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Vanmechelen I, Haberfehlner H, Martens BHM, Vermeulen RJ, Buizer AI, Desloovere K, Aerts JM, Feys H, Monbaliu E. The relationship between manual ability, dystonia and choreoathetosis severity and upper limb movement patterns during reaching and grasping in children and young adults with dyskinetic cerebral palsy. Eur J Paediatr Neurol 2024; 50:41-50. [PMID: 38614013 DOI: 10.1016/j.ejpn.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/22/2024] [Accepted: 04/01/2024] [Indexed: 04/15/2024]
Abstract
INTRODUCTION Impaired upper limb movements are a key feature in dyskinetic cerebral palsy (CP). However, information on how specific movement patterns relate to manual ability, performance and underlying movement disorders is lacking. Insight in these associations may contribute to targeted upper limb management in dyskinetic CP. This study aimed to explore associations between deviant upper limb movement patterns and (1) manual ability, (2) severity of dystonia/choreoathetosis, and (3) movement time/trajectory deviation during reaching and grasping. PARTICIPANTS/METHODS Participants underwent three-dimensional upper limb analysis during reaching forwards (RF), reaching sideways (RS) and reach-and-grasp vertical (RGV) as well as clinical assessment. Canonical correlation and regression analysis with statistical parametric mapping were used to explore associations between clinical/performance parameters and movement patterns (mean and variability). RESULTS Thirty individuals with dyskinetic CP participated (mean age 16±5 y; 20 girls). Lower manual ability was related to higher variability in wrist flexion/extension during RF and RS early in the reaching cycle (p < 0.05). Higher dystonia severity was associated with higher mean wrist flexion (40-82 % of the reaching cycle; p = 0.004) and higher variability in wrist flexion/extension (31-75 %; p < 0.001) and deviation (2-14 %; p = 0.007/60-73 %; p = 0.006) during RF. Choreoathetosis severity was associated with higher elbow pro/supination variability (12-19 %; p = 0.009) during RGV. Trajectory deviation was associated with wrist and elbow movement variability (p < 0.05). CONCLUSION Current novel analysis of upper limb movement patterns and respective timings allows to detect joint angles and periods in the movement cycle wherein associations with clinical parameters occur. These associations are not present at each joint level, nor during the full movement cycle. This knowledge should be considered for individualized treatment strategies.
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Affiliation(s)
- Inti Vanmechelen
- KU Leuven Campus Bruges, Department of Rehabilitation Sciences, Spoorwegstraat 12, Bruges, Belgium.
| | - Helga Haberfehlner
- KU Leuven Campus Bruges, Department of Rehabilitation Sciences, Spoorwegstraat 12, Bruges, Belgium; Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
| | - Brian H M Martens
- Maastricht UMC, Department of Neurology, School of Mental Health and Neurosciences, P. Debyelaan 25, Maastricht, the Netherlands.
| | - R Jeroen Vermeulen
- Maastricht UMC, Department of Neurology, School of Mental Health and Neurosciences, P. Debyelaan 25, Maastricht, the Netherlands.
| | - Annemieke I Buizer
- Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Rehabilitation and Development, 1081 BT, Amsterdam, the Netherlands; Emma Children's Hospital, Amsterdam UMC Location University of Amsterdam, 1105 AZ, Amsterdam, the Netherlands.
| | - Kaat Desloovere
- KU Leuven, Department of Rehabilitation Sciences, Weligerveld 12, Pellenberg, Belgium.
| | - Jean-Marie Aerts
- KU Leuven, Department of Biosystems, Division of Animal and Human Health Engineering, Measure, Model and Manage Bioresponse (M3-BIORES), Leuven, Belgium.
| | - Hilde Feys
- KU Leuven, Department of Rehabilitation Sciences, 0&N4, Herestraat 49, Leuven, Belgium.
| | - Elegast Monbaliu
- KU Leuven Campus Bruges, Department of Rehabilitation Sciences, Spoorwegstraat 12, Bruges, Belgium.
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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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Furtado S, Galna B, Godfrey A, Rochester L, Gerrand C. Feasibility of using low-cost markerless motion capture for assessing functional outcomes after lower extremity musculoskeletal cancer surgery. PLoS One 2024; 19:e0300351. [PMID: 38547229 PMCID: PMC10977781 DOI: 10.1371/journal.pone.0300351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 02/26/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Physical limitations are frequent and debilitating after sarcoma treatment. Markerless motion capture (MMC) could measure these limitations. Historically expensive cumbersome systems have posed barriers to clinical translation. RESEARCH QUESTION Can inexpensive MMC [using Microsoft KinectTM] assess functional outcomes after sarcoma surgery, discriminate between tumour sub-groups and agree with existing assessments? METHODS Walking, unilateral stance and kneeling were measured in a cross-sectional study of patients with lower extremity sarcomas using MMC and standard video. Summary measures of temporal, balance, gait and movement velocity were derived. Feasibility and early indicators of validity of MMC were explored by comparing MMC measures i) between tumour sub-groups; ii) against video and iii) with established sarcoma tools [Toronto Extremity Salvage Score (TESS)), Musculoskeletal Tumour Rating System (MSTS), Quality of life-cancer survivors (QoL-CS)]. Statistical analysis was conducted using SPSS v19. Tumour sub-groups were compared using Mann-Whitney U tests, MMC was compared to existing sarcoma measures using correlations and with video using Intraclass correlation coefficient agreement. RESULTS Thirty-four adults of mean age 43 (minimum value-maximum value 19-89) years with musculoskeletal tumours in the femur (19), pelvis/hip (3), tibia (9), or ankle/foot (3) participated; 27 had limb sparing surgery and 7 amputation. MMC was well-tolerated and feasible to deliver. MMC discriminated between surgery groups for balance (p<0.05*), agreed with video for kneeling times [ICC = 0.742; p = 0.001*] and showed moderate relationships between MSTS and gait (p = 0.022*, r = -0.416); TESS and temporal outcomes (p = 0.016* and r = -0.0557*), movement velocity (p = 0.021*, r = -0.541); QoL-CS and balance (p = 0.027*, r = 0.441) [* = statistical significance]. As MMC uncovered important relationships between outcomes, it gave an insight into how functional impairments, balance, gait, disabilities and quality of life (QoL) are associated with each other. This gives an insight into mechanisms of poor outcomes, producing clinically useful data i.e. data which can inform clinical practice and guide the delivery of targeted rehabilitation. For example, patients presenting with poor balance in various activities can be prescribed with balance rehabilitation and those with difficulty in movements or activity transitions can be managed with exercises and training to improve the quality and efficiency of the movement. SIGNIFICANCE In this first study world-wide, investigating the use of MMC after sarcoma surgery, MMC was found to be acceptable and feasible to assess functional outcomes in this cancer population. MMC demonstrated early indicators of validity and also provided new knowledge that functional impairments are related to balance during unilateral stance and kneeling, gait and movement velocity during kneeling and these outcomes in turn are related to disabilities and QoL. This highlighted important relationships between different functional outcomes and QoL, providing valuable information for delivering personalised rehabilitation. After completing future validation work in a larger study, this approach can offer promise in clinical settings. Low-cost MMC shows promise in assessing patient's impairments in the hospitals or their homes and guiding clinical management and targeted rehabilitation based on novel MMC outcomes affected, therefore providing an opportunity for delivering personalised exercise programmes and physiotherapy care delivery for this rare cancer.
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Affiliation(s)
- Sherron Furtado
- Department of Orthopaedics and Musculoskeletal Science, University College London, London, United Kingdom
- Therapies and Department of Orthopaedic Oncology, London Sarcoma Service, Royal National Orthopaedic Hospital NHS Trust, Stanmore, United Kingdom
| | - Brook Galna
- School of Allied Health (Exercise Science), Murdoch University, Perth, Australia
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Alan Godfrey
- Computer and Information Science Department, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Lynn Rochester
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Craig Gerrand
- Department of Orthopaedic Oncology, The London Sarcoma Service, Royal National Orthopaedic Hospital NHS Trust, Stanmore, United Kingdom
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Vanmechelen I, Desloovere K, Haberfehlner H, Martens B, Vermeulen JR, Buizer AI, Aerts JM, Feys H, Monbaliu E. Altered upper limb kinematics in individuals with dyskinetic cerebral palsy in comparison with typically developing peers - A statistical parametric mapping study. Gait Posture 2024; 107:141-151. [PMID: 37344269 DOI: 10.1016/j.gaitpost.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 06/12/2023] [Accepted: 06/15/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND Dyskinetic cerebral palsy (DCP) is clinically characterized by involuntary movements and abnormal postures, which can aggravate with activity. While upper limb movement variability is often detected in the clinical picture, it remains unknown how movement patterns of individuals with DCP differ from typically developing (TD) peers. RESEARCH QUESTION Do individuals with DCP show i) higher time-dependent standard deviations of upper limb joint angles and ii) altered upper limb kinematics in time and/or amplitude during functional upper limb tasks in comparison with TD individuals? METHODS Three-dimensional upper limb movement patterns were cross-sectionally compared in 50 individuals with and without DCP during three functional tasks: reach forward (RF), reach and grasp vertical (RGV) and reach sideways (RS). Mean and point-wise standard deviations of angular waveform of the upper limb joint angles were compared between groups to evaluate differences in time and/or amplitude using traditional and non-linear registration statistical parametric mapping. RESULTS Thirty-five extremities from 30 individuals (mean age 17y4m, range 5-25 y; MACS level I(n = 2); II(n = 15); III(n = 16); IV(n = 2)) with DCP and twenty TD individuals (mean age 16y8m, range 8-25 y) were evaluated. The DCP compared to TD group showed higher point-wise standard deviations at the level of all joints, which was time-dependent and varied between tasks. Mean wrist and elbow flexion was higher for the DCP group during RF (0-83 % wrist; 57-100 % elbow), RGV (0-82 % wrist; 12-100 % elbow) and RS (0-43 % wrist; 70-100 % elbow). SIGNIFICANCE This is the first study exploring the movement patterns of individuals with DCP during reaching using quantitative measures. Analyzing these individual movement patterns by statistical parametric mapping (SPM) allows us to focus on both specific joint or on specific timing during the movement cycle. The individual information that this method yields can guide individual therapy aiming to improve reaching function in different parts of the movement cycle or evaluate intervention effects on upper extremity treatment.
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Affiliation(s)
- Inti Vanmechelen
- KU Leuven campus Bruges, Department of Rehabilitation Sciences, Spoorwegstraat 12, Bruges, Belgium.
| | - Kaat Desloovere
- KU Leuven, Department of Rehabilitation Sciences, Weligerveld 12, Pellenberg, Belgium
| | - Helga Haberfehlner
- KU Leuven campus Bruges, Department of Rehabilitation Sciences, Spoorwegstraat 12, Bruges, Belgium; Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Brian Martens
- Maastricht UMC, Department of Neurology, School of Mental Health and Neurosciences, P. Debyelaan 25, Maastricht, the Netherlands
| | - Jeroen R Vermeulen
- Maastricht UMC, Department of Neurology, School of Mental Health and Neurosciences, P. Debyelaan 25, Maastricht, the Netherlands
| | - Annemieke I Buizer
- Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Rehabilitation and Development, 1081 BT Amsterdam, the Netherlands; Emma Children's Hospital, Amsterdam UMC Location University of Amsterdam, 1105 AZ Amsterdam, the Netherlands
| | - Jean-Marie Aerts
- KU Leuven, Department of Biosystems, Division of Animal and Human Health Engineering, Measure, Model and Manage Bioresponse (M3-BIORES), Leuven, Belgium
| | - Hilde Feys
- KU Leuven, Department of Rehabilitation Sciences, 0&N4, Herestraat 49, Leuven, Belgium
| | - Elegast Monbaliu
- KU Leuven campus Bruges, Department of Rehabilitation Sciences, Spoorwegstraat 12, Bruges, Belgium
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Hwang Y, Kwon JY, Na Y. An Exploration of Tri-Axial Accelerometers in Assessing the Therapeutic Efficacy of Constraint-Induced Movement Therapy in Children with Unilateral Cerebral Palsy. SENSORS (BASEL, SWITZERLAND) 2023; 23:9393. [PMID: 38067766 PMCID: PMC10708848 DOI: 10.3390/s23239393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 11/18/2023] [Accepted: 11/23/2023] [Indexed: 12/18/2023]
Abstract
This study aimed to elucidate the role of tri-axial accelerometers in assessing therapeutic interventions, specifically constraint-induced movement therapy (CIMT), in children with unilateral cerebral palsy (UCP). The primary focus was understanding the correlation between the actigraphy metrics recorded during CIMT sessions and the resultant therapeutic outcomes. Children with UCP, aged between 4 and 12 years, participated in this study from July 2021 to December 2022. In conjunction with in-clinic sessions, during which participants wore tri-axial accelerometers on both limbs, we analyzed actigraphy data over three days of routine activities pre- and post-CIMT. While not all metrics derived from the accelerometers indicated significant improvements post-intervention, there was a clear trend towards a more balanced usage of both limbs, particularly evident in Axis 3, associated with vertical movement (p = 0.017). Additionally, a discernible correlation was observed between changes in the magnitude ratio derived from actigraphy data during CIMT (Δweek3-week1) and variations in traditional assessments pre- and post-intervention (ΔT0-T1), specifically the Assisting Hand Assessment grasp and release. Using tri-axial accelerometers has helped clarify the potential impacts of CIMT on children with UCP. The preliminary results suggest a possible link between actigraphy metrics taken during CIMT and the subsequent therapeutic outcomes determined by standardized tests.
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Affiliation(s)
- Youngsub Hwang
- Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul 06355, Republic of Korea;
| | - Jeong-Yi Kwon
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea;
| | - Yoonju Na
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea;
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Cacioppo M, Lempereur M, Houx L, Bouvier S, Bailly R, Brochard S. Detecting Movement Changes in Children with Hemiparesis after Upper Limb Therapies: A Responsiveness Analysis of a 3D Bimanual Protocol. SENSORS (BASEL, SWITZERLAND) 2023; 23:4235. [PMID: 37177439 PMCID: PMC10181373 DOI: 10.3390/s23094235] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/17/2023] [Accepted: 04/20/2023] [Indexed: 05/15/2023]
Abstract
The "Be an Airplane Pilot" (BE API) protocol was developed to evaluate upper limb (UL) kinematics in children with unilateral cerebral palsy (uCP) during bimanual tasks. The aim of this study was to investigate the responsiveness of this protocol to changes in kinematics and movement quality after UL therapies, using individual and group analyses, and to analyse the relationships between kinematic and functional changes in these children. Twenty children with uCP (5-15 years old) either participated in bimanual intensive therapy or received UL botulinum toxin injections. All the children performed the BE API protocol and functional assessments (Assisting Hand Assessment [AHA]) before and after the interventions. The individual analyses found kinematic changes in 100% of the children after therapy. The group analysis found significantly higher trunk and shoulder deviations after the intensive therapy. No significant changes were found for smoothness or trajectory straightness. The changes in the kinematic deviations were moderately correlated with the changes in the AHA scores. This study confirmed the responsiveness of the BE API protocol to change after therapy; therefore, the protocol is now fully validated and can be implemented in clinical practice. Its use should help in the accurate identification of impairments so that individualized treatments can be proposed.
