Sánchez María B, Loram Ian, Holmes Paul, Darby John, Butler Penelope B
Research Centre for Musculoskeletal Science & Sports Medicine, Manchester Metropolitan University, Manchester, UK.
Research Centre for Musculoskeletal Science & Sports Medicine, Manchester Metropolitan University, Manchester, UK.
Gait Posture. 2018 Sep;65:45-50. doi: 10.1016/j.gaitpost.2018.06.176. Epub 2018 Jun 30.
Physical therapy evaluations of motor control are currently based on subjective clinical assessments. Despite validation, these can still be inconsistent between therapists and between clinics, compromising the process of validating a therapeutic intervention and the subsequent generation of evidence-based practice (EBP) guidelines. EBP benefits from well-defined objective measurements that complement existing subjective assessments.
The aim of this study was to develop an objective measure of head/trunk control in children with Cerebral Palsy (CP) using previously developed video-based methods of head/trunk alignment and absence of external support and compare these with the existing subjective Segmental Assessment of Trunk Control (SATCo).
Twelve children with CP were recruited and an average of 3 (±1.1) SATCo tests performed per child. The full SATCo was concurrently video-recorded from a sagittal view; markers were placed on specific landmarks of the head, trunk and pelvis to track and estimate head/trunk segment position. A simplified objective rule was created for control and used on videos showing no external support. This replicated the clinical parameters and enabled identification of the segmental-loss-of-control. The subjectively and objectively identified segmental-loss-of-control were compared using a Pearson Correlation Coefficient.
An angular-threshold of 17° from alignment showed the minimum bias between the subjectively and the objectively measured segmental-loss-of-control (mean error =-0.11 and RMSE = 1.5) and a significant correlation (r = 0.78, r = 0.61, p < .01).
This study showed that simple objective video-based measurements can be used to reconstruct the subjective assessment of segmental head/trunk control. This suggests that a clinically-friendly video-based objective measure has future potential to complement subjective assessments and to assist in the generation of EBP guidelines. Further development will increase the information that can be extracted from video images and enable generation of a fully automated objective measure.
目前运动控制的物理治疗评估基于主观临床评估。尽管经过了验证，但这些评估在治疗师之间以及诊所之间仍可能存在不一致，这损害了验证治疗干预措施的过程以及随后基于证据的实践（EBP）指南的制定。EBP受益于明确的客观测量，这些测量可补充现有的主观评估。
本研究的目的是使用先前开发的基于视频的头部/躯干对齐方法和无外部支撑的方法，开发一种针对脑瘫（CP）儿童头部/躯干控制的客观测量方法，并将其与现有的主观躯干控制分段评估（SATCo）进行比较。
招募了12名CP儿童，每个儿童平均进行3次（±1.1）SATCo测试。从矢状面同时对完整的SATCo进行视频记录；在头部、躯干和骨盆的特定标志点上放置标记，以跟踪和估计头部/躯干节段位置。创建了一个用于控制的简化客观规则，并应用于无外部支撑的视频。这复制了临床参数，并能够识别节段性控制丧失。使用Pearson相关系数比较主观和客观识别的节段性控制丧失。
与对齐角度相差17°时，主观和客观测量的节段性控制丧失之间的偏差最小（平均误差=-0.11，均方根误差=1.5），且具有显著相关性（r=0.78，r=0.61，p<0.01）。
本研究表明，基于视频的简单客观测量可用于重建头部/躯干节段控制的主观评估。这表明，一种临床友好的基于视频的客观测量方法未来有可能补充主观评估，并有助于制定EBP指南。进一步的开发将增加可从视频图像中提取的信息，并能够生成完全自动化的客观测量方法。
