Bimanual movements in children with cerebral palsy: a systematic review of instrumented assessments

Abstract

Background Assessment of bimanual movements, which are frequently impaired in children with cerebral palsy, is highly challenging in clinical practice. Instrumented measures have been developed to evaluate and help to understand impaired upper limb movement during bimanual tasks in these children. The aim of this review was to report instrumented measurement tools (3D motion analysis, sensors, etc.) used for bimanual task movement analysis, and the metrological properties of the measures in children with cerebral palsy. Methods A systematic review was conducted (Prospero CRD42022308517). PubMed, Web of Science, Cochrane and Scopus databases were searched with relevant keywords and inclusion/exclusion criteria. Article quality and biomechanical methods were evaluated with a customized scale and metrological properties with the COSMIN checklist. Results In total, 452 children, mostly with unilateral cerebral palsy, mean age 10.9 (SD 3.2) years, underwent quantitative bimanual assessments in the 31 included studies (mean quality score 22/32 points [SD 4.7]). The tools used were 3D motion analysis (n = 26), accelerometers (n = 2), and other instruments (cube, digitizer, etc.) (n = 3). Children performed 1–5 bimanual tasks in laboratory settings, mostly activities of daily living or game scenarios. Analyses focused mostly on spatiotemporal variables, 6 of which were specifically developed for bilateral measures (task completion time, goal synchronization, movement overlap time, interlimb coupling, continuous relative phase and asynchrony). These instrumented measurements had moderate to good discriminant and convergent validity, but reliability and responsiveness assessments were lacking. Conclusions A large number of quantitative bimanual assessments involving different tools, bimanual tasks and specific variables developed to evaluate bimanual function were found. Development of other relevant variables and validation of these tools are needed to further determine their usefulness, both as research outcomes and to guide therapies in clinical practice. Future research, involving younger children and real-life assessments, will improve our understanding of bimanual function in children with cerebral palsy.

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

“…In the included studies, 84.5% of patients with CP had unilateral impairment, which does not reflect reality as approximately 60% of patients with CP have bilateral impairment [ 121 ]. However, this finding is consistent with previous research [ 21 ] and can again be explained by the large number of quadriplegic patients with severe cognitive impairment [ 122 ]. Yet, patients with bilateral CP are also insufficiently studied using existing clinical tools.…”

“…Most of the reviewed articles used optoelectronic motion capture systems (N = 57/76), which correlates with previous findings [ 15 , 21 , 100 ]. Two articles used the Kinect marker-less motion capture system, 1 article used inertial sensors, 3 used digitizing tablet/instrumented pens, and 4 articles used a joystick/robotic arm (Fig.…”

“…Cacioppo et al . [ 21 ] recently published a review of the use of instrumented measures tools during bimanual tasks in children with CP. They provided a comprehensive overview of the parameters commonly used to describe bimanual movement and successfully analysed their metrological properties.…”

“…A customized checklist of 20 questions was developed based on existing systematic reviews in the field of biomechanics [ 19 – 21 ] to assess the methodological quality of the studies included in the present review. Each question was initially rated zero (missing information) or one (information provided) by the primary reviewer (JR), and then the articles were rated by another reviewer (LH an engineer) for a second rating to ensure consistency and quality.…”

Detecting Movement Changes in Children with Hemiparesis after Upper Limb Therapies: A Responsiveness Analysis of a 3D Bimanual Protocol

“…In a recent systematic review of quantitative assessments of bimanual movements in children with CP, the authors reported that 3D protocols were heterogenous (1-5 tasks), and the drawer-opening task was the most studied but was not sufficiently representative of bimanual function [13]. The analyses have focused mostly on spatiotemporal variables, some of which were specifically developed to measure bimanual function (e.g., task completion time, goal synchronization).…”