provide stable data? PURPOSE OF THE STUDY The purpose of this study was to determine the number of trials necessary to obtain stable kinematic variables during reaching movements in a virtual environment. METHODS Thirty children (10.39 ± 1.68 years) and 20 adults (26.55 ± 3.12 years) participated. All participants interacted with a virtual reality evaluation game called Super Pop VR to collect their reaching kinematics. The players were instructed to pop several sets of virtual bubbles at a self-selected pace and their upper-body coordinates were recorded and reaching kinematics were computed. Two methods (sequential averaging techniques, SAT, and intraclass correlation coefficient, ICC) were carried out to assess performance stability of each kinematic variable. RESULTS For the SAT method, children exhibited 3.11 to 5.96 trial range to achieve stability in the dominant hand and 2.7 to 5.96 trial range in the nondominant hand, whereas adults exhibited 2.65 to 6.16 trial range in the dominant hand and 3.40 to 6.05 range in the nondominant hand. For the ICC method, to reach the "excellent" value of ICC, children's dominant hand required 4.20 trials and their nondominant hand required 2.5 trials, whereas adults' dominant hand required 3.00 trials and their nondominant hand required 2.80 trials. DISCUSSION AND CONCLUSIONS Our findings supported the importance of determining the minimum number of trials required to obtain stable movements regardless of how familiar the movement seems to participants or how sensitive the apparatus is.
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Affiliation(s)
- Yuping Chen
- Department of Physical Therapy, Georgia State University, Atlanta, GA
| | - Sergio Garcia-Vergara
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA
| | - Ayanna Howard
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA
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