Impairment severity selectively affects the control of proximal and distal components of reaching movements in children with hemiplegic cerebral palsy

Abstract

This study explored proximal‐to‐distal components during goal‐directed reaching movements in children with mild or moderate hemiplegic cerebral palsy (HCP); [seven females, four males; mean age 8y 6mo; SD 27mo], compared with age‐matched, typically developing children (seven females, five males; mean age 8y 3mo [SD 25mo]. Severity of HCP was assessed following the approach of Claeys et al. Optoelectronic registrations were made during unimanual reaching‐to‐grasp and reaching‐to‐hit movements with both the affected/non‐preferred and unaffected/preferred side. Regardless of task, the children with HCP, particularly those with moderate impairment, displayed less optimal spatiotemporal organization of movements performed with the affected arm. Compared with the goal to hit, and increasingly with more severe impairment, children with HCP adapted to the goal to grasp by recruiting augmented shoulder movements when reaching with the affected side. A resulting impact on distal kinematics was found in shorter, straighter, and less segmented movement paths. Thus, depending on severity of hemispheric lesions and task complexity, unilateral brain injuries in HCP may selectively affect neural pathways underlying both proximal and distal arm movement control. Levels of both ipsi‐ and contralateral activation in relation to side and lesion severity should be considered in future studies on prehension movements in HCP.

Upper limb performance and the structuring of joint movement in teenagers with cerebral palsy: the reciprocal role of task demands and action capabilities

“…Vertical lines indicate standard deviations. Asterisk indicates significant difference (p < 0.05) atypical motion patterns in individuals with CP have generally been attributed to the effects of the endured brain injury and considered as impeding on optimal performance (e.g., Duque et al 2003;Domellöf et al 2009). However, by varying the conditions under which the task was to be performed, our results indicated that the relation between task performance and underlying joint kinematics was less univocal.…”

“…However, both CP and TD teenagers demonstrated a larger contribution of trunk movement when facing more challenging task conditions. The overall pattern of results indicated that optimal performance (Duque et al 2003;Domellöf et al 2009). However, patterns of joint motion considered characteristic of CP are also noticeable when TD individuals are (a) submitted to challenging upper limb task conditions (Van der Kamp and Steenbergen 1999) or (b) forced to use their non-preferred upper limb for task performance (Steenbergen et al 1995).…”

“…In upper limb task performance, the most consistently observed differences between unilateral CP and typically developing (TD) teenagers include longer movement durations, reduced trajectory straightness and lower peak velocities exhibited by the former (Mackey et al 2006;Steenbergen and Meulenbroek 2006;Smits-Engelsman et al 2007;Domellöf et al 2009;Jaspers et al 2009Jaspers et al , 2011. Compared to their TD peers, teenagers with unilateral CP have also consistently been shown to demonstrate diminished magnitude of elbow extension and increased magnitude of trunk flexion and/or rotation (Mackey et al 2006;Steenbergen and Meulenbroek 2006;Butler et al 2010;Reid et al 2010;Jaspers et al 2009Jaspers et al , 2011.…”

“…Earlier research designed to identify differences in upper limb function between individuals with CP and their TD age-matched peers involved a variety of upper limb tasks: reaching forward, upward and sideways; reaching to grasp different objects; directing the hand to the mouth, to the head or to the contralateral shoulder; and performing fast aiming movements toward targets positioned at different locations, among others (Van Thiel et al 2000;Mackey et al 2006;Steenbergen and Meulenbroek 2006;Rönnqvist and Rösblad 2007;Smits-Engelsman et al 2007;Domellöf et al 2009;Jaspers et al 2009Jaspers et al , 2011Butler et al 2010;Reid et al 2010). The experimental protocols of most of these studies did not include systematic manipulations of the conditions under which the task was performed, such as precision and speed requirements, quality of the tool or upper limb used for performance (for exceptions, see Van Thiel et al 2000;Steenbergen and Meulenbroek 2006;and Smits-Engelsman et al 2007).…”

The influence of hip abduction and rotation on hip contact forces

“…Reduced hip adduction [1,2] and increased external rotation have been observed during stance [2]. These changes have been linked to changes in hip contact force [2].…”