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Affiliation(s)
- Marine Cacioppo
- Department of Physical Medicine and Rehabilitation, Brest University Hospital, 29200 Brest, France
- Pediatric Rehabilitation Department, Fondation ILDYS, 29200 Brest, France
- Laboratoire de Traitement de L’Information Médicale (LaTIM), Inserm U1101, Université de Bretagne-Occidentale, 29200 Brest, France
- Pediatric Neurology Unit, Children’s Hospital, Geneva University Hospitals, 1205 Geneva, Switzerland
| | - Mathieu Lempereur
- Department of Physical Medicine and Rehabilitation, Brest University Hospital, 29200 Brest, France
- Laboratoire de Traitement de L’Information Médicale (LaTIM), Inserm U1101, Université de Bretagne-Occidentale, 29200 Brest, France
| | - Laetitia Houx
- Department of Physical Medicine and Rehabilitation, Brest University Hospital, 29200 Brest, France
- Pediatric Rehabilitation Department, Fondation ILDYS, 29200 Brest, France
- Laboratoire de Traitement de L’Information Médicale (LaTIM), Inserm U1101, Université de Bretagne-Occidentale, 29200 Brest, France
| | - Sandra Bouvier
- Department of Physical Medicine and Rehabilitation, Brest University Hospital, 29200 Brest, France
- Laboratoire de Traitement de L’Information Médicale (LaTIM), Inserm U1101, Université de Bretagne-Occidentale, 29200 Brest, France
| | - Rodolphe Bailly
- Pediatric Rehabilitation Department, Fondation ILDYS, 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, 29200 Brest, France
- Pediatric Rehabilitation Department, Fondation ILDYS, 29200 Brest, France
- Laboratoire de Traitement de L’Information Médicale (LaTIM), Inserm U1101, Université de Bretagne-Occidentale, 29200 Brest, France
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Quantitative assessment of trunk movements in functional reaching in children and adolescents with dyskinetic cerebral palsy. Clin Biomech (Bristol, Avon) 2023; 102:105876. [PMID: 36640748 DOI: 10.1016/j.clinbiomech.2023.105876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 12/28/2022] [Accepted: 01/04/2023] [Indexed: 01/07/2023]
Abstract
BACKGROUND Trunk control and upper limb function are often disturbed in people with dyskinetic cerebral palsy. While trunk control is fundamental in upper limb activities, insights in trunk control in dyskinetic cerebral palsy are missing. This study aimed to determine trunk movement characteristics in individuals with dyskinetic cerebral palsy during reaching. METHODS Twenty individuals with dyskinetic cerebral palsy (MACS level I-III (16y6m)) and 20 typical developing peers (17y2m) were included. Participants performed three tasks: reach forward, reach sideways, and reach and grasp vertically, using a cross-sectional study design. Movements were analyzed using 3D motion capture and a sensor on the trunk. Trunk range of motion, joint angle at point of task achievement, peak and range of angular velocity and linear acceleration were compared between groups using Mann-Whitney U and independent t-tests. FINDINGS Participants with dyskinetic cerebral palsy showed higher trunk range of motion in all planes during reach forward and reach and grasp vertically, and in rotation and lateral flexion during reach sideways. During reach and grasp vertically, the joint angle at point of task achievement differed in the transversal plane. Ranges of angular velocity and linear acceleration were higher for all tasks and planes for participants with dyskinetic cerebral palsy, and for peak values in nearly all planes. INTERPRETATION Current results provide insights in trunk control at population level. This is a first step towards a better and individualized evaluation and treatment for trunk control, being an important factor in improving functional activities for individuals with dyskinetic cerebral palsy.
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Psychometric properties of upper limb kinematics during functional tasks in children and adolescents with dyskinetic cerebral palsy. PLoS One 2022; 17:e0266294. [PMID: 36149848 PMCID: PMC9506636 DOI: 10.1371/journal.pone.0266294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 09/11/2022] [Indexed: 11/19/2022] Open
Abstract
Dyskinetic cerebral palsy (DCP) is characterised by involuntary movements, and the movement patterns of children with DCP have not been extensively studied during upper limb tasks. The aim of this study is to evaluate psychometric properties of upper limb kinematics in participants with DCP and typically developing (TD) participants. In current repeatability and validity study, forty individuals with typical development (n = 20) and DCP (n = 20) performed a reach forward/sideways and a reach and grasp task during motion analysis on two occasions. Joint angles at point of task achievement (PTA) and spatio-temporal parameters were evaluated within-and between-sessions using intra-class correlation coefficients (ICC) and standard error of measurement (SEM). Independent t-tests/Mann-Whitney-U tests were used to compare parameters between groups. Within-session ICC values ranged from 0.45 to 1.0 for all parameters for both groups. Within-session SEM values ranged from 1.1° to 11.7° for TD participants and from 1.9° to 13.0° for participants with DCP. Eight within-session repetitions resulted in the smallest change in ICC and SEM values for both groups. Within-session variability was higher for participants with DCP in comparison with the TD group for the majority of the joint angles and spatio-temporal parameters. Intrinsic variability over time was small for all angles and spatio-temporal parameters, whereas extrinsic variability was higher for elbow and scapula angles. Between-group differences revealed lower shoulder adduction and higher elbow flexion, pronation and wrist flexion, as well as higher trajectory deviation and a lower maximal velocity for participants with DCP. This is the first study to assess the psychometric properties of upper limb kinematics in children and adolescents with DCP, showing that children with DCP show higher variability during task execution, requiring a minimum of eight repetitions. However, their variable movement pattern can be reliably captured within-and between-sessions, confirming the potential of three-dimensional motion analysis for assessment of rehabilitation interventions in DCP.
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Cacioppo M, Lempereur M, Marin A, Rauscent H, Crétual A, Brochard S, Bonan I. Motor patterns of the impaired upper limb in children with unilateral cerebral palsy performing bimanual tasks. Clin Biomech (Bristol, Avon) 2022; 97:105710. [PMID: 35763887 DOI: 10.1016/j.clinbiomech.2022.105710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 06/13/2022] [Accepted: 06/17/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Upper limb movement patterns have not yet been identified in bimanual conditions despite the difficulties children with unilateral cerebral palsy have performing bimanual activities. The aim was to identify specific motor patterns from kinematic deviations during bimanual tasks in this population. METHODS Twenty children with unilateral cerebral palsy and 20 age-matched, typically developing children performed the five tasks of a 3D bimanual protocol. To evaluate upper limb kinematic deviations, 10 Arm Variable Scores were calculated for the affected /non-dominant upper limb of each participant for each task. Sparse K-means cluster analysis was applied to the 50 Arm Variable Scores of all the children to identify motor patterns and determining variables. Clinical tests of impairment (muscle strength, selectivity, spasticity) and function (Assisting hand assessment, Abilhand-Kids) were compared between the clusters obtained. FINDINGS Three different motor patterns were identified using the data from all the children: mild, proximal-distal and proximal-distal with trunk. The most important cluster determinants were the Arm Variable Scores for pronation-supination and wrist extension. In the cerebral palsy group, scores of impairments (p < .01) and function (Assisting Hand Assessment [p < .001] and Abilhand-Kids [p = .004]) differed for each motor pattern. Supination and wrist extension deviations differed significantly between the groups (p < .001). INTERPRETATION During performance of bimanual tasks, children with unilateral cerebral palsy used distinct motor patterns that each corresponded to a specific clinical profile. Elbow-wrist deviations were the largest and most decisive and were specific to the cerebral palsy group: they should be the target of interventions to enhance bimanual function. CLINICALTRIALS gov identifier: NCT03888443.
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Affiliation(s)
- Marine Cacioppo
- Department of Physical Medicine and Rehabilitation, Brest University Hospital, 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.
| | - Mathieu Lempereur
- Department of Physical Medicine and Rehabilitation, Brest University Hospital, 29200 Brest, France; Laboratoire de Traitement de l'information Médicale (LaTIM), Inserm U1101, Université de Bretagne-Occidentale, 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, 35000 Rennes, France
| | - Armel Crétual
- M2S laboratory (Mouvement Sport Santé), Rennes 2 University - ENS Rennes - UEB, Campus de Ker Lann, 35170 Bruz, France
| | - Sylvain Brochard
- Department of Physical Medicine and Rehabilitation, Brest University Hospital, 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
| | - Isabelle Bonan
- Department of Physical Medicine and Rehabilitation, Rennes University Hospital, 35000 Rennes, France; Unité Empenn (ex-Visages) U1228 INSERM-INRIA, IRISA UMR CNRS 6074, Campus de Beaulieu, 35042 Rennes Cedex, France
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10
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Lieber J, Dittli J, Lambercy O, Gassert R, Meyer-Heim A, van Hedel HJA. Clinical utility of a pediatric hand exoskeleton: identifying users, practicability, and acceptance, and recommendations for design improvement. J Neuroeng Rehabil 2022; 19:17. [PMID: 35148786 PMCID: PMC8832660 DOI: 10.1186/s12984-022-00994-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 01/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Children and adolescents with upper limb impairments can experience limited bimanual performance reducing daily-life independence. We have developed a fully wearable pediatric hand exoskeleton (PEXO) to train or compensate for impaired hand function. In this study, we investigated its appropriateness, practicability, and acceptability. METHODS Children and adolescents aged 6-18 years with functional limitations in at least one hand due to a neurological cause were selected for this cross-sectional evaluation. We characterized participants by various clinical tests and quantified bimanual performance with the Assisting Hand Assessment (AHA). We identified children whose AHA scaled score increased by ≥ 7 points when using the hand exoskeleton and determined clinical predictors to investigate appropriateness. The time needed to don each component and the number of technical issues were recorded to evaluate practicability. For acceptability, the experiences of the patients and the therapist with PEXO were evaluated. We further noted any adverse events. RESULTS Eleven children (median age 11.4 years) agreed to participate, but data was available for nine participants. The median AHA scaled score was higher with PEXO (68; IQR: 59.5-83) than without (55; IQR: 37.5-80.5; p = 0.035). The Box and Block test, the Selective Control of the Upper Extremity Scale, and finger extensor muscle strength could differentiate well between those participants who improved in AHA scaled scores by ≥ 7 points and those who did not (sensitivity and specificity varied between 0.75 and 1.00). The median times needed to don the back module, the glove, and the hand module were 62, 150, and 160 s, respectively, but all participants needed assistance. The most critical failures were the robustness of the transmission system, the electronics, and the attachment system. Acceptance was generally high, particularly in participants who improved bimanual performance with PEXO. Five participants experienced some pressure points. No adverse events occurred. CONCLUSIONS PEXO is a safe exoskeleton that can improve bimanual hand performance in young patients with minimal hand function. PEXO receives high acceptance. We formulated recommendations to improve technical issues and the donning before such exoskeletons can be used under daily-life conditions for therapy or as an assistive device. Trial registration Not appropriate.
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Affiliation(s)
- Jan Lieber
- Swiss Children's Rehab - Research Department, University Children's Hospital Zurich, Mühlebergstrasse 104, CH-8910, Affoltern am Albis, Switzerland.,Children's Research Center, University Children's Hospital Zurich, University of Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland
| | - Jan Dittli
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, 8008, Zurich, Switzerland
| | - Olivier Lambercy
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, 8008, Zurich, Switzerland
| | - Roger Gassert
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, 8008, Zurich, Switzerland
| | - Andreas Meyer-Heim
- Swiss Children's Rehab - Research Department, University Children's Hospital Zurich, Mühlebergstrasse 104, CH-8910, Affoltern am Albis, Switzerland.,Children's Research Center, University Children's Hospital Zurich, University of Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland
| | - Hubertus J A van Hedel
- Swiss Children's Rehab - Research Department, University Children's Hospital Zurich, Mühlebergstrasse 104, CH-8910, Affoltern am Albis, Switzerland. .,Children's Research Center, University Children's Hospital Zurich, University of Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland.
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11
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Shim D, Choi JY, Yi SH, Park ES, Kim S, Yoo B, Park D, Park HR, Rha DW. Spatiotemporal parameters from instrumented motion analysis represent clinical measurement of upper limb function in children with cerebral palsy. Gait Posture 2022; 91:326-331. [PMID: 33246774 DOI: 10.1016/j.gaitpost.2020.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 10/26/2020] [Accepted: 11/09/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND There are various tools that measure upper limb function in children with cerebral palsy(CP) clinically, but these measurement methods are examiner-dependent and scale values are not proportional to the upper limb function which makes it difficult to quantify the function. RESEARCH QUESTION The purpose of this study was to investigate whether the new parameters derived from 3D motion analysis reflect the upper limb function which measured by Melbourne Assessment 2 (MA2) in children with cerebral palsy (CP) compared to the clinical measurements. METHODS Forty children with CP (24 boys, 16 girls; mean [SD] age, 6 years 11 months [3 years 5 months]) were recruited. Motion capture was conducted during phases T1-T4 of Reach and Grasp Cycles. New parameters (movement time, number of movement units, index of curvature) were derived from wrist marker data. Range of motion (ROM), accuracy, dexterity, and fluency of unilateral upper limb function were assessed using MA2. Spearman rank coefficients were determined to evaluate correlations between MA2 and the new parameters. RESULTS AND SIGNIFICANCE Index of curvature correlated negatively with MA2 accuracy scores during T1 (rs -0.347, p < 0.05), T2 (rs -0.471, p < 0.01), and T3 (rs -0.660, p < 0.01). Number of movement units correlated negatively with MA2 ROM, accuracy, and fluency scores during T1 (ROM rs -0.334; accuracy rs -0.331; fluency rs -0.375; p < 0.05) and T3 (ROM rs -0.499; accuracy rs -0.531; fluency rs -0.515; p < 0.01). Index of curvature and number of movement units are objective, simple parameters showing fair to good correlation with MA2 accuracy and fluency of upper limb function.
