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The nature of arm movement in children with cerebral palsy when using computer-generated exercise games
Andrew Weightman1, Nick Preston, Martin Levesley
1School of Engineering, Manchester Metropolitan University , Manchester , UK .
Insights
Children with spastic cerebral palsy (CP) use larger shoulder and trunk movements when operating joysticks for computer exercises. This highlights the need to consider torso and shoulder movement in designing assistive technologies for upper limb rehabilitation in children with CP.
Area of Science:
- Rehabilitation Engineering
- Biomedical Engineering
- Neuroscience
Background:
- Cerebral palsy (CP) affects motor control, impacting upper limb function.
- Computer-based rehabilitation offers potential for engaging therapeutic exercises.
- Understanding kinematic differences is crucial for designing effective assistive devices.
Purpose of the Study:
- To compare upper limb kinematics in children with spastic CP, able-bodied children, and adults using a rehabilitation joystick.
- To inform the design requirements of computer-based rehabilitation devices for children with CP.
Main Methods:
- A comparative study involving seven children with spastic CP and nine able-bodied participants (children and adults).
- Participants used a joystick to play a computer game while upper limb kinematics (shoulder and elbow) were recorded.
- Analysis focused on joystick endpoint kinematics, shoulder protraction/retraction, and elbow flexion/extension.
Main Results:
- Children with spastic CP initiated movements slower and exhibited jerkier trajectories compared to able-bodied peers.
- Despite matching task completion times, children with CP deviated from prescribed movement paths.
- Significantly greater shoulder movement magnitudes were observed in the spastic CP group.
Conclusions:
- Children with spastic CP utilize substantial shoulder and trunk movements during joystick-controlled computer exercises.
- This compensatory movement pattern has implications for the design of assistive technologies and user instructions.
- Rehabilitative system design must account for torso/shoulder movement to optimize upper limb therapy quality for children with CP.
Purpose:
To compare upper limb kinematics of children with spastic cerebral palsy (CP) using a passive rehabilitation joystick with those of adults and able-bodied children, to better understand the design requirements of computer-based rehabilitation devices.
Method:
A blocked comparative study involving seven children with spastic CP, nine able-bodied adults and nine able-bodied children, using a joystick system to play a computer game whilst the kinematics of their upper limb were recorded. The translational kinematics of the joystick's end point and the participant's shoulder movement (protraction/retraction) and elbow rotational kinematics (flexion/extension) were analysed for each group.
Results:
Children with spastic CP matched their able-bodied peers in the time taken to complete the computer task, but this was due to a failure to adhere to the task instructions of travelling along a prescribed straight line when moving between targets. The spastic CP group took longer to initiate the first movement, which showed jerkier trajectories and demonstrated qualitatively different movement patterns when using the joystick, with shoulder movements that were significantly of greater magnitude than the able-bodied participants.
Conclusions:
Children with spastic CP generate large shoulder and hence trunk movements when using a joystick to undertake computer-generated arm exercises. This finding has implications for the development and use of assistive technologies to encourage exercise and the instructions given to users of such systems.
Implications For Rehabilitation:
A kinematic analysis of upper limb function of children with CP when using joystick devices is presented. Children with CP may use upper body movements to compensate for limitations in voluntary shoulder and elbow movements when undertaking computer games designed to encourage the practice of arm movement. The design of rehabilitative computer exercise systems should consider movement of the torso/shoulder as it may have implications for the quality of therapy in the rehabilitation of the upper limb in children with CP.
