Impairment severity selectively affects the control of proximal and distal components of reaching movements in children with hemiplegic cerebral palsy

Effectiveness of intensive motor learning approaches from working on a vertical surface on hemiplegic children's upper limb motor skills, a randomized controlled trial

PURPOSE

This study compares the effect of intensive motor learning approaches on improving the quality of upper extremity skills in children with unilateral cerebral palsy (UCP) by working on vertical surfaces versus horizontal surfaces during rehabilitation sessions.

MATERIALS AND METHODS

Forty UCP children of both sexes were randomized into two equal groups. All participants received 60 min of intensive motor learning approaches three days/week for three successive months. These approaches included constraint-induced movement therapy (CIMT), in which children wore a splint or sling on the unaffected upper limb, as well as hand-arm bimanual intensive training (HABIT) that requires the use of both hands during specific play-based activities. The control group received training on a horizontal surface while the child sat in front of an elbow-height table while the study group (vertical surface training) sat or stood in front of a wall/mirror/board. The task requirements were graded to ensure success.

RESULTS

Statistically significant differences were detected between the mean values of post-treatment of all scorers, with a greater percentage of improvement in favor of the study group.

CONCLUSIONS

This study revealed that working on a vertical surface improved upper limb motor skills more significantly than working on a horizontal surface.

Object Weight and Hand Dominance Impact Kinematics in a Functional Reach-to-Drink Task in School-Aged Children

This study evaluates the effects of object weight and hand dominance on the end-point kinematics of the hand-to-mouth (withdrawal) movement in a functional reach-to-drink task for typically developing school-aged children. Using 3D motion capture, speed (average velocity and peak velocity), straightness (ratio), and smoothness (number of velocity peaks and log dimensionless jerk) of hand movements were calculated for the withdrawal motion with three different bottle weights (empty, half-filled, and full). Average velocity (550.4 ± 142.0 versus 512.1 ± 145.6 mm/s) and peak velocity (916.3 ± 234 versus 842.7 ± 198.4 mm/s) were significantly higher with the empty versus half-filled bottle and with the non-dominant (average: 543.5 ± 145.2 mm/s; peak: 896.5 ± 207 mm/s) versus dominant (average: 525.2 ± 40.7 mm/s; peak: 864.2 ± 209.2 mm/s) hand. There were no differences in straightness or smoothness. These findings indicate that increasing weight in reach-to-drink task puts greater constraints on the task. The slower movements with the dominant hand might denote better precision control than the non-dominant hand. The quantitative motion capture results show average values for the kinematic variables for a functional reach-to-drink task in a typically developing population of school-aged children with changing weights of the bottles that are relevant to a real-life scenario. These results could inform the design of individualized therapeutic interventions to improve functional upper-extremity use in children with neurodevelopmental motor disorders.

A systematic review of instrumented assessments for upper limb function in cerebral palsy: current limitations and future directions

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.

Accuracy Constraints Improve Symmetric Bimanual Coordination for Children with and without Unilateral Cerebral Palsy

PURPOSE

To evaluate the influence of accuracy constraints on functional symmetric bimanual coordination for children with Unilateral Spastic Cerebral Palsy (USCP).

METHODS

Ten children with USCP (average age: 9.6; MACS levels: I-II), ten typically developing children, and ten adults lifted a tray with a water bottle on top. Two accuracy constraints of handle size and cap condition were manipulated.

RESULTS

Children with USCP exhibited greater bilateral asymmetry in hand vertical position, timing, upper arm, and elbow control than other groups. Smaller handle decreased bilateral timing differences at lift onset and offset, and decreased bilateral elbow asymmetry at reach and lift offset. Without a cap (accuracy constraint), they showed greater trunk involvement, and less bilateral vertical position and lift offset timing differences (all p < .05).

CONCLUSIONS

Children with USCP showed impaired symmetric bimanual coordination. Higher accuracy constraints improved some bimanual spatial and temporal control. Therefore, task accuracy constraints should be manipulated carefully for training.

Intensive Unimanual Training Leads to Better Reaching and Head Control than Bimanual Training in Children with Unilateral Cerebral Palsy

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.

Influence of accuracy constraints on bimanual coordination and gait performance in children with unilateral spastic cerebral palsy

BACKGROUND

Children with unilateral spastic cerebral palsy (USCP) have both upper and lower extremities movement impairments of their more affected side. Many daily activities require whole body movement control. However, most studies for children with USCP only evaluated either upper or lower extremity impairments.

