Department of Family, Nutrition, and Exercise Sciences, Queens College, City University of New York, 65-30 Kissena Blvd, Flushing, NY 11367, USA.
Res Dev Disabil. 2012 Sep-Oct;33(5):1649-57. doi: 10.1016/j.ridd.2012.04.003. Epub 2012 May 2.
Children with hemiplegia have deficits in motor planning in addition to their impairments in movement of their more-affected upper extremity (UE). However, little is known about the relationship between motor planning and multi-segment coordination during functional activities in this population. In the present study, motor planning strategies and multi-segment coordination of the head, trunk, and UE were examined during a functional reach-grasp-eat task in children with hemiplegia. Ten children with hemiplegia (age 4-10 years; MACS levels I-II) and ten age-matched, typically developing children participated in the study. Children were asked to reach, grasp and transport a cookie to the mouth with one hand while 3-D kinematic analyses were performed. A more extended wrist (p = 0.001) and higher end-point position of grasping (p = 0.001) were found for both UEs of children with hemiplegia. The less-affected UE had greater trunk contribution (p = 0.018) and greater shoulder flexion (p = 0.002) and elbow extension (p = 0.005) during reaching compared to the TDC. The more-affected UE had impaired movement control with greater head rotation (p = 0.011), higher variability of end-point location in space (p = 0.001), greater trunk contribution (p = 0.018), and reduced wrist rotation (p = 0.007) compared with the less-affected UE and TDC. Additionally, delayed timing of maximum shoulder (p = 0.03) and elbow flexion (p = 0.008) during reaching, and maximum wrist pronation (p = 0.004) during eating were found for the more-affected UE. The results showed different multi-segment control for both UEs in children with hemiplegia compared to TDC. They also reflect impaired motor planning since the same movement strategies were used for both UEs. Furthermore, we suggest that inefficient multi-segment coordination of the more-affected UE is used to compensate for impaired motor planning and control.
偏瘫儿童除了受影响的上肢（UE）运动障碍外，在运动规划方面也存在缺陷。然而，对于该人群在功能活动中运动规划与多节段协调之间的关系，人们知之甚少。在本研究中，我们研究了偏瘫儿童在功能性伸手-抓握-进食任务中头、躯干和 UE 的运动规划策略和多节段协调。10 名偏瘫儿童（年龄 4-10 岁；MACS 水平 I-II）和 10 名年龄匹配的、正常发育的儿童参加了研究。要求儿童用一只手伸手、抓握和运送饼干到嘴里，并进行 3D 运动学分析。发现偏瘫儿童的两只 UE 手腕伸展（p = 0.001）和抓握的终点位置更高（p = 0.001）。与 TDC 相比，偏瘫儿童的非优势 UE 在伸手时具有更大的躯干贡献（p = 0.018）和更大的肩部屈曲（p = 0.002）和肘部伸展（p = 0.005）。优势 UE 的运动控制受损，头部旋转更大（p = 0.011），空间终点位置的变异性更高（p = 0.001），躯干贡献更大（p = 0.018），手腕旋转减少（p = 0.007），与非优势 UE 和 TDC 相比。此外，还发现优势 UE 在伸手时最大肩部（p = 0.03）和肘部屈曲（p = 0.008）以及进食时最大腕部旋前（p = 0.004）的时间延迟。研究结果表明，与 TDC 相比，偏瘫儿童的两只 UE 具有不同的多节段控制。这也反映了运动规划受损，因为两只 UE 都使用了相同的运动策略。此外，我们认为，优势 UE 的低效多节段协调用于补偿运动规划和控制受损。
