Upper Limb Function, Kinematic Analysis, and Dystonia Assessment in Children With Spastic Diplegic Cerebral Palsy and Periventricular Leukomalacia

Abstract

Assessment of upper limb function, kinematic analysis, and dystonia in patients with spastic diplegia cerebral palsy and periventricular leukomalacia. Seven children with spastic diplegia cerebral palsy and 8 controls underwent upper limb kinematics. Movement duration, average and maximum linear velocity, index of curvature, index of dystonia, and target accuracy and stability were analyzed. In the patients with spastic diplegia, Gross Motor Function and Manual Ability Classification Systems were determined, and spasticity and dystonia were rated using the Modified Ashworth and the Burke-Fahn-Marsden Dystonia scales respectively. Children with spastic diplegia demonstrated a tendency toward higher index of dystonia reflecting overflow, higher index of curvature, lower velocities, and poor target accuracy and stability. All patients showed clinical evidence of dystonia in the upper limbs. Dystonia scores correlated with the Manual Ability Classification System (r = 0.86, P = .01) and with the index of dystonia (r = 0.82, P = .02). Children with spastic diplegia cerebral palsy present dystonia in the upper limbs. This is functionally relevant and can be measured with kinematic analysis.

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

“…Involuntary movement Involuntary movement was mainly quantified by determining the overflow of muscle activation that is not directly required for a task, thus resulting in involuntary movement. This was mostly measured as kinematic overflow by 3D motion analysis [51,54,60,61] and overflow of muscle activation by sEMG [44,[71][72][73][74]. Different stimuli were used to trigger overflow e.g.…”

“…Different stimuli were used to trigger overflow e.g. movement of contralateral arm, hand, fingers, antagonist muscles [44,51,54,60,61,71,73,74], and eye-blinking [61]. Other studies measured the involuntary movement component during voluntary movements [48,82], while holding the arm in a raised position and during lying in rest [62].…”

“…These recommendations and protocols were (partly) used in several of the reviewed articles [38-41, 53, 55-57, 60, 61]. Parameters that were mostly used to assess dyskinetic movements during gait and upper extremity tasks included variability and timing of movement trajectories, jerk, kinematic overflow and overflow measured by sEMG [39,42,44,53,54,57,58,60,61,71,73,74]. Some of these parameters have already been shown to have a strong correlation to clinical comparator instruments (r > 0.70) (e.g.…”

“…Some of these parameters have already been shown to have a strong correlation to clinical comparator instruments (r > 0.70) (e.g. variability of ankle trajectory during swing [39], kinematic overflow [51,60,61] number of movement units (i.e. acceleration-deacceleration) [52] and movement, reach or hold time [52,55] (see Additional file 3) and might be interesting for assessment of treatment effects.…”

Clinical Presentation of Spasticity and Passive Range of Motion Deviations in Dyskinetic Cerebral Palsy in Relation to Dystonia, Choreoathetosis, and Functional Classification Systems

“…Higher presence and severity of spasticity were obtained for the LL whereas dystonia and choreoathetosis were more present and severe in the UL, which aligns with previous research. 11,34 Interestingly, spasticity and limited pROM showed fair and significant correlations with dystonia for the proximal LL but not for the distal LL (where the highest spasticity severity occurs). Correlation coefficients are greater if there is more variability among the observations.…”