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Affiliation(s)
- Dain Shim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ja Young Choi
- Department of Rehabilitation Medicine, Daejeon-Chungcheong Regional Rehabilitation Center, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Sook-Hee Yi
- Seoul Rehabilitation Hospital, Seoul, Republic of Korea
| | - Eun Sook Park
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seungki Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Beomki Yoo
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dongho Park
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hye-Rin Park
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dong-Wook Rha
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
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12
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Francisco-Martínez C, Prado-Olivarez J, Padilla-Medina JA, Díaz-Carmona J, Pérez-Pinal FJ, Barranco-Gutiérrez AI, Martínez-Nolasco JJ. Upper Limb Movement Measurement Systems for Cerebral Palsy: A Systematic Literature Review. SENSORS 2021; 21:s21237884. [PMID: 34883885 PMCID: PMC8659477 DOI: 10.3390/s21237884] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 11/19/2021] [Accepted: 11/24/2021] [Indexed: 01/06/2023]
Abstract
Quantifying the quality of upper limb movements is fundamental to the therapeutic process of patients with cerebral palsy (CP). Several clinical methods are currently available to assess the upper limb range of motion (ROM) in children with CP. This paper focuses on identifying and describing available techniques for the quantitative assessment of the upper limb active range of motion (AROM) and kinematics in children with CP. Following the screening and exclusion of articles that did not meet the selection criteria, we analyzed 14 studies involving objective upper extremity assessments of the AROM and kinematics using optoelectronic devices, wearable sensors, and low-cost Kinect sensors in children with CP aged 4–18 years. An increase in the motor function of the upper extremity and an improvement in most of the daily tasks reviewed were reported. In the population of this study, the potential of wearable sensors and the Kinect sensor natural user interface as complementary devices for the quantitative evaluation of the upper extremity was evident. The Kinect sensor is a clinical assessment tool with a unique markerless motion capture system. Few authors had described the kinematic models and algorithms used to estimate their kinematic analysis in detail. However, the kinematic models in these studies varied from 4 to 10 segments. In addition, few authors had followed the joint assessment recommendations proposed by the International Society of Biomechanics (ISB). This review showed that three-dimensional analysis systems were used primarily for monitoring and evaluating spatiotemporal variables and kinematic parameters of upper limb movements. The results indicated that optoelectronic devices were the most commonly used systems. The joint assessment recommendations proposed by the ISB should be used because they are approved standards for human kinematic assessments. This review was registered in the PROSPERO database (CRD42021257211).
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Affiliation(s)
- Celia Francisco-Martínez
- Electronics Engineering Department, National Technology of Mexico in Celaya, Celaya 38010, Mexico; (C.F.-M.); (J.A.P.-M.); (J.D.-C.); (F.J.P.-P.); (A.I.B.-G.)
| | - Juan Prado-Olivarez
- Electronics Engineering Department, National Technology of Mexico in Celaya, Celaya 38010, Mexico; (C.F.-M.); (J.A.P.-M.); (J.D.-C.); (F.J.P.-P.); (A.I.B.-G.)
- Correspondence: ; Tel.: +52-(461)-111-2862
| | - José A. Padilla-Medina
- Electronics Engineering Department, National Technology of Mexico in Celaya, Celaya 38010, Mexico; (C.F.-M.); (J.A.P.-M.); (J.D.-C.); (F.J.P.-P.); (A.I.B.-G.)
| | - Javier Díaz-Carmona
- Electronics Engineering Department, National Technology of Mexico in Celaya, Celaya 38010, Mexico; (C.F.-M.); (J.A.P.-M.); (J.D.-C.); (F.J.P.-P.); (A.I.B.-G.)
| | - Francisco J. Pérez-Pinal
- Electronics Engineering Department, National Technology of Mexico in Celaya, Celaya 38010, Mexico; (C.F.-M.); (J.A.P.-M.); (J.D.-C.); (F.J.P.-P.); (A.I.B.-G.)
| | - Alejandro I. Barranco-Gutiérrez
- Electronics Engineering Department, National Technology of Mexico in Celaya, Celaya 38010, Mexico; (C.F.-M.); (J.A.P.-M.); (J.D.-C.); (F.J.P.-P.); (A.I.B.-G.)
| | - Juan J. Martínez-Nolasco
- Mechatronics Engineering Department, National Technology of Mexico in Celaya, Celaya 38010, Mexico;
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13
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Chen HL, Lin SY, Yeh CF, Chen RY, Tang HH, Ruan SJ, Wang TN. Development and Feasibility of a Kinect-Based Constraint-Induced Therapy Program in the Home Setting for Children With Unilateral Cerebral Palsy. Front Bioeng Biotechnol 2021; 9:755506. [PMID: 34765593 PMCID: PMC8576521 DOI: 10.3389/fbioe.2021.755506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 10/08/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Cerebral palsy (CP) is the leading cause of childhood-onset physical disability. Children with CP often have impaired upper limb (UL) function. Constraint-induced therapy (CIT) is one of the most effective UL interventions for children with unilateral CP. However, concerns about CIT for children have been repeatedly raised due to frustration caused by restraint of the child’s less-affected UL and lack of motivation for the intensive protocol. Virtual reality (VR), which can mitigate the disadvantages of CIT, potentially can be used as an alternative mediator for implementing CIT. Therefore, we developed a VR-based CIT program for children with CP using the Kinect system. Aims: The feasibility of the Kinect-based CIT program was evaluated for children with unilateral CP using a two-phase study design. Materials and Methods: In phase 1, ten children with unilateral CP were recruited. To confirm the achievement of the motor training goals, maximal UL joint angles were evaluated during gameplay. To evaluate children’s perceptions of the game, a questionnaire was used. In phase 2, eight children with unilateral CP were recruited and received an 8 weeks Kinect-based CIT intervention. Performance scores of the game and outcomes of the box and block test (BBT) were recorded weekly. Results: In phase 1, results supported that the design of the program was CIT-specific and was motivational for children with unilateral CP. In phase 2, game performance and the BBT scores began showing stable improvements in the fifth week of intervention. Conclusion: It suggested the Kinect-based CIT program was beneficial to the motor function of the affected UL for children with unilateral CP. According to the results of this feasibility study, larger and controlled effectiveness studies of the Kinect-based CIT program can be conducted to further improve its clinical utility. Clinical Trial Registration: ClinicalTrials.gov, NCT02808195; Comparative effectiveness of a Kinect-based unilateral arm training system vs. CIT for children with CP
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Affiliation(s)
- Hao-Ling Chen
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan.,School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Szu-Yu Lin
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chun-Fu Yeh
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ren-Yu Chen
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hsien-Hui Tang
- Department of Industrial and Commercial Design, National Taiwan University of Science and Technology, Taipei, Taiwan
| | - Shanq-Jang Ruan
- Department of Electronic and Computer Engineering, National Taiwan University of Science and Technology, Taipei, Taiwan
| | - Tien-Ni Wang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan.,School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
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14
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Abd-Elfattah HM, Aly SM. Effect of Core Stability Exercises on Hand Functions in Children With Hemiplegic Cerebral Palsy. Ann Rehabil Med 2021; 45:71-78. [PMID: 33557483 PMCID: PMC7960954 DOI: 10.5535/arm.20124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 09/28/2020] [Indexed: 11/05/2022] Open
Abstract
Objective To investigate the effectiveness of core stability exercises on hand functions in children with hemiplegic cerebral palsy. Methods Fifty-two children with hemiplegic cerebral palsy ranging in age from 6 years to 8 years were enrolled in this study. They were randomly assigned to two (control and study) groups. The control group received the selected physiotherapy exercises, and the study group received the same selected physiotherapy exercise program and core stability exercises. Time motor performance, gross manual dexterity, and upper extremity skills assessed using the Jebsen Taylor Hand Function Test, Box and Block Test, and Quality Upper Extremity Skill Test, respectively, were measured before and after 12 weeks of the treatment program. Results There were significant improvements in both groups by comparing the mean values of all measured variables before and after treatment (p<0.05). There were significant differences between the control and study groups with respect to all measured variables when comparing the post-treatment outcomes (p<0.05). Conclusion This study suggests that core stability exercises can be an effective intervention that may improve hand functions in children with hemiplegic cerebral palsy.
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Affiliation(s)
- Hanaa Mohsen Abd-Elfattah
- Department of Physical Therapy for Pediatrics and Pediatric Surgery, Faculty of Physical Therapy, Badr University, Cairo, Egypt
| | - Sobhy Mahmoud Aly
- Department of Biomechanics, Faculty of Physical Therapy, Cairo University, Cairo, Egypt
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15
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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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16
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Abstract
BACKGROUND The functional elbow range of motion in children and adolescents has not been previously reported. In adults, a functional motion arc of 30 to 130 degrees of elbow flexion and 50 degrees of pronation to 50 degrees of supination is well established. Contemporary tasks such as cellular phone use and keyboarding require greater elbow flexion and pronation than the functional motion arc. Whether or not this is true in children has yet to be established. We hypothesize that to perform functional and contemporary tasks, children and adolescents use a greater range of elbow motion and forearm rotation as compared with adults. METHODS Twenty-eight subjects performed 8 functional tasks and 4 contemporary tasks. Kinematic data were captured using a 3-dimensional motion analysis system as previously described. Mean and SD was collected for elbow flexion, extension, pronation, and supination. Unpaired t tests were performed to compare elbow kinematics of children 6- to 11-year-old (n=14) to that of adolescents 12- to 17-year-old (n=14), with a significance criterion of P-value <0.05. RESULTS The mean arc of motion to achieve functional tasks was 28 to 146 degrees of elbow extension/flexion and 54 degrees of supination to 65 degrees of pronation. Contemporary tasks utilized 40 to 148 degrees of elbow extension/flexion and 49 degrees of supination to 65 degrees of pronation. A greater supination/pronation arc (107 degrees) and greater elbow flexion (148 degrees) were used to bring a cellular phone to the ear, whereas greater pronation (65 degrees) was used to type on a keyboard. Statistically significant differences were observed between children and adolescents in each of the 12 tasks, with the exception of using a fork. CONCLUSIONS A motion arc of 30 to 130 degrees of elbow flexion and 50 to 50 degrees of pronation/supination is sufficient to achieve most positional and functional tasks in children and adolescents. However, specific contemporary tasks such as the use of a cellular phone and typing on a keyboard utilize more elbow flexion and pronation. Awareness of greater use of flexion and pronation to achieve contemporary tasks may help guide surgeons in the care of patients with posttraumatic elbow and forearm deformities and contractures. LEVEL OF EVIDENCE Level II-investigation of a diagnostic test.
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17
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Simon-Martinez C, Mailleux L, Jaspers E, Ortibus E, Desloovere K, Klingels K, Feys H. Effects of combining constraint-induced movement therapy and action-observation training on upper limb kinematics in children with unilateral cerebral palsy: a randomized controlled trial. Sci Rep 2020; 10:10421. [PMID: 32591590 PMCID: PMC7320002 DOI: 10.1038/s41598-020-67427-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 05/26/2020] [Indexed: 11/15/2022] Open
Abstract
Modified constraint-induced movement therapy (mCIMT) improves upper limb (UL) motor execution in unilateral cerebral palsy (uCP). As these children also show motor planning deficits, action-observation training (AOT) might be of additional value. Here, we investigated the combined value of AOT to mCIMT on UL kinematics in children with uCP in a randomized controlled trial. Thirty-six children with uCP completed an UL kinematic and clinical evaluation after participating in a 9-day mCIMT camp wearing a splint for 6 h/day. The experimental group (mCIMT + AOT, n = 20) received 15 h of AOT, i.e. video-observation and execution of unimanual tasks. The control group (mCIMT + placebo, n = 16) watched biological-motion free videos and executed the same tasks. We examined changes in motor control (movement duration, peak velocity, time-to-peak velocity, and trajectory straightness) and kinematic movement patterns (using Statistical Parametric Mapping) during the execution of three unimanual, relevant tasks before the intervention, after and at 6 months follow-up. Adding AOT to mCIMT mainly affected movement duration during reaching, whereas little benefit is seen on UL movement patterns. mCIMT, with or without AOT, improved peak velocity and trajectory straightness, and proximal movement patterns. Clinical and kinematic improvements are poorly related. Although there seem to be limited benefits of AOT to CIMT on UL kinematics, our results support the inclusion of kinematics to capture changes in motor control and movement patterns of the proximal joints.
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Affiliation(s)
- Cristina Simon-Martinez
- Department of Rehabilitation Sciences, KU Leuven, 3000, Leuven, Belgium. .,Information Systems Institute, University of Applied Sciences Western Switzerland (HES-SO Valais), Sierre, Switzerland.
| | - Lisa Mailleux
- Department of Rehabilitation Sciences, KU Leuven, 3000, Leuven, Belgium
| | - Ellen Jaspers
- Neural Control of Movement Lab, ETH Zurich, Zurich, Switzerland
| | - Els Ortibus
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Kaat Desloovere
- Department of Rehabilitation Sciences, KU Leuven, 3000, Leuven, Belgium.,Clinical Motion Analysis Laboratory, University Hospitals Leuven, Leuven, Belgium
| | - Katrijn Klingels
- Department of Rehabilitation Sciences, KU Leuven, 3000, Leuven, Belgium.,Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Hilde Feys
- Department of Rehabilitation Sciences, KU Leuven, 3000, Leuven, Belgium
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18
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Hung YC, Spingarn A, Friel KM, Gordon AM. Intensive Unimanual Training Leads to Better Reaching and Head Control than Bimanual Training in Children with Unilateral Cerebral Palsy. Phys Occup Ther Pediatr 2020; 40:491-505. [PMID: 31942818 DOI: 10.1080/01942638.2020.1712513] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
AIMS To quantify the changes in joint movement control and motor planning of the more-affected upper extremity (UE) during a reach-grasp-eat task in children with Unilateral Spastic Cerebral Palsy (USCP) after either constraint-induced movement therapy (CIMT) or hand-arm bimanual intensive therapy (HABIT). METHODS Twenty children with USCP (average age 7.7; MACS levels I-II) were randomized into either a CIMT or HABIT group. Both groups received intensive training 6 h a day for 15 days. Children performed a reach-grasp-eat task before and after training with their more-affected hand using 3D kinematic analysis. RESULTS Both groups illustrated shorter movement time during reaching, grasping, and eating phases after training (p < 0.05). Additionally, both intensive training approaches improved joint control with decreased trunk involvement, greater elbow, and wrist excursions during the reaching phase, and greater elbow excursion during the eating phase (p < 0.05). However, only the CIMT group decreased hand curvature during reaching, lowered hand position at grasp, and decreased head rotation during the eating phase (p < 0.05). CONCLUSIONS The current findings showed that both CIMT and HABIT improved UE joint control, but there were greater effects of CIMT on the more-affected UE motor planning and head control for children with USCP.