RESEARCH QUESTION

The present study aimed to assess the effects of accuracy constraints on walking and bimanual coordination for children with USCP during a whole body task.

METHODS

Ten children with USCP (age: 7-12 years; GMFCS levels: I - II) and ten age-matched typically-developed children (TDC) participated in the study. They were asked to walk and carry a water bottle with and without a cap using a tray at a preferred speed while 3-D kinematic analyses were performed. The two tasks of carrying a water bottle with and without a cap were each performed 5 trials with randomized order between participants.

RESULTS

TDC significantly decreased their walking speed, stride length, height differences between the two hands (symmetric bimanual coordination), vertical hand movement, and elbow joint excursion under higher accuracy constraints with no water bottle cap. Children with USCP showed significantly decreased walking speed, vertical hand movement, and elbow joint excursion under higher accuracy constraints. Children with USCP also significantly decreased walking deviation of line of progression.

SIGNIFICANCE

It is exciting to see that children with USCP GMFCS levels I and II were able to maintain their bimanual coordination and modify their gait performance under higher accuracy constraints. Therefore, future treatments or assessments could consider manipulating accuracy constraints even during complex whole body tasks for children with USCP.

Effect of the severity of manual impairment and hand dominance on anticipatory and compensatory postural adjustments during manual reaching in children with cerebral palsy

AIM

To investigate the role of the severity of manual impairment and of hand dominance on postural sway during anticipatory [APA] and compensatory [CPA] postural adjustments in a seated manual reaching task performed by children with cerebral palsy (CP) and typical children (TC).

METHODS

We tested 26 TC (mean age 9.5 ± 2.1 years) and 29 children with CP (age 9.6 ± 3 years) classified based on manual impairment levels as mild (Manual Ability Classification System [MACS] I; n = 18) or moderate-to-severe (MACS II-III, n = 11). Participants were instructed to reach towards a target using their dominant vs. non-dominant arm while sitting on a force-plate. Center of pressure (CoP) sway was analyzed during APA and CPA.

RESULTS

For all groups, using the non-dominant arm determined greater amplitude and velocity of CoP sway in CPA. Children with moderate-to-severe manual impairment showed greater sway during APA and CPA compared to mild impairment and TC groups.

CONCLUSION

More severe manual impairment resulted in higher sway during the anticipatory and compensatory phases of the reaching task. Using the non-dominant arm resulted in greater compensatory adjustments during reaching.

Whole body organization during a symmetric bimanual pick up task for children with unilateral cerebral palsy

BACKGROUND

Information on whole-body coordination involving bimanual coordination for children with unilateral spastic cerebral palsy (USCP) is limited.

RESEARCH QUESTION

The purpose of the current study is to test the hypothesis that during a whole-body pick up task, children with USCP will organize their whole- body movements and bimanual coordination differently than typically-developing children (TDC).

METHODS

Twelve children with USCP (average age: 8.3; MACS levels: I-II) and twelve age-matched TDC participated in the study. Children were asked to reach down, grasp, and pick up an empty box to waist height while Kinematic and Kinetic data were recorded and analyzed using a VICON system and two AMTI force plates.

RESULTS

Children with USCP had longer overall movement time, reaching down time, and grasping movement time (all P < 0.05) than TDC. Less bimanual coordination was indicated by greater finger vertical position differences and movement onset and offset timing differences (all P < 0.05). Additionally, greater bilateral joint position on differences were found for shoulder, elbow, hip, and knee when reaching down and for shoulder and elbow at the end of the task (all P < 0.05). Greater asymmetric bilateral ground reaction force and greater lateral and anterior center of pressure excursion were also found in children with USCP (all P < 0.05).

SIGNIFICANCE

Impairments in both bimanual and whole-body coordination were found during a simple whole-body task in children with USCP. Future treatments or assessments should consider whole-body tasks involving dual task constraints.

Structured skill practice during intensive bimanual training leads to better trunk and arm control than unstructured practice in children with unilateral spastic cerebral palsy

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.

Differences in autonomic functions as related to induced stress between children with and without cerebral palsy while performing a virtual meal-making task

BACKGROUND

Efforts to improve the participation and performance of children with cerebral palsy (CP) are often related to the adaptation of environmental conditions to meet their cognitive and motor abilities. However, the influence of affective stimuli within the environment on emotion and performance, and their ability to improve or impede the children's participation has not been investigated in any systematic way although the emerging evidence suggests that it affects the individuals in many levels.

