Aim We explored the psychometric properties of the recently developed Tyneside Pegboard Test (TPT) for unimanual and bimanual dexterity in children with unilateral cerebral palsy (CP) and investigated the impact of sensorimotor impairments on manual dexterity. Method In this cross‐sectional study, the TPT was assessed in 49 children with unilateral CP (mean age 9y 8mo, SD 1y 11mo, range 6–15y; 30 males, 19 females; 23 with right unilateral CP). All participants additionally underwent a standardized upper limb evaluation at body function and activity level. We investigated: (1) known‐group, concurrent, and construct validity and (2) impact of sensorimotor impairments including spasticity, grip force, stereognosis, and mirror movements using analysis of covariance, Spearman’s rank correlation (r), and multiple linear regression (R2) respectively. Results TPT outcomes significantly differed according to the Manual Ability Classification System (p<0.001, known‐group validity). Relationships were found between the unimanual TPT tasks and the Jebsen‐Taylor Hand Function Test (r=0.86–0.88, concurrent validity). Bimanual TPT tasks were negatively correlated with the Assisting Hand Assessment, ABILHAND‐Kids, and Children’s Hand‐use Experience Questionnaire (r=−0.38 to −0.78, construct validity). Stereognosis was the main determinant influencing all tasks (p<0.001, R2=37–50%). Unimanual dexterity was additionally determined by grip strength (p<0.05, R2=8–9%) and mirror movements in the more impaired hand (p<0.05, R2=4–8%). Bimanual dexterity was also explained by mirror movements in the more impaired hand (p<0.01, R2=10–16%) and spasticity (p=0.04, R2=5%). Interpretation The TPT is a valid test to measure unimanual and bimanual dexterity in unilateral CP. The results further emphasize the importance of somatosensory impairments in children with unilateral CP. The Tyneside Pegboard Test is valid for measuring unimanual and bimanual dexterity in unilateral cerebral palsy. Children with poorer manual ability show worse unimanual and bimanual dexterity. Stereognosis is the main predictor of both unimanual and bimanual dexterity. Stronger mirror movements in the more impaired hand result in worse bimanual dexterity.
Impaired hand proprioception can lead to difficulties in performing fine motor tasks, thereby affecting activities of daily living. The majority of children with unilateral cerebral palsy (uCP) experience proprioceptive deficits, but accurately quantifying these deficits is challenging due to the lack of sensitive measurement methods. Robot-assisted assessments provide a promising alternative, however, there is a need for solutions that specifically target children and their needs. We propose two novel robotics-based assessments to sensitively evaluate active and passive position sense of the index finger metacarpophalangeal joint in children. We then investigate test-retest reliability and discriminant validity of these assessments in uCP and typically developing children (TDC), and further use the robotic platform to gain first insights into fundamentals of hand proprioception. Both robotic assessments were performed in two sessions with 1-h break in between. In the passive position sense assessment, participant's finger is passively moved by the robot to a randomly selected position, and she/he needs to indicate the perceived finger position on a tablet screen located directly above the hand, so that the vision of the hand is blocked. Active position sense is assessed by asking participants to accurately move their finger to a target position shown on the tablet screen, without visual feedback of the finger position. Ten children with uCP and 10 age-matched TDC were recruited in this study. Test-retest reliability in both populations was good (intraclass correlation coefficients (ICC) >0.79). Proprioceptive error was larger for children with uCP than TDC (passive: 11.49° ± 5.57° vs. 7.46° ± 4.43°, p = 0.046; active: 10.17° ± 5.62° vs. 5.34° ± 2.03°, p < 0.001), indicating discriminant validity. The active position sense was more accurate than passive, and the scores were not correlated, underlining the need for targeted assessments to comprehensively evaluate proprioception. There was a significant effect of age on passive position sense in TDC but not uCP, possibly linked to disturbed development of proprioceptive acuity in uCP. Overall, the proposed robot-assisted assessments are reliable, valid and a promising alternative to commonly used clinical methods, which could help gain a better understanding of proprioceptive impairments in uCP, facilitating the design of novel therapies.
Herestraat 49, box 1510 cristina.simon@kuleuven.be Phone number: +32 16 37 61 95 Word count: 4121 words. ABSTRACT Background. Mirror movements (MM) influence bimanual performance in children with unilateral cerebral palsy (uCP). Whilst MM are related to brain lesion characteristics and the corticospinal tract (CST) wiring pattern, the combined impact of these neurological factors remains unknown. Objective. To investigate the combined impact of neurological factors on MM.Methods. Forty-nine children with uCP (mean age 10y6mo) performed a repetitive squeezing task to quantify similarity between MM activity (MM-similarity) and strength of the MM activity (MMintensity). We used MRI to evaluate lesion type (periventricular white matter, N=30) corticosubcortical, N=19), the extent of ipsilesional damage and damage to basal ganglia, thalamus and corpus callosum. The CST wiring pattern (17 CSTcontralateral, 16 CSTipsilateral, 16 CSTbilateral) was assessed with Transcranial Magnetic Stimulation. Data was analyzed with simple and multiple regression analyses.Results. MM-similarity in the more-affected hand was higher with more damage to the corpus callosum. MM-intensity was higher in children with CSTcontralateral with damage to the basal ganglia and thalamus. In the less-affected hand, MM-similarity was explained by the interaction between lesion type and CST wiring pattern, with higher MM-similarity in children with corticosubcortical lesions in the CSTcontralateral group. MM-intensity was higher with larger damage to the corpus callosum and unilateral lesions. Conclusions. A complex combination of neurological factors influences MM characteristics andthe mechanisms differ between hands.
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