Department of Bioengineering, Stanford University, United States.
Gait Posture. 2010 May;32(1):72-7. doi: 10.1016/j.gaitpost.2010.03.011. Epub 2010 Apr 7.
The ability to reach, grasp, transport, and release objects is essential for activities of daily living. The objective of this study was to develop a quantitative method to assess upper limb motor deficits in children with cerebral palsy (CP) using three-dimensional motion analysis. We report kinematic data from 25 typically developing (TD) children (11 males, 14 females; ages 5-18 years) and 2 children with spastic hemiplegic CP (2 females, ages 14 and 15 years) during the Reach and Grasp Cycle. The Cycle includes six sequential tasks: reach, grasp cylinder, transport to mouth (T(1)), transport back to table (T(2)), release cylinder, and return to initial position. It was designed to represent a functional activity that was challenging yet feasible for children with CP. For example, maximum elbow extension was 43+/-11 degrees flexion in the TD group. Consistent kinematic patterns emerged for the trunk and upper limb: coefficients of variation at point of task achievement for reach, T(1), and T(2) for trunk flexion-extension were (.11, .11, .11), trunk axial rotation (.06, .06, .06), shoulder elevation (.13, .11, .13), elbow flexion-extension (.25, .06, .23), forearm pronation-supination (.08, .10, .11), and wrist flexion-extension (.25, .21, .22). The children with CP demonstrated reduced elbow extension, increased wrist flexion and trunk motion, with an increased tendency to actively externally rotate the shoulder and supinate the forearm during T(1) compared to the TD children. The consistent normative data and clinically significant differences in joint motion between the CP and TD children suggest the Reach and Grasp Cycle is a repeatable protocol for objective clinical evaluation of functional upper limb motor performance.
伸手、抓握、搬运和释放物体的能力是日常生活活动的基础。本研究旨在使用三维运动分析开发一种定量方法来评估脑瘫（CP）儿童的上肢运动障碍。我们报告了 25 名正常发育（TD）儿童（11 名男性，14 名女性；年龄 5-18 岁）和 2 名痉挛性偏瘫 CP 儿童（2 名女性，年龄 14 岁和 15 岁）在伸手和抓握周期中的运动学数据。该周期包括六个连续的任务：伸手、抓握圆柱体、搬运到口（T(1))、搬运回桌（T(2))、释放圆柱体和返回初始位置。它旨在代表一项具有挑战性但对 CP 儿童可行的功能性活动。例如，TD 组最大的肘部伸展为 43+/-11 度的屈曲。在躯干和上肢上出现了一致的运动模式：到达任务点时的躯干俯仰和屈伸的变异系数为伸展（ reach ）、T(1)和 T(2)（.11，.11，.11），躯干轴向旋转（.06，.06，.06），肩部抬高（.13，.11，.13），肘部屈伸（.25，.06，.23），前臂旋前-旋后（.08，.10，.11），和手腕屈伸（.25，.21，.22）。CP 儿童的肘部伸展减少，手腕弯曲和躯干运动增加，与 TD 儿童相比，T(1)期间肩部主动外旋和前臂旋前的趋势增加。CP 儿童和 TD 儿童在关节运动方面一致的规范数据和临床显著差异表明，伸手和抓握周期是一种可重复的协议，用于客观临床评估功能性上肢运动表现。