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Affiliation(s)
- Ya-Ching Hung
- Department of Family, Nutrition, and Exercise Sciences, Queens College, City University of New York, Flushing, NY, USA
| | - Aryeh Spingarn
- Department of Family, Nutrition, and Exercise Sciences, Queens College, City University of New York, Flushing, NY, USA
| | - Kathleen M Friel
- Neuroscience, Burke Medical Research Institute, Weill Cornell Medicine, White Plains, NY, USA
| | - Andrew M Gordon
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA
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19
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Dehem S, Montedoro V, Brouwers I, Edwards MG, Detrembleur C, Stoquart G, Renders A, Heins S, Dehez B, Lejeune T. Validation of a robot serious game assessment protocol for upper limb motor impairment in children with cerebral palsy. NeuroRehabilitation 2019; 45:137-149. [PMID: 31498135 DOI: 10.3233/nre-192745] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The ROBiGAME project aims to implement serious games on robots to rehabilitate upper limb (UL) motor function in children with cerebral palsy (CP). Serious game characteristics (target position, level of assistance/resistance, level of force) are typically adapted based on the child's assessment before and continuously during the game (measuring UL working area, kinematics and muscle strength). OBJECTIVE This study developed an UL robotic motor assessment protocol to configure the serious game. METHODS Forty-nine healthy children and 20 CP children participated in the study. The clinical assessment consisted of the child's UL length and isometric force. The robot assessment consisted of the child's UL working area (WA), the UL isometric and isokinetic force in three directions and the UL kinematics during a pointing task toward targets placed at different distances. RESULTS Results showed that WA and UL isometric force were moderately to highly correlated with clinical measures. Ratios between the UL isokinetic force generated on three directions were established. The velocity and straightness indexes of all children increased when they had to reach to targets placed more distant. CONCLUSIONS This protocol can be integrated into different serious games in order to continuously configure the game characteristics to a child's performance. TRIAL REGISTRATION The study was registered at ClinicalTrials.gov (NCT02543424), 12 August 2015.
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Affiliation(s)
- Stéphanie Dehem
- Université Catholique de Louvain, Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Neuro Musculo Skeletal Lab (NMSK), Brussels, Belgium.,Université Catholique de Louvain, Louvain Bionics, Louvain-la-Neuve, Belgium
| | - Vincenza Montedoro
- Université Catholique de Louvain, Psychological Sciences Research Institute, Louvain-La-Neuve, Belgium.,Université Catholique de Louvain, Louvain Bionics, Louvain-la-Neuve, Belgium
| | - Isaline Brouwers
- Cliniques Universitaires Saint-Luc, Service de Médecine Physique et Réadaptation, Brussels, Belgium
| | - Martin Gareth Edwards
- Université Catholique de Louvain, Psychological Sciences Research Institute, Louvain-La-Neuve, Belgium.,Université Catholique de Louvain, Louvain Bionics, Louvain-la-Neuve, Belgium
| | - Christine Detrembleur
- Université Catholique de Louvain, Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Neuro Musculo Skeletal Lab (NMSK), Brussels, Belgium.,Université Catholique de Louvain, Louvain Bionics, Louvain-la-Neuve, Belgium
| | - Gaëtan Stoquart
- Université Catholique de Louvain, Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Neuro Musculo Skeletal Lab (NMSK), Brussels, Belgium.,Cliniques Universitaires Saint-Luc, Service de Médecine Physique et Réadaptation, Brussels, Belgium.,Université Catholique de Louvain, Louvain Bionics, Louvain-la-Neuve, Belgium
| | - Anne Renders
- Cliniques Universitaires Saint-Luc, Service de Médecine Physique et Réadaptation, Brussels, Belgium
| | - Sophie Heins
- Université Catholique de Louvain, Centre de Recherche en Energie et Mecatronique (CEREM), Louvain-la-Neuve, Belgium.,Université Catholique de Louvain, Louvain Bionics, Louvain-la-Neuve, Belgium
| | - Bruno Dehez
- Université Catholique de Louvain, Centre de Recherche en Energie et Mecatronique (CEREM), Louvain-la-Neuve, Belgium.,Université Catholique de Louvain, Louvain Bionics, Louvain-la-Neuve, Belgium
| | - Thierry Lejeune
- Université Catholique de Louvain, Secteur des Sciences de la Santé, Institut de Recherche Expérimentale et Clinique, Neuro Musculo Skeletal Lab (NMSK), Brussels, Belgium.,Cliniques Universitaires Saint-Luc, Service de Médecine Physique et Réadaptation, Brussels, Belgium.,Université Catholique de Louvain, Louvain Bionics, Louvain-la-Neuve, Belgium
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da Silva ESM, Santos GL, Catai AM, Borstad A, Furtado NPD, Aniceto IAV, Russo TL. Effect of aerobic exercise prior to modified constraint-induced movement therapy outcomes in individuals with chronic hemiparesis: a study protocol for a randomized clinical trial. BMC Neurol 2019; 19:196. [PMID: 31416436 PMCID: PMC6694597 DOI: 10.1186/s12883-019-1421-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 07/30/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recovery of upper limb function in individuals after a stroke remains challenging. Modified constraint-induced movement therapy (m-CIMT) has strong evidence for increasing the use and recovery of sensorimotor function of the paretic upper limb. Recent studies have shown that priming with aerobic exercise prior to task-specific training potentiates upper limb recovery in individuals with stroke. This protocol describes a randomized clinical trial designed to determine whether priming with moderate-high intensity aerobic exercise prior to m-CIMT will improve the manual dexterity of the paretic upper limb in individuals with chronic hemiparesis. METHODS Sixty-two individuals with chronic hemiparesis will be randomized into two groups: Aerobic exercise + m-CIMT or Stretching + m-CIMT. m-CIMT includes 1) restraint of the nonparetic upper limb for 90% of waking hours, 2) intensive task-oriented training of the paretic upper limb for 3 h/day for 10 days and 3) behavior interventions for improving treatment adherence. Aerobic exercise will be conducted on a stationary bicycle at intervals of moderate to high intensity. Participants will be evaluated at baseline, 3, 30, and 90 days postintervention by the following instruments: Motor Activity Log, Nottingham Sensory Assessment, Wolf Motor Function Test, Box and Block Test, Nine-Hole Peg Test, Stroke Specific Quality of Life Scale and three-dimensional kinematics. The data will be tested for normality and homogeneity. Parametric data will be analyzed by two-way ANOVA with repeated measures and Bonferroni's adjustment. For nonparametric data, the Friedman test followed by the Wilcoxon test with Bonferroni's adjustment will be used to compare the ratings for each group. To compare the groups in each assessment, the Mann-Whitney test will be used. DISCUSSION This study will provide valuable information about the effect of motor priming for fine upper limb skill improvement in people with chronic poststroke hemiparesis, bringing new evidence about the association of two therapies commonly used in clinical practice. TRIAL REGISTRATION This trial was retrospectively registered (registration number RBR-83pwm3 ) on 07 May 2018.
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Affiliation(s)
- Erika Shirley Moreira da Silva
- Department of Physiotherapy, Laboratory of Neurological Physiotherapy Research, Federal University of São Carlos (UFSCar), Rodovia Washington Luís, Km 235, São Carlos, SP, 13565-905, Brazil
| | - Gabriela Lopes Santos
- Department of Physiotherapy, Laboratory of Neurological Physiotherapy Research, Federal University of São Carlos (UFSCar), Rodovia Washington Luís, Km 235, São Carlos, SP, 13565-905, Brazil.,Health science Institute, Faculty Alfredo Nasse, Aparecida de Goiânia, Goiás, Brazil
| | - Aparecida Maria Catai
- Department of Physiotherapy, Cardiovascular Physical Therapy Laboratory, Federal University of São Carlos (UFSCar), São Carlos, SP, Brazil
| | | | - Natália Pereira Duarte Furtado
- Department of Physiotherapy, Laboratory of Neurological Physiotherapy Research, Federal University of São Carlos (UFSCar), Rodovia Washington Luís, Km 235, São Carlos, SP, 13565-905, Brazil
| | | | - Thiago Luiz Russo
- Department of Physiotherapy, Laboratory of Neurological Physiotherapy Research, Federal University of São Carlos (UFSCar), Rodovia Washington Luís, Km 235, São Carlos, SP, 13565-905, Brazil.
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21
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Gaillard F, Cacioppo M, Bouvier B, Bouzille G, Newman CJ, Pasquet T, Cretual A, Rauscent H, Bonan I. Assessment of bimanual performance in 3-D movement analysis: Validation of a new clinical protocol in children with unilateral cerebral palsy. Ann Phys Rehabil Med 2019; 63:408-415. [PMID: 31301386 DOI: 10.1016/j.rehab.2019.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 04/28/2019] [Accepted: 06/15/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND The "Be an Airplane Pilot" (BE-API) protocol is a novel 3-D movement analysis (3DMA) protocol assessing the bimanual performance of children during a game. OBJECTIVE This study aimed to investigate the reliability and validity of this protocol in children with unilateral cerebral palsy (uCP). METHODS Angular waveforms (WAVE), maximum angles (MAX) and range of motion (ROM) of the trunk, shoulder, elbow and wrist joints were collected in children with uCP and in typically developing children (TDC) during 4 tasks of the BE-API protocol designed to explore specific degrees of freedom (DoF). The inter-trial reliability for children with uCP was assessed with the coefficient of multiple correlation (CMC) for WAVE and the intraclass correlation coefficient (ICC) and standard error of measurement (SEM) for MAX and ROM. Clinical performance-based measures, including the Assisting Hand Assessment (AHA) and ABILHAND-Kids scores, were used to explore correlations between clinical measures and kinematic parameters in children with uCP. RESULTS 20 children with uCP (13 boys; mean age 12.0 [SD 3.2] years) and 20 TDC (11 boys; mean age 11.9 [SD 3.4] years) were included. In children with uCP, most kinematic parameters showed high reliability (WAVE: CMC≥0.82; MAX and ROM: ICC≥0.85, SEM≤4.7°). Elbow extension, forearm supination, and wrist adduction were reduced and wrist flexion was increased for children with uCP versus TDC (P<0.01). In children with uCP, MAX and ROM values were moderately correlated with clinical assessments (AHA score: r=0.48-0.65; ABILHAND-Kids score: r=0.48-0.49). CONCLUSIONS The BE-API protocol is a 3DMA-bimanual performance-based assessment that is highly reliable in children with uCP. Children with uCP and TDC significantly differed in some clinically relevant kinematic parameters. The BE-API is a promising playful tool, helpful for better understanding upper-limb motor movement abnormalities in bimanual conditions and for tailoring treatments to individual deficits.
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Affiliation(s)
- Florence Gaillard
- Department of Physical Medicine and Rehabilitation, Rennes University Hospital, 35033 Rennes, France; M2S laboratory (Mouvement Sport Santé), Rennes 2 University-ENS Rennes - UEB, Campus de Ker Lann, 35170 Bruz, France.
| | - Marine Cacioppo
- Department of Physical Medicine and Rehabilitation, Rennes University Hospital, 35033 Rennes, France
| | - Brice Bouvier
- M2S laboratory (Mouvement Sport Santé), Rennes 2 University-ENS Rennes - UEB, Campus de Ker Lann, 35170 Bruz, France
| | - Guillaume Bouzille
- INSERM U1099, 35000 Rennes, France; CIC Inserm 1414. Centre de Données Cliniques, Rennes University Hospital, 35033 Rennes, France
| | - Christopher J Newman
- Paediatric Neurology and Neurorehabilitation Unit, Lausanne University Hospital, Nestlé Hospital, CHUV, 1011 Lausanne, Switzerland
| | - Thibault Pasquet
- Department of Physical Medicine and Rehabilitation, 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
| | - Hélène Rauscent
- Department of Physical Medicine and Rehabilitation, Rennes University Hospital, 35033 Rennes, France
| | - Isabelle Bonan
- Department of Physical Medicine and Rehabilitation, Rennes University Hospital, 35033 Rennes, France
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Abd El Rhm A, El Sayed S K, Mosaad Abd G, Hassan Abo M. Influence of Biofeedback and Task Oriented Training on Hand Skills in Children with Spastic Cerebral Palsy. JOURNAL OF MEDICAL SCIENCES 2019. [DOI: 10.3923/jms.2019.63.68] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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23
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Valevicius AM, Boser QA, Lavoie EB, Chapman CS, Pilarski PM, Hebert JS, Vette AH. Characterization of normative angular joint kinematics during two functional upper limb tasks. Gait Posture 2019; 69:176-186. [PMID: 30769260 DOI: 10.1016/j.gaitpost.2019.01.037] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 01/18/2019] [Accepted: 01/26/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Optical motion capture is a powerful tool for assessing upper body kinematics, including compensatory movements, in different populations. However, the lack of a standardized protocol with clear functional relevance hinders its clinical acceptance. RESEARCH QUESTION The objective of this study was to use motion capture to: (1) characterize angular joint kinematics in a normative population performing two complex, yet standardized upper limb tasks with clear functional relevance; and (2) assess the protocol's intra-rater reliability. METHODS Twenty non-disabled adults performed the previously developed Pasta Box Task and Cup Transfer Task. The kinematics of the upper body were captured using an optoelectronic motion capture system and rigid plates with reflective markers. Angular joint trajectories, peak angle, range of motion (RoM), and peak angular velocity were extracted for the trunk, shoulder, elbow, forearm, and wrist. Intra-class correlation was used to assess the intra-rater reliability of the kinematic measures. RESULTS Both tasks required minimal trunk motion. Cross-body movements required greater RoM at the trunk, shoulder, and elbow joints compared to movements in front of the body. Reaches to objects further away from the body required greater trunk and elbow joint RoM compared to reaches to objects closer to the body. Transporting the box of pasta required the wrist to maintain an extended position. The two different grasp patterns in the Cup Transfer Task forced the wrist into a flexed and ulnar-deviated position for the near cup, and an extended and radial-deviated position for the far cup. For both tasks, the majority of measures displayed intra-class correlation values above 0.75, indicating good reliability. SIGNIFICANCE Our protocol and functional tasks elicit a degree of movement sensitivity that is not available in current clinical assessments. Our study also provides a comprehensive dataset that can serve as a normative benchmark for quantifying movement compensations following impairment.
