Dystonia and choreoathetosis presence and severity in relation to powered wheelchair mobility performance in children and youth with dyskinetic cerebral palsy

Bekteshi, Saranda; Konings, Marco J.; Nica, Ioana Gabriela; Gakopoulos, Sotirios; Aerts, Jean‐Marie; Hallez, Hans; Monbaliu, Elegast

doi:10.1016/j.ejpn.2020.08.002

Cited by 7 publications

(7 citation statements)

References 44 publications

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“…27 In contrast, studies of power mobility report high performance even for children and adolescents in GMFCS levels IV to V with restricted hand function (Manual Ability Classification System levels IV-V). 27,28 With increasing evidence of the benefits of independent mobility and with sufficient mobility options available nowadays, it is time to close the gap between research and clinical practice. To encourage independent mobility from an early age and throughout life, therapists should provide available information to parents and those living with CP and make sure different mobility options are available in different settings.…”

Section: Discussionmentioning

confidence: 99%

“…A study of factors influencing wheeled mobility in children with CP showed that only a few achieve independent mobility in their manual wheelchairs even if they have good hand function and upper extremity range of movement 27 . In contrast, studies of power mobility report high performance even for children and adolescents in GMFCS levels IV to V with restricted hand function (Manual Ability Classification System levels IV–V) 27,28 . With increasing evidence of the benefits of independent mobility and with sufficient mobility options available nowadays, it is time to close the gap between research and clinical practice.…”

Section: Discussionmentioning

confidence: 99%

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Probability of independent walking and wheeled mobility in individuals with cerebral palsy

Noten

Pettersson

Czuba

et al. 2023

Develop Med Child Neuro

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AimTo estimate the probability of independent walking and wheeled mobility in individuals with cerebral palsy (CP) at home and in the community in relation to age and gross motor function.MethodThis was a longitudinal cohort study using data reported into the combined Swedish CP follow‐up programme and national quality registry from October 2000 to October 2022. Walking, walking with aids, wheeled mobility, and assisted mobility defined independent or assisted mobility at home and in the community, based on the Functional Mobility Scale with additional data on wheelchair performance, were assessed.ResultsThere were 52 858 examinations reported for 6647 individuals with CP (age range 0–32 years, follow‐up period 0–22 years). Most children and adults in Gross Motor Function Classification System (GMFCS) levels I or II walked without assistive devices. The probability of dependence on others for mobility in the community was high for both children and adults in GMFCS levels III to V.InterpretationAlthough independent mobility is vital for participation and social inclusion, many children and adults with CP are dependent on others for mobility. We recommend clinicians, together with families and individuals with CP, explore how to increase access to independent mobility from an early age and continuously throughout the life course.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Probability of independent walking and wheeled mobility in individuals with cerebral palsy

Noten

Pettersson

Czuba

et al. 2023

Develop Med Child Neuro

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“…Such control interfaces have been developed in research environments [39,40], and manufactured and applied on an individual basis [24,27,41]. A clinical evaluation was done [42] with the Adremo head/foot steering system (Adremo Revalidatietechniek, The Netherlands).…”

Section: Support Of Head Positionmentioning

confidence: 99%

“…Although some (preliminary) results are available on the head support as control interface during wheelchair driving and the associated mobility performance [24,42], the performance and effectiveness of head support itself (i.e., the supporting function) during driving of the wheelchair has not yet been studied, and therefore deserves further attention.…”

