In-depth quantification of bimanual coordination using the Kinarm exoskeleton robot in children with unilateral cerebral palsy

Abstract

Background Robots have been proposed as tools to measure bimanual coordination in children with unilateral cerebral palsy (uCP). However, previous research only examined one task and clinical interpretation remains challenging due to the large amount of generated data. This cross-sectional study aims to examine bimanual coordination by using multiple bimanual robotics tasks in children with uCP, and their relation to task execution and unimanual performance. Methods The Kinarm exoskeleton robot was used in 50 children with uCP (mean age: 11 years 11 months ± 2 years 10 months, Manual Ability Classification system (MACS-levels: l = 27, ll = 16, lll = 7)) and 50 individually matched typically developing children (TDC). All participants performed three tasks: object-hit (hit falling balls), ball-on-bar (balance a ball on a bar while moving to a target) and circuit task (move a cursor along a circuit by making horizontal and vertical motions with their right and left hand, respectively). Bimanual parameters provided information about bimanual coupling and interlimb differences. Differences between groups and MACS-levels were investigated using ANCOVA with age as covariate (α < 0.05, $${\upeta }_{p}^{2}$$ η p 2 ). Correlation analysis (r) linked bimanual coordination to task execution and unimanual parameters. Results Children with uCP exhibited worse bimanual coordination compared to TDC in all tasks (p ≤ 0.05, $${\eta }_{p}^{2}$$ η p 2 = 0.05–0.34). The ball-on-bar task displayed high effect size differences between groups in both bimanual coupling and interlimb differences (p < 0.001, $${\eta }_{p}^{2}$$ η p 2 = 0.18–0.36), while the object-hit task exhibited variations in interlimb differences (p < 0.001, $${\eta }_{p}^{2}$$ η p 2 = 0.22–0.34) and the circuit task in bimanual coupling (p < 0.001, $${\eta }_{p}^{2}$$ η p 2 = 0.31). Mainly the performance of the ball-on-bar task (p < 0.05, $${\eta }_{p}^{2}$$ η p 2 = 0.18–0.51) was modulated by MACS-levels, showing that children with MACS-level lll had worse bimanual coordination compared to children with MACS-level l and/or II. Ball-on-bar outcomes were highly related to task execution (r = − 0.75–0.70), whereas more interlimb differences of the object-hit task were moderately associated with a worse performance of the non-dominant hand (r = − 0.69–(− 0.53)). Conclusion This study gained first insight in important robotic tasks and outcome measures to quantify bimanual coordination deficits in children with uCP. The ball-on-bar task showed the most discriminative ability for both bimanual coupling and interlimb differences, while the object-hit and circuit tasks are unique to interlimb differences and bimanual coupling, respectively.

The relation between visual functions, functional vision, and bimanual function in children with unilateral cerebral palsy

“…No correlation was found with the other bimanual coordination assessments (Kinarm ball-on-bar level 2 and Box opening task). A possible explanation is that the Kinarm circuit task requires more cognitive demand and the nest and more complex integration of visual stimuli (i.e., recognition and stabilization of the cursor position and keep the ball within the circuit borders) (Decraene et al, 2023), which is not crucial for less complex bimanual coordination tasks such as opening a box and pushing a button (Box opening task) or moving a ball to a xed target position (Kinarm ball-on-bar level 2). Additionally, our results might suggest that the Box opening task and the Kinarm ball-on-bar level 2 could be more appropriate assessments than the Kinarm circuit and the TPT for evaluating purely bimanual coordination in children with uCP.…”

“…CP is a heterogeneous condition, with 44% of the cases presenting with spastic unilateral CP (uCP), characterized by sensorimotor impairments predominantly on one side of the body (Himmelmann & Uvebrant, 2018). In children with uCP, motor di culties are mainly present in the upper limb, resulting in impairments in bimanual dexterity (Basu et al, 2018;Decraene et al, 2021) and coordination (Decraene et al, 2023;Mailleux et al, 2023;Rudisch et al, 2016). Besides motor problems, up to 62% of children with uCP show some degree of VI in the geniculostriate and/or visual-perceptual functions (Crotti et al, 2024).…”

A Training Program Using Modified Joystick-Operated Ride-on Toys to Complement Conventional Upper Extremity Rehabilitation in Children with Cerebral Palsy: Results from a Pilot Study

“…Bimanual tasks may involve symmetrical or asymmetrical movements of both arms [2]. Regardless of specific task constraints, both UEs work synergistically as a single functional unit through precise coordination at the neural, neuromuscular, and biomechanical levels [3]. A large proportion of activities of daily living related to self-care, work/academics, and leisure (e.g., tying shoelaces, buttoning a shirt, opening a jar, using cutlery, cutting a piece of paper using scissors, stringing beads, lifting a heavy tray, etc.)…”