OBJECTIVES

(1) To measure autonomic responses to affective stimuli during a simulated Meal-Maker task in children with CP in comparison to children who are typically developing, and (2) to examine the interactions between autonomic functions, subjective reports of stress, and task performance among children with and without CP.

METHODS

Fifteen children with CP and 19 typically developing peers (6 to 12 years) participated. After completing behavioral questionnaires (e.g., State and Trait Anxiety Inventories), children prepared meals within a camera tracking virtual Meal-Maker environment. Either a negative, positive, or neutral visual stimulus was displayed, selected from the International Affective Picture System. Children also passively viewed the same pictures while rating their valence and arousal levels. Heart rate (HR) and skin conductance were recorded synchronously with stimulus onset.

RESULTS

Significant differences in autonomic functions were found between groups, i.e., a higher "low frequency" to "high frequency" (LF:HF) ratio in the children with CP during the meals associated with a negative stimulus (p=0.011). Only children with CP had significant positive correlations between trait anxiety and LF:HF ratio during virtual meal-making associated with positive (p=0.049) and negative stimuli (p=0.003) but not during neutral stimuli. For children with CP the amplitude of skin conductance response during passive picture viewing was significantly higher for negative than for positive stimuli (p=0.017) but there were no significant changes in autonomic responses during virtual Meal-Maker task. Significant correlations between trait anxiety, autonomic activity during the calm state and Meal-Maker performance outcomes were found only for children with CP.

CONCLUSIONS

In general, the Meal-Maker virtual environment was shown to be a feasible platform for the investigation of the effect of emotionally loaded stimuli on the balance of autonomic functions in children with and without CP. Anxiety level appears to play a significant role in children with CP and should be considered as a potentially important factor during clinical evaluation and intervention. Further studies are needed to develop additional measurements of emotional responses and to refine the types of affective interference.

Coordination of Reach-to-Grasp Kinematics in Individuals With Childhood-Onset Dystonia Due to Hemiplegic Cerebral Palsy

Functional reaching is impaired in dystonia. Here, we analyze upper extremity kinematics to quantify timing and coordination abnormalities during unimanual reach-to-grasp movements in individuals with childhood-onset unilateral wrist dystonia. Kinematics were measured during movements of both upper limbs in a patient group ( n = 11, age = 17.5 ±5 years), and a typically developing control group ( n = 9, age = 16.6 ±5 years). Hand aperture was computed to study the coordination of reach and grasp. Time-varying joint synergies within one upper limb were calculated using a novel technique based on principal component analysis to study intra-limb coordination. In the non-dominant arm, results indicate reduced coordination between reach and grasp in patients who could not lift the grasped object compared to those who could lift it. Lifters exhibit incoordination in distal upper extremity joints later in the movement and non-lifters lacked coordination throughout the movement and in the whole upper limb. The amount of atypical coordination correlates with dystonia severity in patients. Reduced coordination during movement may reflect deficits in the execution of simultaneous movements, motor planning, or muscle activation. Rehabilitation efforts can focus on particular time points when kinematic patterns deviate abnormally to improve functional reaching in individuals with childhood-onset dystonia.

Evaluation and characterization of manual reaching in children with cerebral palsy: A systematic review

Manual reaching is used daily to perform manipulative tasks and activities of daily routine. Children with cerebral palsy (CP) have limitations in this activity, with functional loss as a possible consequence. This review aimed to gather studies that evaluated and characterized manual reaching in children with CP, with the purpose of identifying the aspects analyzed, as well as review and discuss the results in the studies and its relationship to the children's level of functionality. 17 studies were selected for this systematic review from the search in electronic databases. The studies showed that children with CP show deficits in several spatio-temporal variables of reaching compared to typical children, such as longer time to perform the activity, higher peak velocity, lower index of curvature, and greater number of units of motion, which indicates lower smoothness and linearity of the movements of upper limbs. The performance is influenced by the level of motor impairment and various manipulations of the task. However, more studies are needed that help translating these results into treatment strategies that facilitate the performance of manual activities in children with CP.

Training of goal directed arm movements with motion interactive video games in children with cerebral palsy - a kinematic evaluation

OBJECTIVE

The main aim of this study was to evaluate the quality of goal-directed arm movements in 15 children with cerebral palsy (CP) following four weeks of home-based training with motion interactive video games. A further aim was to investigate the applicability and characteristics of kinematic parameters in a virtual context in comparison to a physical context.

