The use of pressure mapping for seating posture characterisation in children with cerebral palsy

Objective measurement of sitting - Application in children with cerebral palsy

BACKGROUND

Children with cerebral palsy (CP) and a severe motor impairment, have limited ability to perform volitional movements due to spasticity, involuntary postures and movements and reduced ability to maintain antigravity head and trunk control. A stable sitting position is a prerequisite for participation in daily life, but there is a lack of objective measurement methods for this population.

RESEARCH QUESTION

Is it feasible to measure a stable sitting position with pressure mapping and 2D motion analysis, and can it detect differences to a) a reference group, b) between subgroups of CP and c) before and after treatment with intrathecal baclofen (ITB)?

METHODS

Pressure mapping, and a 2D motion analysis system, were used to capture movements of centre of pressure (CoP), and movements of head, hand and leg, sitting on a bench for 90 s. Twenty-two children with dyskinetic or bilateral spastic CP, GMFCS III-V, mean age 9.0, and 30 children with typical development (TD) mean age 10.7, were recruited between 2010 and 2019. Seventeen children were treated with ITB. Parents were interviewed regarding aspect of sitting. Non-parametric methods were used for statistical analysis.

RESULTS

Differences in CoP and kinematics were detected with more movements in children with CP compared to children with TD (p < 0.001). There were more movements in children with dyskinetic CP compared to children with bilateral spastic CP as captured with the pressure mapping system (CoP distance p = .005 and Anterio-Posterior sway p = .014). After treatment with ITB, involuntary movements had decreased (CoP p = 0.006-0.035, kinematics p = 0.002-0.020). Parents reported improvement in sitting. The two measurement systems showed consistent results (rho 0.500-0.771, p = <0.001-0.049).

SIGNIFICANCE

It was feasible to objectively measure sitting position in children with a moderate-to-severe motor impairment with differences to a reference group and after an intervention. CoP and head movements were the variables that were easiest to capture.

Development of a sitting posture monitoring system for children using pressure sensors: An application of convolutional neural network

BACKGROUND

Today, sedentary lifestyles are very common for children. Therefore, maintaining a good posture while sitting is very important to prevent musculoskeletal disorders. To maintain a good posture, the formation of good postural habit must be encouraged through posture correction. However, long-term observation is required for effective posture correction. Additionally, posture correction is more effective when it is performed in real time.

OBJECTIVE

The goal of this study is to classify nine representative sitting postures of children by applying a machine learning technique using pressure distribution data according to the sitting postures.

METHODS

In this study, a customized film-type pressure sensor was developed and pressure distribution data from nine sitting postures was collected from seven to twelve year-old children. A convolutional neural network (CNN) was applied to classify the sitting postures and three experiments were conducted to evaluate the performance of the model in three applicable usage scenarios: usage by familiar identifiable users, usage by familiar, but unidentifiable users, and usage by unfamiliar users.

RESULTS

The results of our experiments revealed model accuracies of 99.66%, 99.40%, and 77.35%, respectively. When comparing the recall values for each posture, leaning left and leaning right postures had high recall values, but good posture, leaning forward, and crossed-legs postures had low recall values.

CONCLUSION

The results of experiments indicated that CNN is an excellent classification method to classify the posture when the pressure distribution data is used as input data. This study is expected to contribute a development of system to aid in observing the natural sitting behavior of children and correcting poor posture in real time.

Improving postural symmetry: The effectiveness of the CATCH (Combined Approach to Treatment for Children with Hemiplegia) protocol

PURPOSE

To evaluate postural symmetry in sitting and standing for children with hemiplegic cerebral palsy (hCP) following the Combined Approach to Treatment for Children with Hemiplegia (CATCH) protocol, an intervention combining Constraint Induced Movement Therapy, Bimanual Intensive Therapy and Neuro-Developmental Treatment.

METHODS

The study included 10 children with a diagnosis of hCP and 10 typically developing age-matched peers. Subjects participated in a CATCH camp for six hours daily for eight consecutive days. Postural symmetry measurements in quiet sitting and standing were obtained using a Boditrak pressure-mapping system at four time points: prior to start of camp (T1), first day of camp (T2), last day of camp (T3), and one month post-camp (T4).

RESULTS

Significant differences (p< 0.05) were found in quiet sitting when comparing postural symmetry pre-intervention and one-month post camp. In quiet standing, significant differences (p< 0.05) were found when pre-intervention was compared to one-month post-intervention. One month post-intervention, the intervention group showed no significant difference from the comparison group.

