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Objective measurement of sitting - Application in children with cerebral palsy
Meta N Eek1, Annika Blomkvist2, Kristina Olsson2
1Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden.
Insights
Objective measures like pressure mapping and 2D motion analysis can assess sitting stability in children with cerebral palsy (CP). These methods detect differences between children with CP and typically developing peers, and track improvements after intrathecal baclofen (ITB) treatment.
Area of Science:
- Biomedical Engineering
- Rehabilitation Science
- Pediatric Neurology
Background:
- Children with cerebral palsy (CP) experience severe motor impairments, affecting their ability to maintain a stable sitting position.
- Objective measurement methods for assessing sitting stability in this population are lacking, hindering clinical assessment and treatment evaluation.
Purpose of the Study:
- To determine the feasibility of using pressure mapping and 2D motion analysis to measure sitting stability in children with CP.
- To assess if these methods can detect differences in sitting stability between children with CP and a reference group, between CP subgroups, and before/after intrathecal baclofen (ITB) treatment.
Main Methods:
- Pressure mapping and 2D motion analysis captured center of pressure (CoP) and head, hand, and leg movements during 90-second sitting trials.
- Participants included 22 children with dyskinetic or bilateral spastic CP (GMFCS III-V) and 30 typically developing (TD) children.
- Seventeen children with CP received ITB treatment; parent interviews and statistical analyses were conducted.
Main Results:
- Children with CP exhibited significantly more CoP and kinematic movements than TD children (p < 0.001).
- Dyskinetic CP showed greater movement than bilateral spastic CP (CoP distance p = 0.005, AP sway p = 0.014).
- ITB treatment reduced involuntary movements (CoP p = 0.006-0.035, kinematics p = 0.002-0.020), with consistent parent-reported improvements.
Conclusions:
- Pressure mapping and 2D motion analysis are feasible for objectively measuring sitting stability in children with moderate-to-severe motor impairments.
- These methods can differentiate between children with CP and controls, identify CP subgroups, and quantify treatment effects, with CoP and head movements being key indicators.
Background:
Children with cerebral palsy (CP) and a severe motor impairment, have limited ability to perform volitional movements due to spasticity, involuntary postures and movements and reduced ability to maintain antigravity head and trunk control. A stable sitting position is a prerequisite for participation in daily life, but there is a lack of objective measurement methods for this population.
Research Question:
Is it feasible to measure a stable sitting position with pressure mapping and 2D motion analysis, and can it detect differences to a) a reference group, b) between subgroups of CP and c) before and after treatment with intrathecal baclofen (ITB)?
Methods:
Pressure mapping, and a 2D motion analysis system, were used to capture movements of centre of pressure (CoP), and movements of head, hand and leg, sitting on a bench for 90 s. Twenty-two children with dyskinetic or bilateral spastic CP, GMFCS III-V, mean age 9.0, and 30 children with typical development (TD) mean age 10.7, were recruited between 2010 and 2019. Seventeen children were treated with ITB. Parents were interviewed regarding aspect of sitting. Non-parametric methods were used for statistical analysis.
Results:
Differences in CoP and kinematics were detected with more movements in children with CP compared to children with TD (p < 0.001). There were more movements in children with dyskinetic CP compared to children with bilateral spastic CP as captured with the pressure mapping system (CoP distance p = .005 and Anterio-Posterior sway p = .014). After treatment with ITB, involuntary movements had decreased (CoP p = 0.006-0.035, kinematics p = 0.002-0.020). Parents reported improvement in sitting. The two measurement systems showed consistent results (rho 0.500-0.771, p = <0.001-0.049).
Significance:
It was feasible to objectively measure sitting position in children with a moderate-to-severe motor impairment with differences to a reference group and after an intervention. CoP and head movements were the variables that were easiest to capture.
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