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Detection of pronator muscle overactivity in children with unilateral spastic cerebral palsy: Development of a
Aurélie Sarcher1, Sylvain Brochard2, Brigitte Perrouin-Verbe3
1Motion analysis laboratory, physical medicine and rehabilitation, university hospital of Nantes, 44000 Nantes, France; Laboratory of medical information processing (LaTIM), INSERM UMR 1101, 29200 Brest, France.
Insights
Surface electromyography (EMG) offers a reliable method for detecting pronator muscle overactivity in children with cerebral palsy, improving treatment accuracy. This technique complements clinical assessments for better motor function outcomes.
Area of Science:
- Neurology
- Biomedical Engineering
- Rehabilitation Medicine
Background:
- Spastic cerebral palsy often involves pronator muscle overactivity, complicating supination.
- Clinical assessment of pronator overactivity during movement is challenging.
Purpose of the Study:
- To develop a semi-automatic surface electromyography (EMG) method for detecting pronator muscle overactivity.
- To assess the method's accuracy in children with cerebral palsy during active supination.
Main Methods:
- Recorded kinematic and surface EMG data during pronation-supination in children with cerebral palsy and typically developing children.
- Experts visually assessed EMG signals for muscle overactivity, establishing a reference.
- Adjusted thresholds for a semi-automatic method based on expert visual assessment.
Main Results:
- The semi-automatic EMG method achieved 96% positive and 91% negative predictive values.
- Expert visual assessment showed excellent intra-rater and moderate inter-rater reliability.
- The method successfully discriminated between no overactivity, single, or dual pronator muscle overactivity.
Conclusions:
- Surface EMG is a valuable tool complementing clinical evaluation for pronator overactivity in cerebral palsy.
- This method can enhance treatment accuracy for improved motor function, provided EMG limitations are considered.
Background:
The pronator teres and pronator quadratus muscles are frequently injected with neuromuscular blocking agents to improve supination in children with spastic cerebral palsy and limited active elbow supination. However, determining by simple clinical examination whether these muscles are overactive during active movement is difficult.
Objective:
This study aimed to develop a semi-automatic method to detect pronator muscle overactivity by using surface electromyography (EMG) during active supination movements in children with cerebral palsy.
Methods:
In total, 25 children with unilateral spastic cerebral palsy (10 males; mean [SD] age 10.6 [3.0] years) and 12 typically developing children (7 males; mean age 11.0 [3.0] years) performed pronation-supination movements at 0.50Hz. Kinematic parameters and surface EMG signals were recorded for both pronator muscles. Three experts visually assessed muscle overactivity in the EMG signals of the children with cerebral palsy, in comparison with the reference group. The reliability and discrimination ability of the visual assessments were analysed. Overactivity detection thresholds for the semi-automatic method were adjusted by using the visual assessment by the EMG experts. The positive and negative predictive values of the semi-automatic detection method were calculated.
Results:
Intra-rater reliability of visual assessment by EMG experts was excellent and inter-rater reliability was moderate. For the 25 children with unilateral spastic cerebral palsy, EMG experts could discriminate different profiles of pronator overactivity during active supination: no pronator overactivity, one overactive pronator, or overactivity of both pronators. The positive and negative predictive values were 96% and 91%, respectively, for this semi-automatic detection method.
Conclusions:
Detection of pronator overactivity by using surface EMG provides an important complement to the clinical examination. This method can be used clinically, with the condition that clinicians be aware of surface EMG limitations. We believe use of this method can increase the accuracy of treatment for muscle overactivity, resulting in improved motor function and no worsening of paresis.
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