Bagesteiro Leia B, Tellini Tamires L, Brown Liana E
Department of Kinesiology, San Francisco State University, San Francisco, CA, 94132, USA.
Universidade Federal do ABC, Santo Andre, SP, 09210580, Brazil.
Heliyon. 2023 Feb 2;9(2):e13455. doi: 10.1016/j.heliyon.2023.e13455. eCollection 2023 Feb.
Studies confirm that children with cerebral palsy (CwCP) have difficulty with simple, everyday movements like reaching for objects. Accurate reaching requires that shoulder and elbow joints are coordinated to move the hand along a smooth path to the desired target location. Here we examined multijoint coordination by comparing reaching performance in the affected and unaffected limbs of CwCP (nine children, six girls and three boys, aged 8-10 years) to reaching performance in the non-dominant and dominant limbs of typically-developing age- and gender-matched control (CTR) children. The hypothesis was that CwCP would show the effects of coordination deficits in both their affected and unaffected limbs. All children performed two sessions (one session with each arm) of speeded reaching movements to three targets arranged to manipulate the required pattern of shoulder and elbow coordination. The movements were tracked with a motion tracker allowing us to assess the following measures: movement distance, duration, and speed, hand-path deviation from linearity, final position accuracy and precision, and measures of shoulder and elbow excursion. We found that CwCP made reaches that covered a greater distance and took more time, that their shoulder and elbow rotations were larger, and that their movements showed greater deviation from linearity than the movements performed by CTR children. Children with CP were also more variable than CTR children on every measure except movement duration. The pattern of shoulder and elbow rotation observed in the CwCP group represents a coordination pattern that is significantly different from the pattern used by CTR children and may represent a greater reliance by CwCP on proximal muscular control systems. The discussion section considers the role that the cortical-spinal system may play in multijoint coordination.
研究证实,患有脑瘫的儿童(CwCP)在进行诸如伸手拿取物体等简单的日常动作时存在困难。准确的伸手动作要求肩关节和肘关节相互协调,以便将手沿着一条平滑的路径移动到期望的目标位置。在此,我们通过比较CwCP患儿(9名儿童,6名女孩和3名男孩,年龄在8至10岁之间)患侧和未患侧肢体的伸手动作表现,与年龄和性别匹配的典型发育对照(CTR)儿童非优势侧和优势侧肢体的伸手动作表现,来研究多关节协调。我们的假设是,CwCP患儿的患侧和未患侧肢体均会表现出协调缺陷的影响。所有儿童均进行了两阶段的快速伸手动作(每个手臂各一阶段),目标是三个,其排列方式旨在操控所需的肩肘协调模式。使用运动追踪器对动作进行跟踪,使我们能够评估以下指标:移动距离、持续时间和速度、手部路径与直线的偏差、最终位置的准确性和精确性,以及肩肘活动度的指标。我们发现,与CTR儿童的动作相比,CwCP患儿伸手动作的移动距离更远、耗时更长,其肩部和肘部的旋转幅度更大,并且动作与直线的偏差也更大。除了动作持续时间外,CP患儿在各项指标上的变异性也比CTR儿童更大。在CwCP组中观察到的肩肘旋转模式代表了一种与CTR儿童所使用的模式显著不同的协调模式,可能表明CwCP患儿对近端肌肉控制系统的依赖程度更高。讨论部分考虑了皮质脊髓系统在多关节协调中可能发挥的作用。