METHOD

Kinematics and kinetics were captured while the children performed arm movements directed towards both virtual and physical targets.

RESULTS

The children's movement precision improved, their centre of pressure paths decreased, as did the variability in maximal shoulder angles when reaching for virtual objects. Transfer to a situation with physical targets was mainly indicated by increased movement smoothness.

CONCLUSION

Training with motion interactive games seems to improve arm motor control in children with CP. The results highlight the importance of considering both the context and the task itself when investigating kinematic parameters.

Characteristics of bilateral hand function in individuals with unilateral dystonia due to perinatal stroke: sensory and motor aspects

The authors assessed bilateral motor and sensory function in individuals with upper limb dystonia due to unilateral perinatal stroke and explored interrelationships of motor function and sensory ability. Reach kinematics and tactile sensation were measured in 7 participants with dystonia and 9 healthy volunteers. The dystonia group had poorer motor (hold time, reach time, shoulder/elbow correlation) and sensory (spatial discrimination, stereognosis) outcomes than the control group on the nondominant side. On the dominant side, only sensation (spatial discrimination, stereognosis) was poorer in the dystonia group compared with the control group. In the dystonia group, although sensory and motor outcomes were uncorrelated, dystonia severity was related to poorer stereognosis, longer hold and reach times, and decreased shoulder/elbow coordination. Findings of bilateral sensory deficits in dystonia can be explained by neural reorganization. Visual compensation for somatosensory changes in the nonstroke hemisphere may explain the lack of bilateral impairments in reaching.

Influence of dual task constraints on gait performance and bimanual coordination during walking in children with unilateral cerebral palsy

The purpose of the current study was to evaluate the effects of dual task constraints on walking and bimanual coordination for children with and without unilateral Cerebral Palsy (CP). Ten children with unilateral CP (age 7-11 years; MACS levels I-II) and ten age-matched typically developed children were asked to first stand still while holding a box level (standing condition), second, to walk along a path (baseline condition), and third to walk again while carrying a box steady and level (dual task condition) at a preferred speed. The results showed that children with unilateral CP decreased their walking speed, stride length, step width, and toe clearance from the floor under dual task constraints when compared to the baseline condition (all p's<0.05), however, typically developing children did not change. Children with unilateral CP also had less level box carrying, larger vertical box movement, and larger elbow movements when compared to typically developing children under dual task condition (all p's<0.05). Dual task constraints with a secondary motor task like the current walking with a box task seemed challenging for children with unilateral CP. Therefore, future treatments or assessments should consider using dual task constraints to manipulate the difficulty of tasks.

Timing training in three children with diplegic cerebral palsy: short- and long-term effects on upper-limb movement organization and functioning

Despite the great need of interventions to maintain and improve motor functions in children with diplegic cerebral palsy (DCP), scientific evaluations of existing training methods are rare. This study aimed to explore individual effects of synchronized metronome training (SMT) on motor timing, spatio-temporal movement organization, and subjective experiences of changes in upper-limb functions in three children with DCP. All children participated in an individualized 4-week/12 session SMT training regime. Measurements before training (Pre), after training (Post1), and at 6 months post completed training (Post2) were made by the applied SMT training equipment, optoelectronic registrations of goal-directed upper-limb movements, and a questionnaire assessing subjective experiences of changes in upper-limb functions and usability. In general, the training regime was shown to have little effect on motor timing. However, some positive changes in spatio-temporal movement organization were found. Two children also reported substantial long-lasting positive changes in subjective experiences of hand/arm functionality in terms of increased movement control and reduced muscle tone. For these children, parallel kinematic findings also indicated smoother and faster movement trajectories that remained at Post2. Although highly individualized, the shown improvements in upper-limb kinematics and subjective experiences of improved functionality of the hands/arms for two of the cases warrant further explorations of SMT outcomes in children with DCP.