CONCLUSIONS

Children with hCP demonstrate improvement in postural symmetry in sitting and standing following participation in a CATCH camp. Following the intervention, children with hCP continued to improve postural symmetry and approach age-matched peers.

An Exploration of Comfort and Discomfort Amongst Children and Young People with Intellectual Disabilities Who Depend on Postural Management Equipment

BACKGROUND

The natural response to the intrusive bodily sensation is positional change. This study explored how children and young people (CYP) with intellectual disabilities had their comfort needs met when using adaptive positioning equipment.

METHODS

Thirteen qualitative case studies were undertaken. A parent, a teacher/key worker and a therapist for each CYP were interviewed, and daily routines were observed, with selective video recording. Single case and cross case analyses were undertaken.

RESULTS

Attentive caregivers read the behavioural expressions of the CYP and responded reassuringly, safeguarding them from discomforting experiences. Threats to comfort include the restrictive nature of some equipment accessories, positioning errors and procedural stretching.

CONCLUSIONS

The same item of equipment can be both comfortable and uncomfortable. Given the social and interactional world in which the CYP live and learn, it is others who must accept responsibility for ensuring their optimal level of comfort.

Pressure mapping to assess seated pressure distributions and the potential risk for skin ulceration in a population of sledge hockey players and control subjects

PURPOSE

Ice sledge (or sled) hockey is a fast-paced sport that enables individuals with physical disabilities to play ice hockey. As the attraction to the sport continues to rise, the need for developing better equipment and installing preventative measures for injury will become increasingly important. One such injury includes skin pressure ulceration.

METHOD

A total of 26 subjects including active controls and those with spinal cord injury, multiple sclerosis, limb amputation and traumatic brain injury were studied using a pressure mapping device at the 2012 National Disabled Veterans Winter Sports Clinic to determine the risk for skin pressure ulceration and the impact of cushioning and knee angle positioning on seated pressure distributions.

RESULTS

Sledge hockey athletes may be at increased risk for skin pressure ulceration based on seated pressure distribution data. This experiment failed to demonstrate a benefit for specialty cushioning in either group. Interestingly, knee angle positioning, particularly, knee extension significantly lowered the average seated pressures.

CONCLUSIONS

When considering the risk for skin pressure ulceration, knee angle positioning is of particular clinical importance. More research is warranted, specifically targeting novel cushion and sledge designs and larger groups of individuals with sensory loss and severe spinal deformities. Implications for Rehabilitation Ice sledge (or sled) hockey is a fast-paced and growing adaptive sport played at the Paralympic level. Rehabilitation professionals should consider the potential for skin ulceration in this population of athletes. The effects of cushioning used in the sledge design warrants further investigation. Knee angle positioning; particularly, knee extension significantly lowers seated pressures and may reduce the potential for skin ulceration.

Clinical tools that measure sitting posture, seated postural control or functional abilities in children with motor impairments: a systematic review

OBJECTIVE

To identify and critically appraise clinical measurement tools used to assess sitting posture, seated postural control or functional abilities for children with motor impairment who are candidates for seating interventions.

DATA SOURCES

Searches were run in 15 electronic databases along with hand searching. The search included articles published in English to December 2011.

REVIEW METHODS

Key terms included: posture, sitting, sitting posture, seated posture, seated postural control, sitting position, seating, wheelchair(s), outcome and assess(ment). The PRISMA statement was followed with inclusion criteria set a priori. Two reviewers independently screened titles, reviewed abstracts and identified full-text articles that met criteria. Data extraction included tool description and clinical utility. Two quality-rating scales were used to evaluate conduct of the studies and psychometric properties of the tools.

RESULTS

Of the 497 titles found in the search, 29 full-text articles met the inclusion criteria and 19 tools were identified. Tools represented all components of the International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY), with emphasis on body structure and function and activity components. Evidence supporting reliability and validity varied, with small sample sizes influencing quality ratings. Evidence of the tools' reliability was more prevalent than evidence of the tools' validity. Only four tools reported on responsiveness, an important consideration for evaluating change. Little information on clinical utility was provided.

CONCLUSION

Although a number of tools are available, evidence supporting their use for seating interventions is limited, as is the evidence supporting the strength of their measurement properties. Few tools address participation, environmental factors or the child's and family's perspective.