Negative Influence of Motor Impairments on Upper Limb Movement Patterns in Children with Unilateral Cerebral Palsy. A Statistical Parametric Mapping Study

Abstract

Upper limb three-dimensional movement analysis (UL-3DMA) offers a reliable and valid tool to evaluate movement patterns in children with unilateral cerebral palsy (uCP). However, it remains unknown to what extent the underlying motor impairments explain deviant movement patterns. Such understanding is key to develop efficient rehabilitation programs. Although UL-3DMA has been shown to be a useful tool to assess movement patterns, it results in a multitude of data, challenging the clinical interpretation and consequently its implementation. UL-3DMA reports are often reduced to summary metrics, such as average or peak values per joint. However, these metrics do not take into account the continuous nature of the data or the interdependency between UL joints, and do not provide phase-specific information of the movement pattern. Moreover, summary metrics may not be sensitive enough to estimate the impact of motor impairments. Recently, Statistical Parametric Mapping (SPM) was proposed to overcome these problems. We collected UL-3DMA of 60 children with uCP and 60 typically developing children during eight functional tasks and evaluated the impact of spasticity and muscle weakness on UL movement patterns. SPM vector field analysis was used to analyze movement patterns at the level of five joints (wrist, elbow, shoulder, scapula, and trunk). Children with uCP showed deviant movement patterns in all joints during a large percentage of the movement cycle. Spasticity and muscle weakness negatively impacted on UL movement patterns during all tasks, which resulted in increased wrist flexion, elbow pronation and flexion, increased shoulder external rotation, decreased shoulder elevation with a preference for movement in the frontal plane and increased trunk internal rotation. Scapular position was altered during movement initiation, although scapular movements were not affected by muscle weakness or spasticity. In conclusion, we identified pathological movement patterns in children with uCP and additionally mapped the negative impact of spasticity and muscle weakness on these movement patterns, providing useful insights that will contribute to treatment planning. Last, we also identified a subset of the most relevant tasks for studying UL movements in children with uCP, which will facilitate the interpretation of UL-3DMA data and undoubtedly contribute to its clinical implementation.

Children’s Single-Leg Landing Movement Capability Analysis According to the Type of Sport Practiced

“…SPM has been expanded to one-dimensional signals such as joint angles or GRF [ 29 ]. It can also detect the time or period of time of a whole motor task with differences between signals [ 30 ].…”

Upper limb impairments, process skills, and outcome in children with unilateral cerebral palsy

“…37,55 The findings of our analysis indicate that muscle power and its key relation to manual ability is a more critical element to treat to improve ISC than spasticity in children with unilateral CP. However, given the effects of spasticity on function as defined in our model, and its effect on upper limb movement patterns, 56 spasticity should also be assessed and treated.…”

Effects of combining constraint-induced movement therapy and action-observation training on upper limb kinematics in children with unilateral cerebral palsy: A randomized controlled trial

“…We identified the anatomical landmarks of interest with static calibration trials following the International Society of Biomechanics guidelines 49 . The movement protocol included three tasks: reaching upward (RU), reach-to-grasp vertical (RGV), and hand-to-shoulder (HTS), which are highly discriminative in children with uCP 25 . Children were instructed to perform each task four times at self-selected speed, in two different trials, resulting in 8 movement repetitions per task.…”