Psychometric properties of upper limb kinematics during functional tasks in children and adolescents with dyskinetic cerebral palsy

Abstract

Dyskinetic cerebral palsy (DCP) is characterised by involuntary movements, and the movement patterns of children with DCP have not been extensively studied during upper limb tasks. The aim of this study is to evaluate psychometric properties of upper limb kinematics in participants with DCP and typically developing (TD) participants. In current repeatability and validity study, forty individuals with typical development (n = 20) and DCP (n = 20) performed a reach forward/sideways and a reach and grasp task during motion analysis on two occasions. Joint angles at point of task achievement (PTA) and spatio-temporal parameters were evaluated within-and between-sessions using intra-class correlation coefficients (ICC) and standard error of measurement (SEM). Independent t-tests/Mann-Whitney-U tests were used to compare parameters between groups. Within-session ICC values ranged from 0.45 to 1.0 for all parameters for both groups. Within-session SEM values ranged from 1.1° to 11.7° for TD participants and from 1.9° to 13.0° for participants with DCP. Eight within-session repetitions resulted in the smallest change in ICC and SEM values for both groups. Within-session variability was higher for participants with DCP in comparison with the TD group for the majority of the joint angles and spatio-temporal parameters. Intrinsic variability over time was small for all angles and spatio-temporal parameters, whereas extrinsic variability was higher for elbow and scapula angles. Between-group differences revealed lower shoulder adduction and higher elbow flexion, pronation and wrist flexion, as well as higher trajectory deviation and a lower maximal velocity for participants with DCP. This is the first study to assess the psychometric properties of upper limb kinematics in children and adolescents with DCP, showing that children with DCP show higher variability during task execution, requiring a minimum of eight repetitions. However, their variable movement pattern can be reliably captured within-and between-sessions, confirming the potential of three-dimensional motion analysis for assessment of rehabilitation interventions in DCP.

Reliability and Discriminative Validity of Wearable Sensors for the Quantification of Upper Limb Movement Disorders in Individuals with Dyskinetic Cerebral Palsy

“…Participants were asked to perform three upper limb tasks: reaching forward (RF), reaching sideways (RS), and reach-and-grasp vertical (RGV). These tasks were part of a pre-existing protocol for three-dimensional motion analysis of upper limb tasks [ 19 ]. Five IMUs (XSens MTw Awinda; XSens, Enschede, The Netherlands) were placed on the scapula, sternum, upper arm, forearm, and hand according to a standardized sensor placement protocol.…”

“…Within-session reliability—Intra-class correlation coefficient (ICC) values and associated confidence intervals were calculated: (i) between sensor parameters of eight randomly selected movement cycles of each task (as this number is sufficient to capture the variable movement pattern in DCP) [ 19 ]; and (ii) between the sensor parameters of the full length-signal of the eight repetitions of the RF1, RF2, and RF3 tasks (similar for RGV and RS). Within-session reliability of the parameters was assessed with the intra-class correlation coefficient ICCw(2,1) based on single data [ 34 ].…”

“…It offers a reliable position estimation of anatomical landmarks over time, allowing calculations of upper limb joint angles and, subsequently, the description of abnormal movement patterns over time. In addition, we have recently shown that a minimum of eight repetitions should be included to reflect the variable movement pattern in children and adolescents with DCP [ 19 ]. Although 3DMA offers great insights into abnormal movement patterns, it cannot assess parameters such as movement complexity or movement smoothness.…”