Instrumented assessment of motor function in dyskinetic cerebral palsy: a systematic review

Abstract

Background: In this systematic review we investigate which instrumented measurements are available to assess motor impairments, related activity limitations and participation restrictions in children and young adults with dyskinetic cerebral palsy. We aim to classify these instrumented measurements using the categories of the international classification of functioning, disability and health for children and youth (ICF-CY) and provide an overview of the outcome parameters. Methods: A systematic literature search was performed in November 2019. We electronically searched Pubmed, Embase and Scopus databases. Search blocks included (a) cerebral palsy, (b) athetosis, dystonia and/or dyskinesia, (c) age 2-24 years and (d) instrumented measurements (using keywords such as biomechanics, sensors, smartphone, and robot). Results: Our search yielded 4537 articles. After inspection of titles and abstracts, a full text of 245 of those articles were included and assessed for further eligibility. A total of 49 articles met our inclusion criteria. A broad spectrum of instruments and technologies are used to assess motor function in dyskinetic cerebral palsy, with the majority using 3D motion capture and surface electromyography. Only for a small number of instruments methodological quality was assessed, with only one study showing an adequate assessment of test-retest reliability. The majority of studies was at ICF-CY function and structure level and assessed control of voluntary movement (29 of 49) mainly in the upper extremity, followed by assessment of involuntary movements (15 of 49), muscle tone/motor reflex (6 of 49), gait pattern (5 of 49) and muscle power (2 of 49). At ICF-CY level of activities and participation hand and arm use (9 of 49), fine hand use (5 of 49), lifting and carrying objects (3 of 49), maintaining a body position (2 of 49), walking (1 of 49) and moving around using equipment (1 of 49) was assessed. Only a few methods are potentially suitable outside the clinical environment (e.g. inertial sensors, accelerometers). Conclusion: Although the current review shows the potential of several instrumented methods to be used as objective outcome measures in dyskinetic cerebral palsy, their methodological quality is still unknown. Future development should focus on evaluating clinimetrics, including validating against clinical meaningfulness. New technological developments should aim for measurements that can be applied outside the laboratory.

Design, Validity, and Reliability of a New Test, Based on an Inertial Measurement Unit System, for Measuring Cervical Posture and Motor Control in Children with Cerebral Palsy

“…Previous research has determined the clinical areas of the application of IMUs in CP individuals; concretely, these have been used for the following: (1) Objective diagnosis of motor disorders; (2) Proprioceptive rehabilitation based on visual-motor feedback; and (3) Functional compensation by means of an inertial person–machine interface [ 17 ]. Furthermore, instrumented methods, and specifically IMUs, may lead to a better understanding of the pathophysiological aspects of CP and help guide clinical decision making (e.g., quantifying deficits and determining progress in time) [ 23 , 61 ]. The current study adds a new assessment tool for the diagnosis and assessment of craniocervical posture and motor control impairments in CP children.…”

“…Regarding applicability, the design of the test and the absence of complaints reported by individuals during the assessment demonstrates high feasibility and safety of the protocol, which can be used outside the laboratory. This characteristic is an important feature of any new instrumented propose for motor function assessment in cerebral palsy [ 23 ]. In this sense, since motivation is a part of any attendance procedure in CP success, the ellipse obtained by the covariance matrix, its size and form, affords a form of visual feedback, which is easy to understand for clinicians, patients, and caregivers, as it has been reported for other applications of IMUs [ 62 , 63 ].…”

“…One of the most used assessment tools to study human position and movements are the inertial measurement units (IMUs), due to their portability, ease of application, the high quality of obtained data, and low energy consumption [ 20 ]. Nevertheless, as occurs with any new assessment tool, all the IMU applications should be completely described, reproducible, and validated [ 20 , 21 , 22 ] to establish clinical meaningfulness and predictive importance [ 19 , 23 , 24 ]. Thus, the IMUs have been successfully applied in the study of specific features of neurological diseases, such as range of motion in stroke [ 25 ], Parkinsonian tremor [ 26 , 27 ], or balance in multiple sclerosis [ 28 , 29 ].…”

Identifying cerebral palsy phenotypes objectively

“…These disappointing findings with subjective assessments lead to a reliance on objective assessments. Unfortunately, assessments of motor function in people with dyskinetic CP using 3D motion capture and surface electromyography still do not yet provide the confidence we all ultimately seek 5 …”

“…Unfortunately, assessments of motor function in people with dyskinetic CP using 3D motion capture and surface electromyography still do not yet provide the confidence we all ultimately seek. 5 And so the reliance now is on machine learning based on sensor-provided data. 6 This type of artificial intelligence approach extracts the information from data obtained by sensors, which is then offered to a machine learning program that identifies the signals that most discriminate based on experts' subjective assessments.…”