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Affiliation(s)
- Aïda M Valevicius
- Department of Biomedical Engineering, University of Alberta, 1098 Research Transition Facility, Edmonton, Alberta T6G 2V2, Canada
| | - Quinn A Boser
- Department of Biomedical Engineering, University of Alberta, 1098 Research Transition Facility, Edmonton, Alberta T6G 2V2, Canada
| | - Ewen B Lavoie
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, 3-100 University Hall, Van Vliet Complex, Edmonton, Alberta T6G 2H9, Canada
| | - Craig S Chapman
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, 3-100 University Hall, Van Vliet Complex, Edmonton, Alberta T6G 2H9, Canada
| | - Patrick M Pilarski
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine and Dentistry, University of Alberta, Walter C Mackenzie Health Sciences Centre, 8440 112 Street NW, Edmonton, Alberta T6G 2R7, Canada
| | - Jacqueline S Hebert
- Department of Biomedical Engineering, University of Alberta, 1098 Research Transition Facility, Edmonton, Alberta T6G 2V2, Canada; Division of Physical Medicine and Rehabilitation, Faculty of Medicine and Dentistry, University of Alberta, Walter C Mackenzie Health Sciences Centre, 8440 112 Street NW, Edmonton, Alberta T6G 2R7, Canada; Glenrose Rehabilitation Hospital, Alberta Health Services, 10230 111 Avenue NW, Edmonton, Alberta T5G 0B7, Canada
| | - Albert H Vette
- Department of Biomedical Engineering, University of Alberta, 1098 Research Transition Facility, Edmonton, Alberta T6G 2V2, Canada; Glenrose Rehabilitation Hospital, Alberta Health Services, 10230 111 Avenue NW, Edmonton, Alberta T5G 0B7, Canada; Department of Mechanical Engineering, University of Alberta, Donadeo Innovation Centre for Engineering, 9211 116 Street NW, Edmonton, Alberta T6G 1H9, Canada.
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24
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Shimizu Y, Kadone H, Kubota S, Ueno T, Sankai Y, Hada Y, Yamazaki M. Voluntary Elbow Extension-Flexion Using Single Joint Hybrid Assistive Limb (HAL) for Patients of Spastic Cerebral Palsy: Two Cases Report. Front Neurol 2019; 10:2. [PMID: 30723447 PMCID: PMC6349701 DOI: 10.3389/fneur.2019.00002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 01/03/2019] [Indexed: 11/13/2022] Open
Abstract
Cerebral palsy (CP) patients with spastic diplegia struggle to perform activities of daily life (ADL) using their upper arms. The single-joint-type Hybrid Assistive limb (HAL) for upper limbs is a new portable robot that can provide elbow motion support in accordance with bioelectric activation of patient's biceps and triceps brachii muscles. The purpose of this study is to assess the feasibility and efficacy of the use of HAL for CP patients. Two patients were enrolled in this study. (Case 1: a 19-years-old male, at the Gross Motor Function Classification System (GMFCS) level IV, Case 2: a 17-years-old male at GMFCS level III). Both these patients experienced difficulty in voluntary elbow extension in ADLs. The HAL intervention (eight sessions; voluntary extension-flexion training of the elbow with HAL and clinical evaluation) was conducted for both sides in Case 1 and for the right side in Case 2. Clinical assessments were conducted as follows: Surface electromyography was used to evaluate the muscle activities of the biceps, triceps brachii, trapezius, and pectoralis major during elbow extension-flexion. The voluntary extension-flexion angles of the elbow, the coactivation index of the biceps and triceps brachii muscles, synergy analysis, and the Action Research Arm Test (ARAT) scores were assessed before and after the HAL sessions; the FIM score was evaluated before and after the entire intervention. In Case 1, the voluntary extension angle tended to increase after the HAL sessions. In both cases, the ARAT scores improved after the sessions. The FIM scores improved after HAL intervention. The voluntary extension-flexion of the elbow using the HAL may be a feasible option for rehabilitation of CP patients.
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Affiliation(s)
- Yukiyo Shimizu
- Department of Rehabilitation Medicine, University of Tsukuba Hospital, Tsukuba, Japan
| | - Hideki Kadone
- Center for Innovative Medicine and Engineering, University of Tsukuba Hospital, Tsukuba, Japan
| | - Shigeki Kubota
- Division of Regenerative Medicine for Musculoskeletal System, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Tomoyuki Ueno
- Department of Rehabilitation Medicine, University of Tsukuba Hospital, Tsukuba, Japan
| | - Yoshiyuki Sankai
- Center for Cybernics Research, University of Tsukuba, Tsukuba, Japan
| | - Yasushi Hada
- Department of Rehabilitation Medicine, University of Tsukuba Hospital, Tsukuba, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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25
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A survey of human shoulder functional kinematic representations. Med Biol Eng Comput 2018; 57:339-367. [PMID: 30367391 PMCID: PMC6347660 DOI: 10.1007/s11517-018-1903-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 12/17/2017] [Indexed: 10/28/2022]
Abstract
In this survey, we review the field of human shoulder functional kinematic representations. The central question of this review is to evaluate whether the current approaches in shoulder kinematics can meet the high-reliability computational challenge. This challenge is posed by applications such as robot-assisted rehabilitation. Currently, the role of kinematic representations in such applications has been mostly overlooked. Therefore, we have systematically searched and summarised the existing literature on shoulder kinematics. The shoulder is an important functional joint, and its large range of motion (ROM) poses several mathematical and practical challenges. Frequently, in kinematic analysis, the role of the shoulder articulation is approximated to a ball-and-socket joint. Following the high-reliability computational challenge, our review challenges this inappropriate use of reductionism. Therefore, we propose that this challenge could be met by kinematic representations, that are redundant, that use an active interpretation and that emphasise on functional understanding.
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26
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Taylor S, Girdler S, Parsons R, McLean B, Falkmer T, Carey L, Blair E, Elliott C. Construct validity and responsiveness of the functional Tactile Object Recognition Test for children with cerebral palsy. Aust Occup Ther J 2018; 65:420-430. [DOI: 10.1111/1440-1630.12508] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Susan Taylor
- School of Occupational Therapy and Social Work; Curtin University; Perth WA Australia
- Paediatric Rehabilitation (Kids Rehab WA); Perth Children's Hospital; Perth Western Australia Australia
| | - Sonya Girdler
- School of Occupational Therapy and Social Work; Curtin University; Perth WA Australia
- Population Sciences; Telethon Kids Institute; Perth Western Australia Australia
| | - Richard Parsons
- School of Occupational Therapy and Social Work; Curtin University; Perth WA Australia
| | - Belinda McLean
- School of Paediatrics and Child Health; University of Western Australia; Perth Western Australia Australia
- Paediatric Rehabilitation (Kids Rehab WA); Perth Children's Hospital; Perth Western Australia Australia
| | - Torbjorn Falkmer
- School of Occupational Therapy and Social Work; Curtin University; Perth WA Australia
| | - Leeanne Carey
- Neurorehabilitation and Recovery; The Florey Institute of Neuroscience and Mental Health; Melbourne Victoria Australia
- Occupational Therapy; School of Allied Health; La Trobe University; Melbourne Victoria Australia
| | - Eve Blair
- Population Sciences; Telethon Kids Institute; Perth Western Australia Australia
| | - Catherine Elliott
- School of Occupational Therapy and Social Work; Curtin University; Perth WA Australia
- Paediatric Rehabilitation (Kids Rehab WA); Perth Children's Hospital; Perth Western Australia Australia
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27
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Kuczynski AM, Kirton A, Semrau JA, Dukelow SP. Bilateral reaching deficits after unilateral perinatal ischemic stroke: a population-based case-control study. J Neuroeng Rehabil 2018; 15:77. [PMID: 30115093 PMCID: PMC6097295 DOI: 10.1186/s12984-018-0420-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 07/31/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Detailed kinematics of motor impairment of the contralesional ("affected") and ipsilesional ("unaffected") limbs in children with hemiparetic cerebral palsy are not well understood. We aimed to 1) quantify the kinematics of reaching in both arms of hemiparetic children with perinatal stroke using a robotic exoskeleton, and 2) assess the correlation of kinematic reaching parameters with clinical motor assessments. METHODS This prospective, case-control study involved the Alberta Perinatal Stroke Project, a population-based research cohort, and the Foothills Medical Center Stroke Robotics Laboratory in Calgary, Alberta over a four year period. Prospective cases were collected through the Calgary Stroke Program and included term-born children with magnetic resonance imaging confirmed perinatal ischemic stroke and upper extremity deficits. Control participants were recruited from the community. Participants completed a visually guided reaching task in the KINARM robot with each arm separately, with 10 parameters quantifying motor function. Kinematic measures were compared to clinical assessments and stroke type. RESULTS Fifty children with perinatal ischemic stroke (28 arterial, mean age: 12.5 ± 3.9 years; 22 venous, mean age: 11.5 ± 3.8 years) and upper extremity deficits were compared to healthy controls (n = 147, mean age: 12.7 ± 3.9 years). Perinatal stroke groups demonstrated contralesional motor impairments compared to controls when reaching out (arterial = 10/10, venous = 8/10), and back (arterial = 10/10, venous = 6/10) with largest errors in reaction time, initial direction error, movement length and time. Ipsilesional impairments were also found when reaching out (arterial = 7/10, venous = 1/10) and back (arterial = 6/10). The arterial group performed worse than venous on both contralesional and ipsilesional parameters. Contralesional reaching parameters showed modest correlations with clinical measures in the arterial group. CONCLUSIONS Robotic assessment of reaching behavior can quantify complex, upper limb dysfunction in children with perinatal ischemic stroke. The ipsilesional, "unaffected" limb is often abnormal and may be a target for therapeutic interventions in stroke-induced hemiparetic cerebral palsy.
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Affiliation(s)
- Andrea M Kuczynski
- University of Calgary, Calgary, AB, T2N 2T9, Canada.,Section of Neurology, Department of Pediatrics, Alberta Children's Hospital Research Institute, Calgary, AB, Canada
| | - Adam Kirton
- University of Calgary, Calgary, AB, T2N 2T9, Canada.,Section of Neurology, Department of Pediatrics, Alberta Children's Hospital Research Institute, Calgary, AB, Canada.,Department of Clinical Neurosciences, Foothills Medical Centre, Hotchkiss Brain Institute, 1403 - 29th St. NW, Calgary, AB, Canada
| | - Jennifer A Semrau
- University of Calgary, Calgary, AB, T2N 2T9, Canada.,Department of Clinical Neurosciences, Foothills Medical Centre, Hotchkiss Brain Institute, 1403 - 29th St. NW, Calgary, AB, Canada
| | - Sean P Dukelow
- University of Calgary, Calgary, AB, T2N 2T9, Canada. .,Department of Clinical Neurosciences, Foothills Medical Centre, Hotchkiss Brain Institute, 1403 - 29th St. NW, Calgary, AB, Canada.
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28
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Gaillard F, Cretual A, Cordillet S, Le Cornec C, Gonthier C, Bouvier B, Heyman R, Marleix S, Bonan I, Rauscent H. Kinematic motion abnormalities and bimanual performance in children with unilateral cerebral palsy. Dev Med Child Neurol 2018; 60:839-845. [PMID: 29701242 DOI: 10.1111/dmcn.13774] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/21/2018] [Indexed: 11/27/2022]
Abstract
AIM To evaluate the relationship between the movement abnormalities of the impaired upper limb in children with unilateral cerebral palsy (CP) and bimanual performance. METHOD Twenty-three children with unilateral CP (mean age 11y 10mo [SD 2y 8mo]) underwent evaluation of bimanual performance (Assisting Hand Assessment [AHA]) and a three-dimensional movement analysis to measure deviations in the movement of their affected upper limb, and compared with 23 typically developing children (TDC) (mean age 11y 11mo [SD 2y 5mo]). Kinematic indices, such as the Global Arm Profile Score (APS), which summarizes the global movement deviation of the upper limb from the norm, and the Global Arm Variable Score (AVS), which represent movement deviations for a given joint, were calculated and correlated to AHA. RESULTS Values of kinematic indices were significantly higher in children with unilateral CP than in TDC. A strong correlation between Global-APS and AHA score (r=-0.75) was found. Other significant correlations were found with Global-AVS, especially in distal joints. INTERPRETATION Children with unilateral CP had more movement deviations than TDC. The global movement deviation of the impaired upper limb was strongly correlated with bimanual performance. The influence of distal abnormalities confirms the importance of considering these limitations in therapeutics. WHAT THIS PAPER ADDS Children with unilateral cerebral palsy had more movement deviations than typically developing children in unimanual tasks. A strong relationship was found between movement deviations of the impaired upper limb and bimanual performance.
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Affiliation(s)
- Florence Gaillard
- Department of Physical Medicine and Rehabilitation, CHU Rennes, Rennes, France.,M2S Lab (Mouvement Sport Santé), Université Rennes 2, ENS Rennes, UEB, Bruz, France
| | - Armel Cretual
- M2S Lab (Mouvement Sport Santé), Université Rennes 2, ENS Rennes, UEB, Bruz, France
| | - Sebastien Cordillet
- M2S Lab (Mouvement Sport Santé), Université Rennes 2, ENS Rennes, UEB, Bruz, France
| | - Caroline Le Cornec
- Department of Physical Medicine and Rehabilitation, CHU Rennes, Rennes, France
| | | | - Brice Bouvier
- Department of Physical Medicine and Rehabilitation, CHU Rennes, Rennes, France.,M2S Lab (Mouvement Sport Santé), Université Rennes 2, ENS Rennes, UEB, Bruz, France
| | - Rachel Heyman
- Department of Physical Medicine and Rehabilitation, CHU Rennes, Rennes, France
| | | | - Isabelle Bonan
- Department of Physical Medicine and Rehabilitation, CHU Rennes, Rennes, France.,M2S Lab (Mouvement Sport Santé), Université Rennes 2, ENS Rennes, UEB, Bruz, France
| | - Hélène Rauscent
- Department of Physical Medicine and Rehabilitation, CHU Rennes, Rennes, France
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Simon-Martinez C, dos Santos GL, Jaspers E, Vanderschueren R, Mailleux L, Klingels K, Ortibus E, Desloovere K, Feys H. Age-related changes in upper limb motion during typical development. PLoS One 2018; 13:e0198524. [PMID: 29874278 PMCID: PMC5991355 DOI: 10.1371/journal.pone.0198524] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 05/21/2018] [Indexed: 12/04/2022] Open
Abstract
Background and aim Understanding the maturation of upper limb (UL) movement characteristics in typically developing (TD) children is key to explore UL deficits in those with neurodevelopmental disorders. Three-dimensional motion analysis (3DMA) offers a reliable tool to comprehensively evaluate UL motion. However, studies thus far mainly focused on specific pre-defined parameters extracted from kinematic waveforms. Here, we investigated age-related differences in UL movement characteristics over the entire movement cycle in TD children. Participants and methods We assessed the non-dominant UL of 60 TD children (mean age 10y3m±3y1m) using 3DMA during eight tasks: reaching (forwards (RF), upwards (RU), sideways (RS)), reach-to-grasp (sphere (RGS), vertical cylinder (RGV)) and activities-of-daily-living mimicking tasks (hand-to-head (HTH), hand-to-mouth (HTM), hand-to-shoulder (HTS)). We investigated differences between four age-groups (5-7y, 8-10y, 11-12y, 13-15y) in: (1) spatiotemporal parameters (movement duration, peak velocity, time-to-peak velocity and trajectory straightness), and (2) 12 UL joint angles, using Statistical Parametric Mapping (SPM). Results We found that the 5-7y children moved with lower peak velocity and less straight trajectories compared to the 11-12y group (peak velocity: RS, HTS, p<0.01; trajectory: RU, RS, RGV, HTS, p<0.01) and the 13-15y group (peak velocity: RF, RS, RGS, RGV, HTH, HTS, p<0.01; trajectory, all tasks, p<0.01). The 5-7y children showed increased scapular protraction compared to older children (8-10y and 11-12y, HTS), as well as increased scapular medial rotation compared to the 13-15y group (RGS). During RU, the 5-7y children moved more towards the frontal plane (shoulder), unlike the 13-15y group. Lastly, the 5-7y group used less elbow flexion than older children (11-12y and 13-15y) during HTH and HTS. Discussion and conclusion In conclusion, our results point toward a maturation in UL movement characteristics up to age 11-12y, when UL motion seemed to reach a plateau. The reference values provided in this study will help to further optimize the interpretation of UL deficits in children with neurodevelopmental disorders.
