Department of Physical Medicine and Rehabilitation, Brest University Hospital, 29200 Brest, France; Laboratoire de Traitement de l'information Médicale (LaTIM), Inserm U1101, Université de Bretagne-Occidentale, 29200 Brest, France; Pediatric Rehabilitation Department, Fondation ILDYS, 29200 Brest, France.
Department of Physical Medicine and Rehabilitation, Brest University Hospital, 29200 Brest, France; Laboratoire de Traitement de l'information Médicale (LaTIM), Inserm U1101, Université de Bretagne-Occidentale, 29200 Brest, France.
Clin Biomech (Bristol). 2022 Jul;97:105710. doi: 10.1016/j.clinbiomech.2022.105710. Epub 2022 Jun 22.
Upper limb movement patterns have not yet been identified in bimanual conditions despite the difficulties children with unilateral cerebral palsy have performing bimanual activities. The aim was to identify specific motor patterns from kinematic deviations during bimanual tasks in this population.
Twenty children with unilateral cerebral palsy and 20 age-matched, typically developing children performed the five tasks of a 3D bimanual protocol. To evaluate upper limb kinematic deviations, 10 Arm Variable Scores were calculated for the affected /non-dominant upper limb of each participant for each task. Sparse K-means cluster analysis was applied to the 50 Arm Variable Scores of all the children to identify motor patterns and determining variables. Clinical tests of impairment (muscle strength, selectivity, spasticity) and function (Assisting hand assessment, Abilhand-Kids) were compared between the clusters obtained.
Three different motor patterns were identified using the data from all the children: mild, proximal-distal and proximal-distal with trunk. The most important cluster determinants were the Arm Variable Scores for pronation-supination and wrist extension. In the cerebral palsy group, scores of impairments (p < .01) and function (Assisting Hand Assessment [p < .001] and Abilhand-Kids [p = .004]) differed for each motor pattern. Supination and wrist extension deviations differed significantly between the groups (p < .001).
During performance of bimanual tasks, children with unilateral cerebral palsy used distinct motor patterns that each corresponded to a specific clinical profile. Elbow-wrist deviations were the largest and most decisive and were specific to the cerebral palsy group: they should be the target of interventions to enhance bimanual function.
gov identifier: NCT03888443.
尽管患有单侧脑瘫的儿童在进行双手活动时存在困难，但上肢运动模式在双手条件下尚未确定。目的是在该人群中确定双手任务期间运动的特定运动模式。
20 名单侧脑瘫儿童和 20 名年龄匹配的正常发育儿童完成了 3D 双手协议的 5 项任务。为了评估上肢运动学偏差，为每个参与者的受影响/非优势上肢计算了 10 个上肢变量得分（Arm Variable Scores），每个任务。稀疏 K-均值聚类分析应用于所有儿童的 50 个上肢变量得分，以确定运动模式和确定变量。对获得的聚类进行了功能（辅助手评估、Abilhand-Kids）和功能（辅助手评估、Abilhand-Kids）的评估。
使用所有儿童的数据识别出三种不同的运动模式：轻度、近端-远端和近端-远端伴躯干。最重要的聚类决定因素是旋前-旋后和腕关节伸展的上肢变量得分。在脑瘫组中，障碍评分（p<.01）和功能评分（辅助手评估[p<.001]和 Abilhand-Kids [p=.004]）因每种运动模式而异。旋前和腕关节伸展偏差在两组之间存在显著差异（p<.001）。
在进行双手任务时，患有单侧脑瘫的儿童使用了不同的运动模式，每种模式都对应于特定的临床特征。肘部-腕部偏差最大且最具决定性，并且是脑瘫组特有的：它们应该是增强双手功能干预的目标。
gov 标识符：NCT03888443。