Long-term influences of a preterm birth on movement organization and side specialization in children at 4-8 years of age

This study explored upper-limb and head kinematics during unimanual goal-directed movements in children born preterm (PT) and full-term (FT) aged 4-8 years. Further, functional lateralization was investigated through side-specific kinematics and hand preference observations. Altogether, 141 children were included, divided into three sub-groups based on gestation week at birth (GW). Children born FT (38-41 GW) and moderately PT (33-35 GW) showed faster, smoother, and shorter movement trajectories than children born very PT (V-PT < 33 GW). Only children born FT expressed evident side differences that were characterized by smoother movements with the preferred side. Regarding hand preference, the children born V-PT showed increased rates of non-right-handedness compared with the other groups. Regardless of hand preference, the children born V-PT showed less well organized movements compared with the other groups. These findings suggest that spatio-temporal movement organization and side specialization at pre-/early school-age are affected by a PT birth, and more frequently so for children born before 33 GWs, indicating long-lasting influences on neuromotor development and specialization.

Motor impairment factors related to brain injury timing in early hemiparesis. Part I: expression of upper-extremity weakness

BACKGROUND

Extensive neuromotor development occurs early in human life, but the time that a brain injury occurs during development has not been rigorously studied when quantifying motor impairments.

OBJECTIVE

This study investigated the impact of timing of brain injury on the magnitude and distribution of weakness in the paretic arm of individuals with childhood-onset hemiparesis.

METHODS

A total of 24 individuals with hemiparesis were divided into time periods of injury before birth (PRE-natal, n = 8), around the time of birth (PERI-natal, n = 8), or after 6 months of age (POST-natal, n = 8). They, along with 8 typically developing peers, participated in maximal isometric shoulder, elbow, wrist, and finger torque generation tasks using a multiple-degree-of-freedom load cell to quantify torques in 10 directions. A mixed-model ANOVA was used to determine the effect of group and task on a calculated relative weakness ratio between arms.

RESULTS

There was a significant effect of both time of injury group (P < .001) and joint torque direction (P < .001) on the relative weakness of the paretic arm. Distal joints were more affected compared with proximal joints, especially in the POST-natal group.

CONCLUSIONS

The distribution of weakness provides evidence for the relative preservation of ipsilateral corticospinal motor pathways to the paretic limb in those individuals injured earlier, whereas those who sustained later injury may rely more on indirect ipsilateral corticobulbospinal projections during the generation of torques with the paretic arm.

Relations among upper-limb movement organization and cognitive function at school age in children born preterm

OBJECTIVE

To explore relations between aspects of upper-body spatiotemporal movement organization and intelligence in children born preterm at school age.

METHODS

Three-dimensional (3D) kinematic recordings of arm and head movements during a unimanual precision task were related to performance on the Wechsler Intelligence Scale for Children, 4th edition, in a sample of 32 children born preterm (gestational age, mean: 31.5 weeks [range: 22-35 weeks]; birth weight, mean: 1699 g [range: 404-2962 g]) at 6 years to 8 years with no diagnosed cognitive, sensory, or motor impairments compared with 40 age-matched control children born fullterm.

RESULTS

In the children born preterm, upper-limb movement duration and segmentation of movement trajectories were significantly associated with full-scale intelligence quotient independent of gestational age (GA) and sex. These effects pertained to the preferred side, characterized by more effective movement organization being linked with increased intelligence scores. The same relations were not seen in the controls. Within the children born preterm, a significant effect of GA was also found for some aspects of upper-limb movement organization. Full-scale intelligence quotient was within normal limits for both groups but significantly lower in the preterm (mean: 94.5 [range: 72-120]) compared with the fullterm (mean: 101.7 [range: 76-119]) born children.

CONCLUSIONS

The findings demonstrate that, independent of GA, the spatiotemporal organization of upper-limb movements is partly associated with cognitive performance in children born preterm.

Motor learning of a bimanual task in children with unilateral cerebral palsy

Children with unilateral cerebral palsy (CP) have been shown to improve their motor performance with sufficient practice. However, little is known about how they learn goal-oriented tasks. In the current study, 21 children with unilateral CP (age 4-10 years old) and 21 age-matched typically developed children (TDC) practiced a simple bimanual speed stack task over 15 days of practice. Both groups demonstrated their ability to learn the current bimanual task, but their rate of improvement and learning pattern differed. Children with unilateral CP overall were slower and improved ~10% less than TDC. Most of the improvement occurred during the first 3 days for the TDC, whereas performance did not plateau until 6-8 days for the children with unilateral CP. This initial slower learning rate for children with unilateral CP was also confirmed by better fitting of the curve to an exponential function than the power law function (p<0.05). Therefore, when working with children with unilateral CP, sufficient practice is important (two to three times more than for TDC), and delayed improvement is expected.