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Affiliation(s)
- Cristina Simon-Martinez
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
- * E-mail:
| | - Gabriela Lopes dos Santos
- Laboratory of Neurological Physiotherapy Research, Department of Physiotherapy, Federal University of São Carlos (UFSCar), São Carlos, São Paulo, Brazil
| | - Ellen Jaspers
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
- Neural Control of Movement Lab, Department of Health Sciences and Technology, ETH Zurich, Switzerland
| | - Ruth Vanderschueren
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
| | - Lisa Mailleux
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
| | - Katrijn Klingels
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
- Rehabilitation Research Centre, BIOMED, Hasselt University, Diepenbeek, Belgium
| | - Els Ortibus
- KU Leuven - University of Leuven, Department of Development and Regeneration, Leuven, Belgium
| | - Kaat Desloovere
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
- Clinical Motion Analysis Laboratory, University Hospital Leuven, Pellenberg, Belgium
| | - Hilde Feys
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
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Trac J, Dawe J, Likitlersuang J, Musselman K, Zariffa J. Influence of upper limb movement patterns on accelerometer measurements: a pediatric case series. Physiol Meas 2018; 39:04NT02. [PMID: 29578452 DOI: 10.1088/1361-6579/aab994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Previous studies showed success using wrist-worn accelerometers to monitor upper-limb activity in adults and children with hemiparesis. However, a knowledge gap exists regarding which specific joint movements are reflected in accelerometry readings. We conducted a case series intended to enrich data interpretation by characterizing the influence of different pediatric upper-limb movements on accelerometry data. APPROACH The study recruited six typically developing children and five children with hemiparetic cerebral palsy. The participants performed unilateral and bilateral activities, and their upper limb movements were measured with wrist-worn accelerometers and the Microsoft Kinect, a markerless motion-capture system that tracks skeletal data. The Kinect data were used to quantify specific upper limb movements through joint angle calculations (trunk, shoulder, elbow and wrist). Correlation coefficients (r) were calculated to quantify the influence of individual joint movements on accelerometry data. Regression analyses were performed to examine multi-joint patterns and explain variability across different activities and participants. MAIN RESULTS Single-joint correlation results suggest that pediatric wrist-worn accelerometry data are not biased to particular individual joint movements. Rather, the accelerometry data could best be explained by the movements of the joints with the most functional relevance to the performed activity. SIGNIFICANCE This case series provides deeper insight into the interpretation of wrist-worn accelerometry data, and supports the use of this tool in quantifying functional upper-limb movements in pediatric populations.
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Affiliation(s)
- Jessica Trac
- Department of Electrical and Computer Engineering, McMaster University, Hamilton, Ontario, Canada. Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada. Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
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Sansare A, Zampieri C, Alter K, Stanley C, Farhat N, Keener LA, Porter F. Gait, Balance, and Coordination Impairments in Niemann Pick Disease, Type C1. J Child Neurol 2018; 33:114-124. [PMID: 29246094 PMCID: PMC6534353 DOI: 10.1177/0883073817741054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
This is the first study to objectively measure gait, balance, and upper limb coordination in a group of patients with NPC1 and compare the results to age and gender matched controls. This is also the first study to report effect sizes in these measures. Spatiotemporal gait analysis, static and dynamic posturography, and upper limb reaching motion analysis were performed. The findings showed that the NPC1 subjects had statistically significant deficits on 12 out of the 16 parameters investigated compared to controls, and large effect sizes for all but 1 parameter. When ranking the variables in terms of the effect sizes, the top 5 included at least 1 parameter from each of the 3 motor domains investigated. These results can provide insight to clinical researchers on the selection of outcome measures for longitudinal and interventional studies.
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Affiliation(s)
- Ashwini Sansare
- Research Collaborator, National Institutes of Health Clinical Center, Functional and Applied Biomechanics Section, Rehabilitation Medicine Department, 10 Center Drive, Room 1-1468, MSC 1604, Bethesda, Maryland, USA 20892-1604
| | - Cris Zampieri
- Staff Scientist, National Institutes of Health Clinical Center, Functional & Applied Biomechanics Section, Rehabilitation Medicine Department, 10 Center Drive, Room 1-1468 MSC 1604, Bethesda, Maryland, USA 20892-1604
| | - Katharine Alter
- Medical Director, National Institutes of Health Clinical Center, Functional & Applied Biomechanics Section, Rehabilitation, Medicine Department, 10 Center Drive, Room 1-1468 MSC 1604, Bethesda, Maryland, USA 20892-1604
| | - Christopher Stanley
- Motion Lab Manager, National Institutes of Health Clinical Center, Functional & Applied Biomechanics Section, Rehabilitation Medicine Department, 10 Center Drive, Room 1-1468 MSC 1604, Bethesda, Maryland, USA 20892-1604
| | - Nicole Farhat
- Nurse Practitioner, The Eunice Kennedy Shriver National Institute of Child Health and Human Development, Section on Molecular Dysmorphology, 10 Center Drive, MSC 1103, Bethesda, Maryland. USA 20892
| | - Lee Ann Keener
- Nurse Practitioner, National Institutes of Health Clinical Center, Nursing Department, 10 Center Drive, Bethesda, Maryland, USA 20892
| | - Forbes Porter
- Senior Investigator, The Eunice Kennedy Shriver National Institute of Child Health and Human Development, Section on, Molecular Dysmorphology, 10 Center Drive, MSC 1832, Bethesda, Maryland. USA 20892
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Mailleux L, Simon-Martinez C, Klingels K, Jaspers E, Desloovere K, Demaerel P, Fiori S, Guzzetta A, Ortibus E, Feys H. Structural Brain Damage and Upper Limb Kinematics in Children with Unilateral Cerebral Palsy. Front Hum Neurosci 2017; 11:607. [PMID: 29311871 PMCID: PMC5733007 DOI: 10.3389/fnhum.2017.00607] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 11/28/2017] [Indexed: 12/20/2022] Open
Abstract
Background: In children with unilateral cerebral palsy (uCP) virtually nothing is known on the relation between structural brain damage and upper limb (UL) kinematics quantified with three-dimensional movement analysis (3DMA). This explorative study aimed to (1) investigate differences in UL kinematics between children with different lesion timings, i.e., periventricular white matter (PWM) vs. cortical and deep gray matter (CDGM) lesions and (2) to explore the relation between UL kinematics and lesion location and extent within each lesion timing group. Methods: Forty-eight children (age 10.4 ± 2.7 year; 29 boys; 21 right-sided; 33 PWM; 15 CDGM) underwent an UL 3DMA during a reach-to-grasp task. Spatiotemporal parameters [movement duration, (timing of) maximum velocity, trajectory straightness], the Arm Profile Score (APS) and Arm Variable Scores (AVS) were extracted. The APS and AVS refer to the total amount of movement pathology and movement deviations of the wrist, elbow, shoulder, scapula and trunk respectively. Brain lesion location and extent were scored based on FLAIR-images using a semi-quantitative MRI-scale. Results: Children with CDGM lesions showed more aberrant spatiotemporal parameters (p < 0.03) and more movement pathology (APS, p = 0.003) compared to the PWM group, mostly characterized by increased wrist flexion (p = 0.01). In the CDGM group, moderate to high correlations were found between lesion location and extent and duration, timing of maximum velocity and trajectory straightness (r = 0.53-0.90). Lesion location and extent were further moderately correlated with distal UL movement pathology (wrist flexion/extension, elbow pronation/supination, elbow flexion/extension; r = 0.50-0.65) and with the APS (r = 0.51-0.63). In the PWM group, only a few and low correlations were observed, mostly between damage to the PLIC and higher AVS of elbow flexion/extension, shoulder elevation and trunk rotation (r = 0.35-0.42). Regression analysis revealed damage to the temporal lobe with lesion timing as interactor (27%, p = 0.002) and the posterior limb of the internal capsule (PLIC) (7%, p = 0.04) as the strongest predictors, explaining 34% of the variance in APS. Conclusion: UL kinematic deviations are more influenced by lesion location and extent in children with later (CDGM) versus earlier lesions (PWM), except for proximal movement pathology. Damage to the PLIC is a significant predictor for UL movement pathology irrespective of lesion timing.
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Affiliation(s)
- Lisa Mailleux
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | | | - Katrijn Klingels
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.,BIOMED, Rehabilitation Research Center (REVAL), Hasselt University, Diepenbeek, Belgium
| | - Ellen Jaspers
- Neural Control of Movement Lab, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Kaat Desloovere
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.,Clinical Motion Analysis Laboratory, University Hospitals Leuven, Leuven, Belgium
| | | | | | - Andrea Guzzetta
- IRCCS Stella Maris Foundation, Pisa, Italy.,Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Els Ortibus
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Hilde Feys
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
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Tomita Y, Rodrigues MRM, Levin MF. Upper Limb Coordination in Individuals With Stroke: Poorly Defined and Poorly Quantified. Neurorehabil Neural Repair 2017; 31:885-897. [DOI: 10.1177/1545968317739998] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Background. The identification of deficits in interjoint coordination is important in order to better focus upper limb rehabilitative treatment after stroke. The majority of standardized clinical measures characterize endpoint performance, such as accuracy, speed, and smoothness, based on the assumption that endpoint performance reflects interjoint coordination, without measuring the underlying temporal and spatial sequences of joint recruitment directly. However, this assumption is questioned since improvements of endpoint performance can be achieved through different degrees of restitution or compensation of upper limb motor impairments based on the available kinematic redundancy of the system. Confusion about adequate measurement may stem from a lack a definition of interjoint coordination during reaching. Methods and Results. We suggest an operational definition of interjoint coordination during reaching as a goal-oriented process in which joint degrees of freedom are organized in both spatial and temporal domains such that the endpoint reaches a desired location in a context-dependent manner. Conclusions. In this point-of-view article, we consider how current approaches to laboratory and clinical measures of coordination comply with our definition. We propose future study directions and specific research strategies to develop clinical measures of interjoint coordination with better construct and content validity than those currently in use.
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Affiliation(s)
- Yosuke Tomita
- McGill University, Montreal, Quebec, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Laval, Quebec, Canada
| | - Marcos R. M. Rodrigues
- McGill University, Montreal, Quebec, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Laval, Quebec, Canada
| | - Mindy F. Levin
- McGill University, Montreal, Quebec, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Laval, Quebec, Canada
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Simon-Martinez C, Jaspers E, Mailleux L, Desloovere K, Vanrenterghem J, Ortibus E, Molenaers G, Feys H, Klingels K. Negative Influence of Motor Impairments on Upper Limb Movement Patterns in Children with Unilateral Cerebral Palsy. A Statistical Parametric Mapping Study. Front Hum Neurosci 2017; 11:482. [PMID: 29051729 PMCID: PMC5633911 DOI: 10.3389/fnhum.2017.00482] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 09/19/2017] [Indexed: 11/13/2022] Open
Abstract
Upper limb three-dimensional movement analysis (UL-3DMA) offers a reliable and valid tool to evaluate movement patterns in children with unilateral cerebral palsy (uCP). However, it remains unknown to what extent the underlying motor impairments explain deviant movement patterns. Such understanding is key to develop efficient rehabilitation programs. Although UL-3DMA has been shown to be a useful tool to assess movement patterns, it results in a multitude of data, challenging the clinical interpretation and consequently its implementation. UL-3DMA reports are often reduced to summary metrics, such as average or peak values per joint. However, these metrics do not take into account the continuous nature of the data or the interdependency between UL joints, and do not provide phase-specific information of the movement pattern. Moreover, summary metrics may not be sensitive enough to estimate the impact of motor impairments. Recently, Statistical Parametric Mapping (SPM) was proposed to overcome these problems. We collected UL-3DMA of 60 children with uCP and 60 typically developing children during eight functional tasks and evaluated the impact of spasticity and muscle weakness on UL movement patterns. SPM vector field analysis was used to analyze movement patterns at the level of five joints (wrist, elbow, shoulder, scapula, and trunk). Children with uCP showed deviant movement patterns in all joints during a large percentage of the movement cycle. Spasticity and muscle weakness negatively impacted on UL movement patterns during all tasks, which resulted in increased wrist flexion, elbow pronation and flexion, increased shoulder external rotation, decreased shoulder elevation with a preference for movement in the frontal plane and increased trunk internal rotation. Scapular position was altered during movement initiation, although scapular movements were not affected by muscle weakness or spasticity. In conclusion, we identified pathological movement patterns in children with uCP and additionally mapped the negative impact of spasticity and muscle weakness on these movement patterns, providing useful insights that will contribute to treatment planning. Last, we also identified a subset of the most relevant tasks for studying UL movements in children with uCP, which will facilitate the interpretation of UL-3DMA data and undoubtedly contribute to its clinical implementation.
