Upper limb activity in children with unilateral spastic cerebral palsy: the role of vision in movement strategies

Abstract

USCPUnilateral spastic cerebral palsy LHL Left hemispheric lesion RHL Right hemispheric lesionThis article reviews the capacity of children with unilateral spastic cerebral palsy (USCP) to (re)organize the available degrees of freedom and to use visual information in interceptive actions during motion with either the impaired or the less-impaired hand. Atypical reaching movements, such as increased trunk movement or slower wrist velocity, are considered adaptive coordination patterns that are the result of a change in the constraints. It is argued that manipulation of the task context facilitates children with USCP to enhance performance. For example, when reducing the time available to intercept a ball, the children are found to exceed their usual maximum walking speed and to increase range of motion of the elbow. In addition, the children appear to rely on a visual information strategy similar to typically developing children ('bearing angle'), although more variability is observed when using the impaired arm. The implications for interventions are, it should be recognized, that these children adapt to the impairment by reorganizing the movement system and that this process can be influenced by changing the task context. Attention should be paid to the importance of using correct visual cues for initiation and guidance of interceptive actions, which may be provoked by using external visual triggers.Interceptive actions with the upper limbs, which involve reaching and grasping an object, are part of many daily tasks. They range from simply picking up a cup or opening a door to the more complex actions of shaking hands or catching a ball. Although these tasks seem easy and automatically performed, an interceptive action requires a fine-tuned organization of the movement system to coordinate multiple joints of the musculoskeletal system relative to an object in a dynamic environment. It is when we observe children with mild-to-moderate movement impairments such as unilateral spastic cerebral palsy (USCP) that the difficulties related to coordination and control of the movement and uptake of visual, proprioceptive, haptic information become apparent. In USCP, unilateral brain damage before or around birth leads to physical impairment of the arm and leg of the contralateral bodyside, which leads to a strong asymmetry between body-sides during movement.Here we review how children with USCP perform interceptive actions using a framework that is derived from concepts and theories of Newell 1 and Bernstein. 2 This approach is particularly useful for gaining an understanding about the capabilities of individuals with a physical impairment, because the focus is on the body as a self-organizing dynamic system and not on the impairment that needs to be corrected and controlled by a hierarchical model (see review by Latash and Anson 3 for an extensive discussion). The framework in Figure 1 explains how stable and adaptive movement coordination emerges from the multiple degrees of freedom within the musculoskeletal movement ...

Biomechanical Modeling of Children with Cerebral Palsy to Establish Recreational Rock Climbing Therapy

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