Functional capacity and assistance from the caregiver during daily activities in Brazilian children with cerebral palsy

BACKGROUND

Cerebral Palsy (CP) presents changes in posture and movement as a core characteristic, which requires multiprofessional clinical treatments during children's habilitation or rehabilitation. Besides clinical treatment, it is fundamental that professionals use evaluation systems to quantify the difficulties presented to the individual and their families in their daily lives. We aimed to investigate the functional capacity of individuals with CP and the amount of assistance required by the caregiver in day-to-day activities.

METHODS

Twenty patients with CP, six-year-old on average, were evaluated. The Pediatric Evaluation Inventory of Incapacities was used (PEDI - Pediatric Evaluation Disability Inventory), a system adapted for Brazil that evaluates child's dysfunction in three 3 dimensions: self-care, mobility and social function. To compare the three areas, repeated measures analysis of variance (ANOVA) were used.

RESULTS

We found the following results regarding the functional capacity of children: self-care, 27.4%, ±17.5; mobility, 25.8%, ±33.3 and social function, 36.3%, ±27.7. The results of the demand of aid from the caregiver according to each dimension were: self-care, 9.7%, ±19.9; mobility, 14.1%, ± 20.9 and social function, 19.8%, ±26.1.

CONCLUSION

We indicated that there was no difference between the performance of the subjects in areas of self-care, mobility and social function considering the functional skills and assistance required by the caregiver.

Planning and coordination of a reach-grasp-eat task in children with hemiplegia

Children with hemiplegia have deficits in motor planning in addition to their impairments in movement of their more-affected upper extremity (UE). However, little is known about the relationship between motor planning and multi-segment coordination during functional activities in this population. In the present study, motor planning strategies and multi-segment coordination of the head, trunk, and UE were examined during a functional reach-grasp-eat task in children with hemiplegia. Ten children with hemiplegia (age 4-10 years; MACS levels I-II) and ten age-matched, typically developing children participated in the study. Children were asked to reach, grasp and transport a cookie to the mouth with one hand while 3-D kinematic analyses were performed. A more extended wrist (p = 0.001) and higher end-point position of grasping (p = 0.001) were found for both UEs of children with hemiplegia. The less-affected UE had greater trunk contribution (p = 0.018) and greater shoulder flexion (p = 0.002) and elbow extension (p = 0.005) during reaching compared to the TDC. The more-affected UE had impaired movement control with greater head rotation (p = 0.011), higher variability of end-point location in space (p = 0.001), greater trunk contribution (p = 0.018), and reduced wrist rotation (p = 0.007) compared with the less-affected UE and TDC. Additionally, delayed timing of maximum shoulder (p = 0.03) and elbow flexion (p = 0.008) during reaching, and maximum wrist pronation (p = 0.004) during eating were found for the more-affected UE. The results showed different multi-segment control for both UEs in children with hemiplegia compared to TDC. They also reflect impaired motor planning since the same movement strategies were used for both UEs. Furthermore, we suggest that inefficient multi-segment coordination of the more-affected UE is used to compensate for impaired motor planning and control.

Short- and long-term effects of synchronized metronome training in children with hemiplegic cerebral palsy: a two case study

BACKGROUND

Children with cerebral palsy (CP) require individualized long-term management to maintain and improve motor functions. The objective of this study was to explore potential effects of synchronized metronome training (SMT) on movement kinematics in two children diagnosed with spastic hemiplegic CP (HCP).

METHOD

Both children underwent 4-weeks/12 sessions of SMT by means of the Interactive Metronome (IM). Optoelectronic registrations of goal-directed uni- and bimanual upper-limb movements were made at three occasions; pre-training, post completed training and at 6-months post completed training.

RESULTS

Significant changes in kinematic outcomes following IM training were found for both cases. Findings included smoother and shorter movement trajectories in the bimanual condition, especially for the affected side. In the unimanual condition, Case I also showed increased smoothness of the non-affected side.

CONCLUSIONS

The observed short- and long-term effects on the spatio-temporal organization of upper-limb movements need to be corroborated and extended by further case-control studies.

The role of the scapulo-thoracic and gleno-humeral joints in upper-limb motion in children with hemiplegic cerebral palsy

BACKGROUND

The pathophysiology of abnormal shoulder motion in children with hemiplegic cerebral palsy is not yet well understood. The aim of this study was to compare the motion of the two principle shoulder joints in children with hemiplegic cerebral palsy and typically developing children.

