Spatiotemporal coordination in children with unilateral cerebral palsy: insights from a bimanual goal-directed task

Abstract

Background: In children with unilateral cerebral palsy (uCP), bimanual assessments mostly focus on qualitative assessments of the impaired upper limb during bimanual tasks, which do not capture the spatiotemporal coordination between both hands. Hence, we aimed to advance our understandings in spatiotemporal coordination in children with uCP compared to typically developing children (TDC) using a bimanual goal-directed task. Participants and methodology: In this observational study, thirty-seven children with uCP (11y8m±2y10m, 20 males, 16 right-sided uCP, Manual Ability Classification System level I=23, II=11, III=3) and 37 age and sex-matched TDC opened a box with one hand and pressed a button inside using the opposite hand. Spatiotemporal bimanual (movement time, temporal coupling, movement overlap, goal synchronisation) and unimanual (movement time, path length and smoothness) parameters were extracted. Between groups comparisons were investigated using a two-way mixed ANCOVA with age as covariate (α<0.05). Additionally, correlation coefficients between unimanual and bimanual parameters were calculated. Results: Compared to TDC, children with uCP did not differ in bimanual coupling relative to their movement time (p>0.31, ηp2<0.03). However, they were slower (p=0.01, ηp2=0.13) and presented with unimanual spatiotemporal deficits bilaterally (p<0.03, ηp2>0.10), which worsened in children with lower manual abilities (p<0.04, ηp2>0.19). Moreover, slower movement time was related with increased unimanual spatiotemporal deficits bilaterally (r=0.34-0.80, p<0.001-0.04), suggesting that reduced performance at both sides contributes to bimanual difficulties in children with uCP. Conclusions: The bilateral reduced spatiotemporal coordination, related to longer bimanual movement time, stresses the importance to assess and treat both upper limbs in children with uCP.

The relation between visual functions, functional vision, and bimanual function in children with unilateral cerebral palsy

“…According to previous ndings, the dominant hand condition is the condition that is more discriminative and related to the level of motor impairments (Mailleux et al, 2023;Rudisch et al, 2016). For this reason, in our analysis we only included the dominant hand condition, for which two bimanual parameters, namely total movement time and goal synchronization, were calculated according to the literature (Mailleux et al, 2023;Rudisch et al, 2016). Total movement time indicates the average time in seconds (sec) needed to complete the task while goal synchronization represents the spatial coupling between both hands at the end of the movement normalized across total movement time (sec/sec) .…”

“…In the dominant hand condition, the participant opens the box with the dominant hand and pushes the button with the non-dominant hand, while in the non-dominant hand condition, the non-dominant hand is used to open the box and the dominant hand to push the button. According to previous ndings, the dominant hand condition is the condition that is more discriminative and related to the level of motor impairments (Mailleux et al, 2023;Rudisch et al, 2016). For this reason, in our analysis we only included the dominant hand condition, for which two bimanual parameters, namely total movement time and goal synchronization, were calculated according to the literature (Mailleux et al, 2023;Rudisch et al, 2016).…”

“…CP is a heterogeneous condition, with 44% of the cases presenting with spastic unilateral CP (uCP), characterized by sensorimotor impairments predominantly on one side of the body (Himmelmann & Uvebrant, 2018). In children with uCP, motor di culties are mainly present in the upper limb, resulting in impairments in bimanual dexterity (Basu et al, 2018;Decraene et al, 2021) and coordination (Decraene et al, 2023;Mailleux et al, 2023;Rudisch et al, 2016). Besides motor problems, up to 62% of children with uCP show some degree of VI in the geniculostriate and/or visual-perceptual functions (Crotti et al, 2024).…”