Pennsylvania State University Harrisburg, Middletown, PA, USA.
University of Pittsburgh Medical Center Hamot, Erie, PA, USA.
Gait Posture. 2022 Oct;98:17-23. doi: 10.1016/j.gaitpost.2022.08.007. Epub 2022 Aug 19.
Challenges in measuring dynamic scapular orientation limit assessment of scapulothoracic and glenohumeral contributions to shoulder function in children with brachial plexus birth injury (BPBI). Double calibration acromion marker cluster (D-AMC) and linear model approaches have been validated to estimate scapular motion in healthy adults, but neither has been evaluated in BPBI.
Are the linear model and D-AMC approaches able to accurately estimate scapular orientation in children with BPBI at functional arm postures?
Seventeen children with BPBI positioned their affected limbs in 11 static positions while their segment orientations were measured with motion capture. Linear model and D-AMC estimates of scapular orientation were compared against palpation at six of the static positions with functional relevance to BPBI using a three-way repeat measures ANOVA and a comparison of root mean square errors (RMSE) against literature AMC values for healthy adults.
The D-AMC was similar to palpation across all positions and scapular axes while the linear model differed from palpation in a few instances. RMSEs of the D-AMC (3.7-14.8°) and particularly the linear model (4.6-24.8°) were generally at or beyond the upper range of past AMC analyses on healthy adults (1.6-14.2°), especially for more complex, multiplanar arm postures. Despite the D-AMC outperforming the linear model, this approach still produced clinically meaningful (>10°) errors for roughly (12.7-22.5%) of subjects.
Current methods for estimating dynamic scapular orientation remain less than ideal for BPBI. Use of the D-AMC may be appropriate to gain broad insights into general dynamic scapulothoracic and glenohumeral function; however, given their potential for producing clinically meaningful errors, the D-AMC and linear model are not recommended for diagnostic purposes or outcomes assessment on an individual patient basis unless their patient-specific accuracy has been evaluated and confirmed prior to use.
在评估臂丛神经损伤（BPBI）患儿的肩胛胸壁和盂肱关节对肩部功能的贡献时，动态肩胛定位的挑战限制了评估。双校准肩峰标记簇（D-AMC）和线性模型方法已被验证可用于估计健康成年人的肩胛骨运动，但两者均未在 BPBI 中进行评估。
线性模型和 D-AMC 方法是否能够准确估计 BPBI 患儿在功能臂位时的肩胛骨方位？
17 名 BPBI 患儿将受影响的肢体放置在 11 个静态位置，同时使用运动捕捉测量其节段方向。使用三向重复测量方差分析和与健康成年人 AMC 值的文献 RMS 误差（RMSE）比较，比较了线性模型和 D-AMC 对与 BPBI 具有功能相关性的六个静态位置的肩胛骨方位的估计值与触诊结果。
在所有位置和肩胛骨轴上，D-AMC 与触诊结果相似，而线性模型在少数情况下与触诊结果不同。D-AMC（3.7-14.8°）和特别是线性模型（4.6-24.8°）的 RMSE 通常处于或超过过去对健康成年人的 AMC 分析的上限（1.6-14.2°），尤其是对于更复杂的多平面臂位。尽管 D-AMC 的表现优于线性模型，但该方法仍然为大约（12.7-22.5%）的受试者产生了具有临床意义的（>10°）误差。
目前用于估计动态肩胛骨方位的方法仍然不能完全满足 BPBI 的要求。D-AMC 的使用可能适合于广泛了解一般动态肩胛胸壁和盂肱关节功能；然而，由于它们存在产生具有临床意义的误差的可能性，除非在使用之前已经评估和确认了其针对特定患者的准确性，否则不建议将 D-AMC 和线性模型用于诊断目的或基于个体患者的结果评估。