METHODS

10 children in each group carried out 6 tasks recorded by an optoelectronic system. The analysis protocol was based on an acromion marker cluster, a functional method to determine the gleno-humeral rotation center and different Euler sequences thus providing three dimensional thoraco-humeral, scapulo-thoracic and gleno-humeral kinematics during upper-limb motion.

FINDINGS

In the children with hemiplegic cerebral palsy, the scapulo-thoracic joint was more protracted (P<0.05) and tended to be more laterally rotated depending on the tasks and the degree of humeral elevation. The gleno-humeral joint was limited in elevation (P<0.09), internal rotation (P<0.05) and plane of elevation (P<0.05) depending on the task. At rest, the orientation of the arm was more related to the scapular posture than to the gleno-humeral orientation, the latter which appeared to compensate the initial internal arm rotation at the beginning of the motion.

INTERPRETATION

The scapulo-thoracic joint plays a key role in arm posture at rest and during motion but does not seem to limit arm motion. The gleno-humeral joint compensates the scapula orientation at small degrees of humeral elevation but has a reduced total range of motion. Clinical management should focus on both joints taking into account their respective roles in upper-limb motion in this population.

Wrist and Finger Torque Sensor for the quantification of upper limb motor impairments following brain injury

This paper details the design of the Wrist and Finger Torque Sensing module (WFTS): a lightweight, portable device that measures isometric wrist and finger flexion and extension joint torques. The WFTS can be used in combination with rehabilitation robots such as the ACT-3D, with isometric measurement stations, or as a stand-alone device. Because many robotic devices are limited in that they involve the hand in isolation, the WFTS is designed to investigate abnormal joint torque coupling at the paretic wrist and fingers in individuals with adult-onset stroke or childhood hemiplegia during 3D arm movements or isometric generation of shoulder and elbow torques. In short, the versatility of the WFTS allows for a variety of applications.

Three-dimensional upper limb movement characteristics in children with hemiplegic cerebral palsy and typically developing children

The aim of this study was to measure which three-dimensional spatiotemporal and kinematic parameters differentiate upper limb movement characteristics in children with hemiplegic cerebral palsy (HCP) from those in typically developing children (TDC), during various clinically relevant tasks. We used a standardized protocol containing three reach tasks (forwards, upwards, and sideways), two reach-to-grasp tasks (with objects requiring different hand orientations), and three gross motor tasks. Spatiotemporal (movement duration, trajectory straightness, maximum velocity, and timing of maximum velocity), as well as kinematic parameters (discrete angles and waveforms of the trunk, scapula, shoulder, elbow and wrist), were compared between 20 children with HCP (age 10.9 ± 2.9 years) and 20 individually age-matched TDC (age 10.9 ± 3.0 years). Kinematic calculations followed the recommendations from the International Society of Biomechanics. Results showed that children with HCP had longer movement durations, less straight hand trajectories, and lower maximum velocities compared to the TDC. Timing of maximum velocity did not differ between both groups. The movement pathology in children with HCP was highlighted by increased trunk movements and reduced shoulder elevation during reaching and reach-to-grasp. We also measured an increased anterior tilting and protraction of the scapula in children with HCP, although differences were not significant for all tasks. Finally, compared to the TDC, children with HCP used less elbow extension and supination and more wrist flexion to execute all tasks. This study reported distinct 3D upper limb movement characteristics in children with HCP and age-matched TDC, establishing the discriminative ability of the measurement procedure. From a clinical perspective, combining spatiotemporal and kinematic parameters may facilitate the identification of the pathological movement patterns seen in children with HCP and thereby add to a well-targeted upper limb treatment planning.

The cognitive neuroscience of prehension: recent developments

Prehension, the capacity to reach and grasp, is the key behavior that allows humans to change their environment. It continues to serve as a remarkable experimental test case for probing the cognitive architecture of goal-oriented action. This review focuses on recent experimental evidence that enhances or modifies how we might conceptualize the neural substrates of prehension. Emphasis is placed on studies that consider how precision grasps are selected and transformed into motor commands. Then, the mechanisms that extract action relevant information from vision and touch are considered. These include consideration of how parallel perceptual networks within parietal cortex, along with the ventral stream, are connected and share information to achieve common motor goals. On-line control of grasping action is discussed within a state estimation framework. The review ends with a consideration about how prehension fits within larger action repertoires that solve more complex goals and the possible cortical architectures needed to organize these actions.