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Affiliation(s)
| | - Ellen Jaspers
- Neural Control of Movement Lab, ETH Zurich, Zurich, Switzerland
| | - Lisa Mailleux
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Kaat Desloovere
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.,Clinical Motion Analysis Laboratory, University Hospitals Leuven, Leuven, Belgium
| | | | - Els Ortibus
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Guy Molenaers
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium.,Department of Orthopedic Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Hilde Feys
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Katrijn Klingels
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.,Rehabilitation Research Center (REVAL), BIOMED, University of Hasselt, Diepenbeek, Belgium
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Pons R, Vanezis A, Skouteli H, Papavasiliou A, Tziomaki M, Syrengelas D, Darras N. Upper Limb Function, Kinematic Analysis, and Dystonia Assessment in Children With Spastic Diplegic Cerebral Palsy and Periventricular Leukomalacia. J Child Neurol 2017; 32:936-941. [PMID: 28776460 DOI: 10.1177/0883073817722451] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Assessment of upper limb function, kinematic analysis, and dystonia in patients with spastic diplegia cerebral palsy and periventricular leukomalacia. Seven children with spastic diplegia cerebral palsy and 8 controls underwent upper limb kinematics. Movement duration, average and maximum linear velocity, index of curvature, index of dystonia, and target accuracy and stability were analyzed. In the patients with spastic diplegia, Gross Motor Function and Manual Ability Classification Systems were determined, and spasticity and dystonia were rated using the Modified Ashworth and the Burke-Fahn-Marsden Dystonia scales respectively. Children with spastic diplegia demonstrated a tendency toward higher index of dystonia reflecting overflow, higher index of curvature, lower velocities, and poor target accuracy and stability. All patients showed clinical evidence of dystonia in the upper limbs. Dystonia scores correlated with the Manual Ability Classification System (r = 0.86, P = .01) and with the index of dystonia (r = 0.82, P = .02). Children with spastic diplegia cerebral palsy present dystonia in the upper limbs. This is functionally relevant and can be measured with kinematic analysis.
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Affiliation(s)
- Roser Pons
- 1 First Department of Pediatrics, Agia Sofia Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Athanasios Vanezis
- 2 Gait and Motion Analysis Center, ELEPAP-Rehabilitation for the Disabled, Athens, Greece
| | - Helen Skouteli
- 2 Gait and Motion Analysis Center, ELEPAP-Rehabilitation for the Disabled, Athens, Greece
| | | | - Magda Tziomaki
- 2 Gait and Motion Analysis Center, ELEPAP-Rehabilitation for the Disabled, Athens, Greece
| | - Dimitris Syrengelas
- 4 Department of Pediatric Physical Therapy, Agia Sofia Children's Hospital, Athens, Greece
| | - Nikolaos Darras
- 2 Gait and Motion Analysis Center, ELEPAP-Rehabilitation for the Disabled, Athens, Greece
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Mailleux L, Jaspers E, Ortibus E, Simon-Martinez C, Desloovere K, Molenaers G, Klingels K, Feys H. Clinical assessment and three-dimensional movement analysis: An integrated approach for upper limb evaluation in children with unilateral cerebral palsy. PLoS One 2017; 12:e0180196. [PMID: 28671953 PMCID: PMC5495347 DOI: 10.1371/journal.pone.0180196] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 06/12/2017] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION The clinical application of upper limb (UL) three-dimensional movement analysis (3DMA) in children with unilateral cerebral palsy (uCP) remains challenging, despite its benefits compared to conventional clinical scales. Moreover, knowledge on UL movement pathology and how this relates to clinical parameters remains scarce. Therefore, we investigated UL kinematics across different manual ability classification system (MACS) levels and explored the relation between clinical and kinematic parameters in children with uCP. PATIENTS AND METHODS Fifty children (MACS: I = 15, II = 26, III = 9) underwent an UL evaluation of sensorimotor impairments (grip force, muscle strength, muscle tone, two-point discrimination, stereognosis), bimanual performance (Assisting Hand Assessment, AHA), unimanual capacity (Melbourne Assessment 2, MA2) and UL-3DMA during hand-to-head, hand-to-mouth and reach-to-grasp tasks. Global parameters (Arm Profile Score (APS), duration, (timing of) maximum velocity, trajectory straightness) and joint specific parameters (angles at task endpoint, ROM and Arm Variable Scores (AVS)) were extracted. The APS and AVS refer respectively to the total amount of movement pathology and movement deviations of wrist, elbow, shoulder, scapula and trunk. RESULTS Longer movement durations and increased APS were found with higher MACS-levels (p<0.001). Increased APS was also associated with more severe sensorimotor impairments (r = -0.30-(-0.73)) and with lower AHA and MA2-scores (r = -0.50-(-0.86)). For the joint specific parameters, stronger movement deviations distally were significantly associated with increased muscle weakness (r = -0.32-(-0.74)) and muscle tone (r = 0.33-(-0.61)); proximal movement deviations correlated only with muscle weakness (r = -0.35-0.59). Regression analysis exposed grip force as the most important predictor for the variability in APS (p<0.002). CONCLUSION We found increased movement pathology with increasing MACS-levels and demonstrated the adverse impact of especially muscle weakness. The lower correlations suggest that 3DMA provides additional information regarding UL motor function, particularly for the proximal joints. Integrating both methods seems clinically meaningful to obtain a comprehensive representation of all aspects of a child's UL functioning.
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Affiliation(s)
- Lisa Mailleux
- KU Leuven–University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
- * E-mail:
| | - Ellen Jaspers
- KU Leuven–University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
- Neural Control of Movement Lab, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Els Ortibus
- KU Leuven–University of Leuven, Department of Development and Regeneration, Leuven, Belgium
| | | | - Kaat Desloovere
- KU Leuven–University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
- University Hospitals Leuven, Clinical Motion Analysis Laboratory, Leuven, Belgium
| | - Guy Molenaers
- KU Leuven–University of Leuven, Department of Development and Regeneration, Leuven, Belgium
- University Hospitals Leuven, Department of Orthopaedic Medicine, Leuven, Belgium
| | - Katrijn Klingels
- KU Leuven–University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
- UHasselt–Hasselt University, BIOMED, Rehabilitation Research Center (REVAL), Diepenbeek, Belgium
| | - Hilde Feys
- KU Leuven–University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
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Garavaglia L, Pagliano E, Arnoldi MT, LoMauro A, Zanin R, Baranello G, Aliverti A, Pittaccio S. Two single cases treated by a new pseudoelastic upper-limb orthosis for secondary dystonia of the young. IEEE Int Conf Rehabil Robot 2017; 2017:1260-1265. [PMID: 28813994 DOI: 10.1109/icorr.2017.8009422] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The study proposes a new treatment for dystonia based on a dynamic wearable orthosis equipped with metallic materials of non-linear mechanical characteristics. Two boys with upper-limb dystonia were enrolled, as well as six healthy children. Fully-customised devices were made for the patients. They used the orthosis for one month and their performances were evaluated before and after the treatment. The assessment was done with clinical scales (Modified Ashworth Score, Melbourne Upper Limb Assessment, PedsQL), interviews and optoelectronic kinematic analysis. Normal kinematics was obtained from the healthy group for comparison. Kinematic analysis showed modifications in motor patterns for both patients, with increases in the ranges of motion of initially stiff segments, improvements in posture, emergence of multi-joint strategies. Clinical scales did not always show similar trends in the two cases. The changes in control strategies could be linked to the force field dynamically applied by the device and appear to be learnable. This interpretation will be further tested with larger groups and longer treatments.
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Radtka S, Zayac J, Goldberg K, Long M, Ixanov R. Reliability and comparison of trunk and pelvis angles, arm distance and center of pressure in the seated functional reach test with and without foot support in children. Gait Posture 2017; 53:86-91. [PMID: 28119231 DOI: 10.1016/j.gaitpost.2016.12.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 12/08/2016] [Accepted: 12/20/2016] [Indexed: 02/02/2023]
Abstract
This study determined test-retest reliability of trunk and pelvis joint angles, arm distance and center of pressure (COP) excursion for the seated functional reach test (FRT) and compared these variables during the seated FRT with and without foot support. Fifteen typically developing children (age 9.3±4.1years) participated. Trunk and pelvis joint angles, arm distance, and COP excursion were collected on two days using three-dimensional motion analysis and a force plate while subjects reached maximally with and without foot support in the anterior, anterior/lateral, lateral, posterior/lateral directions. Age, weight, height, trunk and arm lengths were correlated (p<0.01) with maximum arm distance reached. Maximum arm distance, trunk and pelvis joint angles, and COP with and without foot support were not significant (p<0.05) for the two test periods. Excellent reliability (ICCs>0.75) was found for maximum arm distance reached in all four directions in the seated FRT with and without foot support. Most trunk and pelvis joint angles and COP excursions during maximum reach in all four directions showed excellent to fair reliability (ICCs>0.40-0.75). Reaching with foot support in all directions was significantly greater (p<0.05) than without foot support; however, most COP excursions and trunk and pelvic angles were not significantly different. Findings support the addition of anterior/lateral and posterior/lateral reaching directions in the seated FRT. Trunk and pelvis movement analysis is important to examine in the seated FRT to determine the specific movement strategies needed for maximum reaching without loss of balance.
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Affiliation(s)
- Sandra Radtka
- University of California at San Francisco/San Francisco State University, Graduate Program in Physical Therapy, San Francisco State University, 1600 Holloway Avenue, San Francisco, CA, 94132, USA.
| | - Jacqueline Zayac
- University of California at San Francisco/San Francisco State University, Graduate Program in Physical Therapy, San Francisco State University, 1600 Holloway Avenue, San Francisco, CA, 94132, USA
| | - Krystyna Goldberg
- University of California at San Francisco/San Francisco State University, Graduate Program in Physical Therapy, San Francisco State University, 1600 Holloway Avenue, San Francisco, CA, 94132, USA
| | - Michael Long
- University of California at San Francisco/San Francisco State University, Graduate Program in Physical Therapy, San Francisco State University, 1600 Holloway Avenue, San Francisco, CA, 94132, USA
| | - Rustem Ixanov
- University of California at San Francisco/San Francisco State University, Graduate Program in Physical Therapy, San Francisco State University, 1600 Holloway Avenue, San Francisco, CA, 94132, USA
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Combined Ultrasound Imaging and Biomechanical Modeling to Estimate Triceps Brachii Musculotendon Changes in Stroke Survivors. BIOMED RESEARCH INTERNATIONAL 2017; 2016:5275768. [PMID: 28053984 PMCID: PMC5183538 DOI: 10.1155/2016/5275768] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 10/26/2016] [Accepted: 11/07/2016] [Indexed: 11/17/2022]
Abstract
The aim of this study was to investigate the changes of musculotendon parameters of triceps brachii in persons after stroke based on subject-specific biomechanical modeling technique combined with in vivo ultrasound measurement. Five chronic stroke survivors and five normal control subjects were recruited. B-mode ultrasound was applied to measure muscle pennation angle and the optimal length of three heads of triceps' brachii at different joint angle positions in resting and isometric contraction. Measured ultrasound data were used to reduce the unknown parameters during the modeling optimization process. The results showed that pennation angles varied with joint angles, and the longhead TRI pennation from stroke group was smaller than the literature value. The maximum isometric muscle stress from persons after stroke was significantly smaller than that found in the unimpaired subjects. The prediction of joint torque fits well with the measured data from the control group, whereas the prediction error is larger in results from persons after stroke. In vivo parameters from ultrasound data could help to build a subject-specific biomechanical model of elbow extensor for both unimpaired and hemiplegic subjects, and then the results driven from the model could enhance the understanding of motor function changes for persons after stroke.
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Hung YC, Brandão MB, Gordon AM. Structured skill practice during intensive bimanual training leads to better trunk and arm control than unstructured practice in children with unilateral spastic cerebral palsy. RESEARCH IN DEVELOPMENTAL DISABILITIES 2017; 60:65-76. [PMID: 27912104 DOI: 10.1016/j.ridd.2016.11.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 10/25/2016] [Accepted: 11/19/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Recently, intensive practice showed good efficacy in improving upper extremity function for children with unilateral spastic cerebral palsy (USCP). However, little is known about the significance of skill progression frequently used during intensive practice. AIMS We evaluate the importance of skill progression during intensive bimanual practice on movement coordination. METHODS AND PROCEDURES Twenty children with USCP (average age: 8.5; MACS levels: I-III) participated in the study. Ten children were randomly allocated to a structured practice group (SPG) with skill progression, and the other 10 children randomized to an unstructured practice group (UPG) without skill progression. Both groups practiced bimanual activities 6h a day for 15days. Children were asked to perform a bimanual drawer-opening task before and after intensive practice using 3-D kinematic analyses. OUTCOMES AND RESULTS Both groups showed improved temporal bimanual coordination with increased normalized movement overlap of the two hands (p=0.005) and decreased goal synchronization time (p=0.002). However, only the SPG showed decreased trunk involvement (p=0.01) and increased elbow joint excursion (p=0.017) with decreased variability (p=0.015 and 0.048 respectively). CONCLUSIONS AND IMPLICATIONS The results highlighted the importance of skill progression for intensive practice to improve upper extremity and trunk movement control and consistency for children with USCP.
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Affiliation(s)
- Ya-Ching Hung
- Department of Family, Nutrition, and Exercise Sciences, Queens College, City University of New York, 65-30 Kissena Blvd, Flushing, NY 11367, USA.
| | - Marina B Brandão
- Departamento de Terapia Ocupacional, Universidade Federal de Minas Gerais, Av. Pres. Antonio Carlos, 6627, Belo Horizonte, MG, 31270901, Brazil
| | - Andrew M Gordon
- Department of Biobehavioral Sciences, Teachers College, Columbia University, 525 West 120th Street, Box 93, New York, NY 10027, USA
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Ferreira HNC, Cirne GNDM, Pereira SA, Lima NMFV, Cacho RDO, Cacho EWA. Upper extremity motor quality evaluation in children with Cerebral Palsy. FISIOTERAPIA EM MOVIMENTO 2017. [DOI: 10.1590/1980-5918.030.s01.ao27] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Introduction: Cerebral Palsy (CP) is a non-progressive disorder that may compromise functional abilities of the upper limbs due to motor and sensitive loss, that are still poorly evaluated and described by reliable tools. Objective: This study aimed to evaluate motor quality and skills of the upper extremity in children with CP in regions of Trairi and Seridó from Rio Grande do Norte state (Brazil). Methods: It is a cross-sectional exploratory study, with a qualitative approach, with 17 children with CP, aged between four and eight years. The following instruments were used for upper extremity evaluation: Manual Ability Classification System (MACS), Quality of Upper Extremity Skills Test (QUEST) and Gross Motor Function Classification System (GMFCS). Results: Mean and standard deviation (sd) of QUEST total score and the domains dissociated movement, grasp, weight bearing and extensive protection were, respectively, 41.06/37.08; 53.12/34.50; 15.51/62.98; 37.76/37.52; 42.48/47.26. MACS and GMFCS median scores were, respectively, 3 (three) and 5 (five); high positive correlation was observed between MACS and GMFCS (rs=0.83) and high negative correlation between GMFCS and total QUEST (rs=-0.83), as well as between MACS and QUEST (rs=-0.84); and MACS and all QUEST domains (rs=-0.73; rs=-0.82; rs=-0.76; rs=-0.79), p<0.001. Conclusion: Children with CP showed deficit in motor quality and skills of the upper limb, allowing to infer functional limitations regarding manipulation of objects and consequent dependence during life activities.
