对单侧脑瘫儿童手部主动和被动位置觉进行可靠且有效的机器人评估

Reliable and Valid Robotic Assessments of Hand Active and Passive Position Sense in Children With Unilateral Cerebral Palsy.

作者信息

Zbytniewska-Mégret Monika, Decraene Lisa, Mailleux Lisa, Kleeren Lize, Kanzler Christoph M, Gassert Roger, Ortibus Els, Feys Hilde, Lambercy Olivier, Klingels Katrijn

机构信息

Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, Institute of Robotics and Intelligent Systems, ETH Zurich, Zurich, Switzerland.

Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.

出版信息

Front Hum Neurosci. 2022 Aug 1;16:895080. doi: 10.3389/fnhum.2022.895080. eCollection 2022.

Abstract

Impaired hand proprioception can lead to difficulties in performing fine motor tasks, thereby affecting activities of daily living. The majority of children with unilateral cerebral palsy (uCP) experience proprioceptive deficits, but accurately quantifying these deficits is challenging due to the lack of sensitive measurement methods. Robot-assisted assessments provide a promising alternative, however, there is a need for solutions that specifically target children and their needs. We propose two novel robotics-based assessments to sensitively evaluate active and passive position sense of the index finger metacarpophalangeal joint in children. We then investigate test-retest reliability and discriminant validity of these assessments in uCP and typically developing children (TDC), and further use the robotic platform to gain first insights into fundamentals of hand proprioception. Both robotic assessments were performed in two sessions with 1-h break in between. In the passive position sense assessment, participant's finger is passively moved by the robot to a randomly selected position, and she/he needs to indicate the perceived finger position on a tablet screen located directly above the hand, so that the vision of the hand is blocked. Active position sense is assessed by asking participants to accurately move their finger to a target position shown on the tablet screen, without visual feedback of the finger position. Ten children with uCP and 10 age-matched TDC were recruited in this study. Test-retest reliability in both populations was good (intraclass correlation coefficients (ICC) >0.79). Proprioceptive error was larger for children with uCP than TDC (passive: 11.49° ± 5.57° vs. 7.46° ± 4.43°, = 0.046; active: 10.17° ± 5.62° vs. 5.34° ± 2.03°, < 0.001), indicating discriminant validity. The active position sense was more accurate than passive, and the scores were not correlated, underlining the need for targeted assessments to comprehensively evaluate proprioception. There was a significant effect of age on passive position sense in TDC but not uCP, possibly linked to disturbed development of proprioceptive acuity in uCP. Overall, the proposed robot-assisted assessments are reliable, valid and a promising alternative to commonly used clinical methods, which could help gain a better understanding of proprioceptive impairments in uCP, facilitating the design of novel therapies.

摘要

手部本体感觉受损会导致执行精细运动任务困难,进而影响日常生活活动。大多数单侧脑瘫(uCP)儿童存在本体感觉缺陷,但由于缺乏敏感的测量方法,准确量化这些缺陷具有挑战性。机器人辅助评估提供了一种有前景的替代方法,然而,需要有专门针对儿童及其需求的解决方案。我们提出了两种基于机器人技术的新颖评估方法,以灵敏地评估儿童食指掌指关节的主动和被动位置感觉。然后,我们调查了这些评估在uCP儿童和正常发育儿童(TDC)中的重测信度和区分效度,并进一步利用机器人平台对手部本体感觉的基本原理获得初步见解。两种机器人评估均分两个阶段进行,中间休息1小时。在被动位置感觉评估中,参与者的手指由机器人被动移动到一个随机选择的位置,然后她/他需要在直接位于手部上方的平板电脑屏幕上指出所感知到的手指位置,从而遮挡手部的视觉。主动位置感觉通过要求参与者在没有手指位置视觉反馈的情况下,将手指准确移动到平板电脑屏幕上显示的目标位置来评估。本研究招募了10名uCP儿童和10名年龄匹配的TDC儿童。两个群体的重测信度都很好(组内相关系数(ICC)>0.79)。uCP儿童的本体感觉误差大于TDC儿童(被动:11.49°±5.57°对7.46°±4.43°,P = 0.046;主动:10.17°±5.62°对5.34°±2.03°,P<0.001),表明具有区分效度。主动位置感觉比被动位置感觉更准确,且分数不相关,这突出了需要进行针对性评估以全面评估本体感觉。年龄对TDC儿童的被动位置感觉有显著影响,但对uCP儿童没有影响,这可能与uCP儿童本体感觉敏锐度的发育紊乱有关。总体而言,所提出的机器人辅助评估是可靠、有效的,并且是常用临床方法的一种有前景的替代方法,这有助于更好地理解uCP中的本体感觉障碍,促进新疗法的设计。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/42e2/9376476/f314b759f314/fnhum-16-895080-g0001.jpg

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