Clinical assessment and three-dimensional movement analysis: An integrated approach for upper limb evaluation in children with unilateral cerebral palsy
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Published on: February 12, 2018
Lisa Mailleux1, Ellen Jaspers1,2, Els Ortibus3
1KU Leuven-University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium.
Insights
Three-dimensional movement analysis (3DMA) in children with unilateral cerebral palsy (uCP) reveals increased upper limb (UL) pathology with higher Manual Ability Classification System (MACS) levels, particularly linked to muscle weakness. Integrating 3DMA with clinical assessments offers a comprehensive view of UL function.
Area of Science:
- Pediatric Rehabilitation
- Movement Science
- Biomedical Engineering
Background:
- Clinical assessment of upper limb (UL) function in children with unilateral cerebral palsy (uCP) using three-dimensional movement analysis (3DMA) presents challenges.
- Limited understanding exists regarding UL movement pathology and its correlation with clinical parameters in this population.
Purpose of the Study:
- To investigate UL kinematics across different Manual Ability Classification System (MACS) levels in children with uCP.
- To explore the relationship between clinical and kinematic parameters of UL function in children with uCP.
Main Methods:
- Fifty children with uCP (MACS levels I, II, III) underwent comprehensive evaluations, including sensorimotor assessments, bimanual and unimanual performance tests (Assisting Hand Assessment, Melbourne Assessment 2), and UL-3DMA during functional tasks.
- Extracted global parameters (e.g., Arm Profile Score) and joint-specific parameters (e.g., Arm Variable Scores) to quantify movement pathology and deviations.
Main Results:
- Higher MACS levels correlated with increased movement durations and greater overall movement pathology (Arm Profile Score).
- Increased movement pathology was associated with more severe sensorimotor impairments and lower functional performance scores (AHA, MA2).
- Distal joint deviations were linked to muscle weakness and tone, while proximal deviations correlated mainly with muscle weakness; grip force emerged as a key predictor of overall movement pathology.
Conclusions:
- Movement pathology in the upper limb increases with higher MACS levels in children with uCP, with muscle weakness being a significant contributing factor.
- Three-dimensional movement analysis provides valuable, complementary information to clinical assessments, especially for proximal joint function.
- Integrating 3DMA with clinical evaluations offers a more holistic understanding of upper limb motor function in children with uCP.
Introduction:
The clinical application of upper limb (UL) three-dimensional movement analysis (3DMA) in children with unilateral cerebral palsy (uCP) remains challenging, despite its benefits compared to conventional clinical scales. Moreover, knowledge on UL movement pathology and how this relates to clinical parameters remains scarce. Therefore, we investigated UL kinematics across different manual ability classification system (MACS) levels and explored the relation between clinical and kinematic parameters in children with uCP.
Patients And Methods:
Fifty children (MACS: I = 15, II = 26, III = 9) underwent an UL evaluation of sensorimotor impairments (grip force, muscle strength, muscle tone, two-point discrimination, stereognosis), bimanual performance (Assisting Hand Assessment, AHA), unimanual capacity (Melbourne Assessment 2, MA2) and UL-3DMA during hand-to-head, hand-to-mouth and reach-to-grasp tasks. Global parameters (Arm Profile Score (APS), duration, (timing of) maximum velocity, trajectory straightness) and joint specific parameters (angles at task endpoint, ROM and Arm Variable Scores (AVS)) were extracted. The APS and AVS refer respectively to the total amount of movement pathology and movement deviations of wrist, elbow, shoulder, scapula and trunk.
Results:
Longer movement durations and increased APS were found with higher MACS-levels (p<0.001). Increased APS was also associated with more severe sensorimotor impairments (r = -0.30-(-0.73)) and with lower AHA and MA2-scores (r = -0.50-(-0.86)). For the joint specific parameters, stronger movement deviations distally were significantly associated with increased muscle weakness (r = -0.32-(-0.74)) and muscle tone (r = 0.33-(-0.61)); proximal movement deviations correlated only with muscle weakness (r = -0.35-0.59). Regression analysis exposed grip force as the most important predictor for the variability in APS (p<0.002).
Conclusion:
We found increased movement pathology with increasing MACS-levels and demonstrated the adverse impact of especially muscle weakness. The lower correlations suggest that 3DMA provides additional information regarding UL motor function, particularly for the proximal joints. Integrating both methods seems clinically meaningful to obtain a comprehensive representation of all aspects of a child's UL functioning.
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