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Aboelnasr EA, Hegazy FA, Altalway HA. Kinematic characteristics of reaching in children with hemiplegic cerebral palsy: A comparative study. Brain Inj 2016; 31:83-89. [DOI: 10.1080/02699052.2016.1210230] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | - Fatma A. Hegazy
- Faculty of Physical Therapy, Cairo University, Cairo, Egypt
- Physiotherapy Department, College of Health Sciences, University of Sharjah, Sharjah City, United Arab Emirates
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Assi A, Bakouny Z, Karam M, Massaad A, Skalli W, Ghanem I. Three-dimensional kinematics of upper limb anatomical movements in asymptomatic adults: Dominant vs. non-dominant. Hum Mov Sci 2016; 50:10-18. [PMID: 27639219 DOI: 10.1016/j.humov.2016.09.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 09/06/2016] [Accepted: 09/10/2016] [Indexed: 11/24/2022]
Abstract
The effect of dominance on upper limb (UL) kinematics has only been studied on scapular movements. Moreover, when an anatomical UL movement is performed in a specific plane, secondary movements in the remaining planes involuntarily occur. These secondary movements have not been previously evaluated. The aim of this study was to compare the kinematics of primary and secondary angles of dominant and non-dominant UL during anatomical movements in asymptomatic adults. 25 asymptomatic adults performed 6 anatomical movements bilaterally: shoulder flexion-extension, abduction-adduction, horizontal abduction-adduction, internal-external rotation, elbow flexion-extension and wrist pronation-supination. Kinematics of the dominant and non-dominant UL were compared by their ranges of motion (ROM) and their angular waveforms (Coefficient of Multiple Correlations, CMC). The comparison between dominant and non-dominant UL kinematics showed different strategies of movement, most notably during elbow flexion-extension (CMC=0.29): the dominant UL exhibited more pronation at maximal elbow flexion. Significant secondary angles were found on most of the UL anatomical movements; e.g. a secondary ROM of shoulder (humero-thoracic) external-internal rotation (69°±16°) was found when the subject intended to perform maximal shoulder abduction-adduction (119°±21°). Bias of dominance should be considered when comparing pathological limb to the controlateral one. Normative values of primary and secondary angles during anatomical movements could be used as a reference for future studies on UL of subjects with neurological or orthopedic pathologies.
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Affiliation(s)
- Ayman Assi
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon; Gait and Motion Analysis Lab, SESOBEL, Beirut, Lebanon.
| | - Ziad Bakouny
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon.
| | - Mohammad Karam
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon.
| | - Abir Massaad
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon; Gait and Motion Analysis Lab, SESOBEL, Beirut, Lebanon.
| | - Wafa Skalli
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, France.
| | - Ismat Ghanem
- Laboratory of Biomechanics and Medical Imaging, Faculty of Medicine, University of Saint-Joseph, Beirut, Lebanon; Hôtel-Dieu de France Hospital, Beirut, Lebanon.
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de los Reyes-Guzmán A, Dimbwadyo-Terrer I, Pérez-Nombela S, Monasterio-Huelin F, Torricelli D, Pons JL, Gil-Agudo A. Novel kinematic indices for quantifying upper limb ability and dexterity after cervical spinal cord injury. Med Biol Eng Comput 2016; 55:833-844. [DOI: 10.1007/s11517-016-1555-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 07/30/2016] [Indexed: 12/17/2022]
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De los Reyes-Guzmán A, Dimbwadyo-Terrer I, Pérez-Nombela S, Monasterio-Huelin F, Torricelli D, Pons JL, Gil-Agudo A. Novel kinematic indices for quantifying movement agility and smoothness after cervical Spinal Cord Injury. NeuroRehabilitation 2016; 38:199-209. [PMID: 26923358 DOI: 10.3233/nre-161311] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND After cervical Spinal Cord Injury (SCI), upper limb movements made by patients have a lack of smoothness and a hand velocity profile characterized by a high number of velocity peaks. OBJECTIVE The aim of the present paper is to propose three novel kinematic indices for quantifying movement agility and smoothness, and to analyze their discriminative capability between healthy and pathological people. METHODS 18 people, healthy and two groups of patients with cervical SCI, participated in the study. Kinematic indices in relation to movement agility and smoothness were computed from hand trajectories and velocity profiles during the performance of the ADL of drinking from a glass. RESULTS The proposed indices discriminated between healthy and SCI people. The results are greater in healthy than SCI people. Both smoothness indices detected significant differences between healthy and both SCI groups. Moreover, the Agility index showed capacity for discriminating between both patients groups. CONCLUSIONS The main contribution of this research consists on the proposal of kinematic indices from experimental data, whose results are dimensionless and relative to a pattern of healthy subjects. We hope that kinematic indices proposed are a step toward the standardization of the quantitative assessment of movement characteristics and functional impairments.
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Affiliation(s)
- Ana De los Reyes-Guzmán
- Department of Biomechanics and Technical Aids. National Hospital for Spinal Cord Injury (SESCAM), Finca La Peraleda, Toledo, Spain
| | - Iris Dimbwadyo-Terrer
- Occupational Thinks Research Group, Centro Superior de Estudios La Salle (UAM), C/La Salle, Madrid, Spain
| | - Soraya Pérez-Nombela
- Department of Biomechanics and Technical Aids. National Hospital for Spinal Cord Injury (SESCAM), Finca La Peraleda, Toledo, Spain
| | - Félix Monasterio-Huelin
- Department of Special Technologies Applied to Telecommunication. Higher Technical School of Telecommunications Engineering, Technical University of Madrid, University City, Madrid, Spain
| | - Diego Torricelli
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), C/Doctor Arce, Madrid, Spain
| | - José Luis Pons
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), C/Doctor Arce, Madrid, Spain
| | - Angel Gil-Agudo
- Department of Biomechanics and Technical Aids. National Hospital for Spinal Cord Injury (SESCAM), Finca La Peraleda, Toledo, Spain
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Seruya M, Dickey RM, Fakhro A. Surgical Treatment of Pediatric Upper Limb Spasticity: The Wrist and Hand. Semin Plast Surg 2016; 30:29-38. [PMID: 26869861 DOI: 10.1055/s-0035-1571254] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The wrist and hand are essential in the placement of the upper extremity in a functional position for grasp, pinch, and release activities. This depends on the delicate balance between the extrinsic and intrinsic muscles of the wrist and hand. Spasticity alters this equilibrium, limiting the interaction of the upper limb with the environment. Classically, pediatric patients with upper limb spasticity present with a flexed wrist, thumb-in-palm, and flexed finger posture. These contractures are typically secondary to spasticity of the extrinsic flexor muscles of the wrist and hand and intrinsic muscles of the thumb and digits. Tendon release, lengthening, or transfer procedures may help correct the resultant abnormal postures. A total wrist arthrodesis with or without proximal row carpectomy may help address the severely flexed wrist deformity. With proper diagnosis, a well-executed surgical plan, and a consistent hand rehabilitation regimen, successful surgical outcomes can be achieved.
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Affiliation(s)
- Mitchel Seruya
- Division of Plastic and Maxillofacial Surgery, USC Keck School of Medicine, Los Angeles, California
| | - Ryan M Dickey
- Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
| | - Abdulla Fakhro
- Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
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van Meulen FB, Klaassen B, Held J, Reenalda J, Buurke JH, van Beijnum BJF, Luft A, Veltink PH. Objective Evaluation of the Quality of Movement in Daily Life after Stroke. Front Bioeng Biotechnol 2016; 3:210. [PMID: 26793705 PMCID: PMC4710748 DOI: 10.3389/fbioe.2015.00210] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 12/22/2015] [Indexed: 11/23/2022] Open
Abstract
Background Stroke survivors are commonly left with disabilities that impair activities of daily living. The main objective of their rehabilitation program is to maximize the functional performance at home. However, the actual performance of patients in their home environment is unknown. Therefore, objective evaluation of daily life activities of stroke survivors in their physical interaction with the environment is essential for optimal guidance of rehabilitation therapy. Monitoring daily life movements could be very challenging, as it may result in large amounts of data, without any context. Therefore, suitable metrics are necessary to quantify relevant aspects of movement performance during daily life. The objective of this study is to develop data processing methods, which can be used to process movement data into relevant metrics for the evaluation of intra-patient differences in quality of movements in a daily life setting. Methods Based on an iterative requirement process, functional and technical requirements were formulated. These were prioritized resulting in a coherent set of metrics. An activity monitor was developed to give context to captured movement data at home. Finally, the metrics will be demonstrated in two stroke participants during and after their rehabilitation phases. Results By using the final set of metrics, quality of movement can be evaluated in a daily life setting. As example to demonstrate potential of presented methods, data of two stroke patients were successfully analyzed. Differences between in-clinic measurements and measurements during daily life are observed by applying the presented metrics and visualization methods. Heel height profiles show intra-patient differences in height, distance, stride profile, and variability between strides during a 10-m walk test in the clinic and walking at home. Differences in distance and stride profile between both feet were larger at home, than in clinic. For the upper extremities, the participant was able to reach further away from the pelvis and cover a larger area. Discussion Presented methods can be used for the objective evaluation of intra-patient differences in movement quality between in-clinic and daily life measurements. Any observed progression or deterioration of movement quality could be used to decide on continuing, stopping, or adjusting rehabilitation programs.
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Affiliation(s)
- Fokke B van Meulen
- Biomedical Signals and Systems, MIRA - Institute for Biomedical Technology and Technical Medicine, University of Twente , Enschede , Netherlands
| | - Bart Klaassen
- Biomedical Signals and Systems, MIRA - Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, Netherlands; Centre for Telematics and Information Technology, University of Twente, Enschede, Netherlands
| | - Jeremia Held
- Biomedical Signals and Systems, MIRA - Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, Netherlands; Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital of Zurich, Zurich, Switzerland
| | - Jasper Reenalda
- Roessingh Research and Development, Roessingh Rehabilitation Hospital, Enschede, Netherlands; Biomechanical Engineering, MIRA - Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, Netherlands
| | - Jaap H Buurke
- Biomedical Signals and Systems, MIRA - Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, Netherlands; Roessingh Research and Development, Roessingh Rehabilitation Hospital, Enschede, Netherlands
| | - Bert-Jan F van Beijnum
- Biomedical Signals and Systems, MIRA - Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, Netherlands; Centre for Telematics and Information Technology, University of Twente, Enschede, Netherlands
| | - Andreas Luft
- Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital of Zurich , Zurich , Switzerland
| | - Peter H Veltink
- Biomedical Signals and Systems, MIRA - Institute for Biomedical Technology and Technical Medicine, University of Twente , Enschede , Netherlands
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Management of the spastic wrist and hand in cerebral palsy. J Hand Surg Am 2015; 40:1035-40; quiz 1041. [PMID: 25841769 DOI: 10.1016/j.jhsa.2014.11.025] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 11/19/2014] [Accepted: 11/20/2014] [Indexed: 02/02/2023]
Abstract
Research from the last 5 years on the pathophysiology and treatment of upper extremity sequelae of cerebral palsy (CP) is presented. The development of new treatments of CP-affected limbs, utilizing the brain's inherent neuroplasticity, remains an area of promising and active research. Functional magnetic resonance imaging scans have evaluated the role of neuroplasticity in adapting to the initial central nervous system insult. Children with CP appear to have greater recruitment of the ipsilateral brain for motor and sensory functions of the affected upper limb. Studies have also shown that constraint-induced movement therapy results in localized increase in gray matter volume of the sensorimotor cortex contralateral to the affected arm targeted during rehabilitation. Recent therapy interventions have emphasized the role of home therapy programs, the transient effects of splinting, and the promise of constraint-induced movement therapy and bimanual hand training. The use of motion laboratory analysis to characterize the movement pattern disturbances in children with CP continues to expand. Classification systems for CP upper limb continue to expand and improve their reliability, including use of the House Classification, the Manual Ability Classification System, and the Shriner's Hospital Upper Extremity Evaluation. Surgical outcomes have greater patients' satisfaction when they address functional limitations, also in addition to aesthetics, which may improve patients' self-esteem. Surgical techniques for elbow, wrist, fingers, and thumb continue to be refined. Research into each of these areas continues to expand our understanding of the nervous system insults that cause CP, how they may be modified, and how hand surgeons can continue to serve patients by improving their upper limb function and aesthetics.
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The reliability of the ELEPAP clinical protocol for the 3D kinematic evaluation of upper limb function. Gait Posture 2015; 41:431-9. [PMID: 25534948 DOI: 10.1016/j.gaitpost.2014.11.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Revised: 11/04/2014] [Accepted: 11/16/2014] [Indexed: 02/02/2023]
Abstract
Upper limb (UL) kinematic assessment protocols are becoming integrated into clinical practice due to their development over the last few years. We propose the ELEPAP UL protocol, a contemporary UL kinematic protocol that can be applied to different pathological conditions. This model is based on ISB modeling recommendations, uses functional joint definitions, and models three joints of the shoulder girdle. The specific aim of this study was to determine the within and between session reliability of the ELEPAP UL model. Ten healthy subjects (mean age: 13.6±4.3 years) performed four reach-to-grasp and five functional tasks, which included a novel throwing task to assess a wide spectrum of motor skills. Three trials of every task in two different sessions were analyzed. The reliability of angular waveforms was evaluated by measurement error (σ) and coefficient of multiple correlation (CMC). Spatiotemporal parameters were assessed by standard error of measurement (SEM). Generally joint kinematics presented low σw and σb errors (<100). A selection of angular waveforms errors was presented to inspect error fluctuation in different phases, which was found to be related to the demands of the different movements. CMCw and CMCb values (>0.60) were found, demonstrating good to excellent reliability especially in joints with larger ranges of motion. The throwing task proved equally reliable, enhancing the universal application of the protocol. Compared to the literature, this study demonstrated higher reliability of the thorax, scapula and wrist joints. This was attributed to the highly standardized procedure and the implementation of recent methodological advancements. In conclusion, ELEPAP protocol was proved a reliable tool to analyze UL kinematics.
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Figueiredo PRP, Silva PL, Avelar BS, da Fonseca ST, Bootsma RJ, Mancini MC. Upper limb performance and the structuring of joint movement in teenagers with cerebral palsy: the reciprocal role of task demands and action capabilities. Exp Brain Res 2015; 233:1155-64. [DOI: 10.1007/s00221-014-4195-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 12/29/2014] [Indexed: 10/24/2022]
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