Section: Dynamic Environmentsmentioning

confidence: 99%

Head support in wheelchairs (scoping review): state-of-the-art and beyond

Geers

Prinsen

Pijl

et al. 2021

Disability and Rehabilitation: Assistive Technology

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Background: Many wheelchair users experience disabilities in stabilising and positioning of the head. For these users, adequate head support is required. Although several types of head supports are available, further development of these systems is needed to improve functionality and quality of life, especially for the group of severely challenged users. For this group, user needs have not been clearly established. In this article, we provide an overview of the state-of-the-art in wheelchair mounted head supports and associated scientific evidence in order to identify requirements for the next generation of head support systems. Materials and methods: A scoping review was performed including scientific literature (PubMed/ Scopus), patents (Espacenet/Google Scholar) and commercial information. Types of head support and important system characteristics for future head support systems were proposed from consultations with wheelchair users (n ¼ 3), occupational therapists (n ¼ 3) and an expert panel. Results: Forty scientific papers, 90 patents and 80 descriptions of commercial devices were included in the scoping review. The identified head support systems were categorised per head support type. Only limited scientific clinical evidence with respect to the effectiveness of existing head support systems was found. From the user and expert consultations, a need was identified for personalised head support systems that intuitively combine changes in sitting and head position with continuous optimal support of the head to accommodate severely challenged users. Conclusions: This study presents the state-of-the-art in head support systems. Additionally, several important system characteristics are introduced that provide guidance for the development and improvement of head supports. ä IMPLICATIONS FOR REHABILITATIONEspecially for the group of severely challenged wheelchair users, current head support systems require further development to improve their users' quality of life. The desired system characteristics which are discussed in this review are an important step in the definition of requirements for the next generation of head supports.

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“…Interventions in this group are mostly aimed at reducing dystonia and include invasive neuromodulation treatments such as intrathecal baclofen (Bonouvrie et al, 2019) and deep brain stimulation (Koy and Timmermann, 2017). In addition, advanced rehabilitation techniques (such as alternative computer access solutions and powered mobility (Bekteshi et al, 2020)) are commonly applied within this group. Frequent and effective monitoring of dystonia would be extremely important for the indication and evaluation of these interventions but is often not applied clinically due to time constraints and lack of objectiveness in quantifying severity.…”

Section: Introductionmentioning

confidence: 99%

Towards automated video-based assessment of dystonia in dyskinetic cerebral palsy: A novel approach using markerless motion tracking and machine learning

Haberfehlner

Ven²,

Burg³

et al. 2023

Front. Robot. AI

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Introduction: Video-based clinical rating plays an important role in assessing dystonia and monitoring the effect of treatment in dyskinetic cerebral palsy (CP). However, evaluation by clinicians is time-consuming, and the quality of rating is dependent on experience. The aim of the current study is to provide a proof-of-concept for a machine learning approach to automatically assess scoring of dystonia using 2D stick figures extracted from videos. Model performance was compared to human performance.Methods: A total of 187 video sequences of 34 individuals with dyskinetic CP (8–23 years, all non-ambulatory) were filmed at rest during lying and supported sitting. Videos were scored by three raters according to the Dyskinesia Impairment Scale (DIS) for arm and leg dystonia (normalized scores ranging from 0–1). Coordinates in pixels of the left and right wrist, elbow, shoulder, hip, knee and ankle were extracted using DeepLabCut, an open source toolbox that builds on a pose estimation algorithm. Within a subset, tracking accuracy was assessed for a pretrained human model and for models trained with an increasing number of manually labeled frames. The mean absolute error (MAE) between DeepLabCut’s prediction of the position of body points and manual labels was calculated. Subsequently, movement and position features were calculated from extracted body point coordinates. These features were fed into a Random Forest Regressor to train a model to predict the clinical scores. The model performance trained with data from one rater evaluated by MAEs (model-rater) was compared to inter-rater accuracy.Results: A tracking accuracy of 4.5 pixels (approximately 1.5 cm) could be achieved by adding 15–20 manually labeled frames per video. The MAEs for the trained models ranged from 0.21 ± 0.15 for arm dystonia to 0.14 ± 0.10 for leg dystonia (normalized DIS scores). The inter-rater MAEs were 0.21 ± 0.22 and 0.16 ± 0.20, respectively.Conclusion: This proof-of-concept study shows the potential of using stick figures extracted from common videos in a machine learning approach to automatically assess dystonia. Sufficient tracking accuracy can be reached by manually adding labels within 15–20 frames per video. With a relatively small data set, it is possible to train a model that can automatically assess dystonia with a performance comparable to human scoring.

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Dystonia and choreoathetosis presence and severity in relation to powered wheelchair mobility performance in children and youth with dyskinetic cerebral palsy

Cited by 7 publications

References 44 publications

Probability of independent walking and wheeled mobility in individuals with cerebral palsy

Probability of independent walking and wheeled mobility in individuals with cerebral palsy

Head support in wheelchairs (scoping review): state-of-the-art and beyond

Towards automated video-based assessment of dystonia in dyskinetic cerebral palsy: A novel approach using markerless motion tracking and machine learning

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