Motor patterns of the impaired upper limb in children with unilateral cerebral palsy performing bimanual tasks
Marine Cacioppo1, Mathieu Lempereur2, Antoine Marin3
1Department of Physical Medicine and Rehabilitation, Brest University Hospital, 29200 Brest, France; Laboratoire de Traitement de l'information Médicale (LaTIM), Inserm U1101, Université de Bretagne-Occidentale, 29200 Brest, France; Pediatric Rehabilitation Department, Fondation ILDYS, 29200 Brest, France.
Insights
Children with unilateral cerebral palsy exhibit distinct upper limb movement patterns during bimanual tasks. Identifying these motor patterns, particularly elbow-wrist deviations, is key for targeted interventions to improve bimanual function.
Area of Science:
- Neuroscience
- Pediatrics
- Rehabilitation Medicine
Background:
- Children with unilateral cerebral palsy (UCP) face challenges in bimanual activities.
- Specific upper limb movement patterns in UCP during bimanual tasks remain unidentified.
Purpose of the Study:
- To identify distinct motor patterns in children with UCP during bimanual tasks.
- To correlate these motor patterns with clinical profiles of impairment and function.
Main Methods:
- Utilized a 3D bimanual protocol with 20 children with UCP and 20 typically developing children.
- Calculated Arm Variable Scores for kinematic deviations and applied sparse K-means cluster analysis.
- Correlated identified motor patterns with clinical impairment and functional assessments.
Main Results:
- Identified three motor patterns: mild, proximal-distal, and proximal-distal with trunk involvement.
- Pronation-supination and wrist extension deviations were key determinants of motor patterns.
- Significant differences in impairment and function scores were observed across motor patterns in the UCP group.
Conclusions:
- Children with UCP display specific motor patterns during bimanual tasks, each linked to a distinct clinical profile.
- Elbow-wrist deviations are prominent and specific to UCP, indicating them as crucial targets for therapeutic interventions.
- Understanding these motor patterns can guide the development of more effective rehabilitation strategies for bimanual function in UCP.
Background:
Upper limb movement patterns have not yet been identified in bimanual conditions despite the difficulties children with unilateral cerebral palsy have performing bimanual activities. The aim was to identify specific motor patterns from kinematic deviations during bimanual tasks in this population.
Methods:
Twenty children with unilateral cerebral palsy and 20 age-matched, typically developing children performed the five tasks of a 3D bimanual protocol. To evaluate upper limb kinematic deviations, 10 Arm Variable Scores were calculated for the affected /non-dominant upper limb of each participant for each task. Sparse K-means cluster analysis was applied to the 50 Arm Variable Scores of all the children to identify motor patterns and determining variables. Clinical tests of impairment (muscle strength, selectivity, spasticity) and function (Assisting hand assessment, Abilhand-Kids) were compared between the clusters obtained.
Findings:
Three different motor patterns were identified using the data from all the children: mild, proximal-distal and proximal-distal with trunk. The most important cluster determinants were the Arm Variable Scores for pronation-supination and wrist extension. In the cerebral palsy group, scores of impairments (p < .01) and function (Assisting Hand Assessment [p < .001] and Abilhand-Kids [p = .004]) differed for each motor pattern. Supination and wrist extension deviations differed significantly between the groups (p < .001).
Interpretation:
During performance of bimanual tasks, children with unilateral cerebral palsy used distinct motor patterns that each corresponded to a specific clinical profile. Elbow-wrist deviations were the largest and most decisive and were specific to the cerebral palsy group: they should be the target of interventions to enhance bimanual function.
Clinicaltrials:
gov identifier: NCT03888443.
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