Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Katholieke Universiteit Leuven, Tervuursevest 101, 3001 Leuven, Belgium.
Res Dev Disabil. 2011 Nov-Dec;32(6):2283-94. doi: 10.1016/j.ridd.2011.07.038. Epub 2011 Sep 8.
The aim of this study was to measure which three-dimensional spatiotemporal and kinematic parameters differentiate upper limb movement characteristics in children with hemiplegic cerebral palsy (HCP) from those in typically developing children (TDC), during various clinically relevant tasks. We used a standardized protocol containing three reach tasks (forwards, upwards, and sideways), two reach-to-grasp tasks (with objects requiring different hand orientations), and three gross motor tasks. Spatiotemporal (movement duration, trajectory straightness, maximum velocity, and timing of maximum velocity), as well as kinematic parameters (discrete angles and waveforms of the trunk, scapula, shoulder, elbow and wrist), were compared between 20 children with HCP (age 10.9 ± 2.9 years) and 20 individually age-matched TDC (age 10.9 ± 3.0 years). Kinematic calculations followed the recommendations from the International Society of Biomechanics. Results showed that children with HCP had longer movement durations, less straight hand trajectories, and lower maximum velocities compared to the TDC. Timing of maximum velocity did not differ between both groups. The movement pathology in children with HCP was highlighted by increased trunk movements and reduced shoulder elevation during reaching and reach-to-grasp. We also measured an increased anterior tilting and protraction of the scapula in children with HCP, although differences were not significant for all tasks. Finally, compared to the TDC, children with HCP used less elbow extension and supination and more wrist flexion to execute all tasks. This study reported distinct 3D upper limb movement characteristics in children with HCP and age-matched TDC, establishing the discriminative ability of the measurement procedure. From a clinical perspective, combining spatiotemporal and kinematic parameters may facilitate the identification of the pathological movement patterns seen in children with HCP and thereby add to a well-targeted upper limb treatment planning.
本研究旨在测量三维时空和运动学参数，以区分偏瘫脑瘫（HCP）儿童与正常发育儿童（TDC）在各种临床相关任务中上肢运动特征。我们使用包含三个伸展任务（向前、向上和向侧面）、两个伸手抓握任务（需要不同手型的物体）和三个粗大运动任务的标准化方案。比较了 20 名 HCP 儿童（年龄 10.9 ± 2.9 岁）和 20 名年龄匹配的 TDC 儿童（年龄 10.9 ± 3.0 岁）之间的时空（运动持续时间、轨迹直线度、最大速度和最大速度时间）和运动学参数（躯干、肩胛骨、肩部、肘部和手腕的离散角度和波形）。运动学计算遵循国际生物力学学会的建议。结果表明，与 TDC 相比，HCP 儿童的运动持续时间更长，手轨迹更不直，最大速度更低。最大速度时间在两组之间没有差异。HCP 儿童在伸手和伸手抓握过程中躯干运动增加和肩部抬高减少，突出了其运动病理。我们还测量到 HCP 儿童肩胛骨前倾斜和前突增加，尽管所有任务的差异均不显著。最后，与 TDC 相比，HCP 儿童在执行所有任务时使用较少的肘部伸展和旋后，更多的手腕弯曲。本研究报告了 HCP 儿童与年龄匹配的 TDC 之间明显的 3D 上肢运动特征，确立了测量程序的区分能力。从临床角度来看，时空和运动学参数的结合可能有助于识别 HCP 儿童中出现的病理性运动模式，从而有助于有针对性的上肢治疗计划。
