Sidiropoulos Alexis, Magill Richard, Gordon Andrew
Department of Biobehavioral Sciences, Teachers College, Columbia University, 525 West 120th Street, New York, NY, 10027, USA.
Department of Biobehavioral Sciences, Teachers College, Columbia University, 525 West 120th Street, New York, NY, 10027, USA.
Gait Posture. 2021 May;86:251-255. doi: 10.1016/j.gaitpost.2021.03.028. Epub 2021 Mar 24.
Children with cerebral palsy indicate poor continuous gait inter-limb coordination compared to typically developing children. Limited research exists in the understanding of the coordinative relationship between the arms and legs of these children and if the phasing relationships between limbs can be improved.
Which motor control factors impact coordination in children with cerebral palsy and can coordination improve with intervention?
This literature review provides a comprehensive overview of the current knowledge of continuous coordination in a pediatric, pathologic population with an emphasis on inter-limb coordination. Peer-reviewed research articles related to inter-limb coordination, with a focus on gait, were reviewed to identify relevant research and any gaps in the literature which could inform future study design. Consideration of the most appropriate analysis for evaluation of such movement is also presented.
The coordinative difficulties experienced by children with cerebral palsy may originate from the deficits in motor control, muscle tone, and weakness caused by damage to the central nervous system, which is vital in motor control of inter-limb coordination. Continuous inter-limb coordination in children with cerebral palsy may be improved with enhanced function of the upper extremities through intensive motor-learning based rehabilitation or botulinum toxin injection of the more-affected arm. Importantly, analysis of limb movements should include continuous measures of relative phase, as it provides a more detailed description of coordination compared to discrete measures.
Improved upper extremity function may produce a positive change in the phasing relationship between the arms and legs. This type of coordination should be analyzed using relative phase analysis, as this type of analysis can provide more information compared to traditional spatiotemporal parameters. However, more research is required to fully understand the connection between improved upper extremity function and its positive impact on gait coordination in children with cerebral palsy.
与正常发育的儿童相比，脑瘫儿童表现出较差的连续步态肢体间协调性。对于理解这些儿童手臂和腿部之间的协调关系以及肢体间的相位关系是否可以改善，相关研究有限。
哪些运动控制因素会影响脑瘫儿童的协调性，以及协调性能否通过干预得到改善？
这篇文献综述全面概述了儿科病理性人群中当前关于连续协调性的知识，重点是肢体间协调性。对与肢体间协调性相关的同行评审研究文章进行了综述，重点关注步态，以确定相关研究以及文献中可能为未来研究设计提供信息的任何空白。还介绍了对评估此类运动最合适分析方法的考虑。
脑瘫儿童所经历的协调困难可能源于中枢神经系统损伤导致的运动控制、肌张力和力量方面的缺陷，而中枢神经系统在肢体间协调的运动控制中至关重要。通过基于强化运动学习的康复或对受影响更严重的手臂注射肉毒杆菌毒素来增强上肢功能，可能会改善脑瘫儿童的连续肢体间协调性。重要的是，对肢体运动的分析应包括相对相位的连续测量，因为与离散测量相比，它能提供更详细的协调性描述。
改善上肢功能可能会使手臂和腿部之间的相位关系产生积极变化。这种协调性类型应使用相对相位分析进行分析，因为与传统时空参数相比，这种分析可以提供更多信息。然而，需要更多研究来充分理解改善上肢功能与它对脑瘫儿童步态协调性的积极影响之间的联系。
