Planning and coordination of a reach-grasp-eat task in children with hemiplegia

Children with hemiplegia have deficits in motor planning in addition to their impairments in movement of their more-affected upper extremity (UE). However, little is known about the relationship between motor planning and multi-segment coordination during functional activities in this population. In the present study, motor planning strategies and multi-segment coordination of the head, trunk, and UE were examined during a functional reach-grasp-eat task in children with hemiplegia. Ten children with hemiplegia (age 4-10 years; MACS levels I-II) and ten age-matched, typically developing children participated in the study. Children were asked to reach, grasp and transport a cookie to the mouth with one hand while 3-D kinematic analyses were performed. A more extended wrist (p = 0.001) and higher end-point position of grasping (p = 0.001) were found for both UEs of children with hemiplegia. The less-affected UE had greater trunk contribution (p = 0.018) and greater shoulder flexion (p = 0.002) and elbow extension (p = 0.005) during reaching compared to the TDC. The more-affected UE had impaired movement control with greater head rotation (p = 0.011), higher variability of end-point location in space (p = 0.001), greater trunk contribution (p = 0.018), and reduced wrist rotation (p = 0.007) compared with the less-affected UE and TDC. Additionally, delayed timing of maximum shoulder (p = 0.03) and elbow flexion (p = 0.008) during reaching, and maximum wrist pronation (p = 0.004) during eating were found for the more-affected UE. The results showed different multi-segment control for both UEs in children with hemiplegia compared to TDC. They also reflect impaired motor planning since the same movement strategies were used for both UEs. Furthermore, we suggest that inefficient multi-segment coordination of the more-affected UE is used to compensate for impaired motor planning and control.