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Motor patterns of the impaired upper limb in children with unilateral cerebral palsy performing bimanual tasks

  • Marine Cacioppo
    Correspondence
    Corresponding author at: Department of Physical Medicine and Rehabilitation, Brest University Hospital, 2 Avenue Foch, 29200 Brest, France.
    Affiliations
    Department of Physical Medicine and Rehabilitation, Brest University Hospital, 29200 Brest, France

    Laboratoire de Traitement de l'information Médicale (LaTIM), Inserm U1101, Université de Bretagne-Occidentale, 29200 Brest, France

    Pediatric Rehabilitation Department, Fondation ILDYS, 29200 Brest, France
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  • Mathieu Lempereur
    Affiliations
    Department of Physical Medicine and Rehabilitation, Brest University Hospital, 29200 Brest, France

    Laboratoire de Traitement de l'information Médicale (LaTIM), Inserm U1101, Université de Bretagne-Occidentale, 29200 Brest, France
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  • Antoine Marin
    Affiliations
    M2S laboratory (Mouvement Sport Santé), Rennes 2 University - ENS Rennes - UEB, Campus de Ker Lann, 35170 Bruz, France
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  • Hélène Rauscent
    Affiliations
    Department of Physical Medicine and Rehabilitation, Rennes University Hospital, 35000 Rennes, France
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  • Armel Crétual
    Affiliations
    M2S laboratory (Mouvement Sport Santé), Rennes 2 University - ENS Rennes - UEB, Campus de Ker Lann, 35170 Bruz, France
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  • Sylvain Brochard
    Affiliations
    Department of Physical Medicine and Rehabilitation, Brest University Hospital, 29200 Brest, France

    Laboratoire de Traitement de l'information Médicale (LaTIM), Inserm U1101, Université de Bretagne-Occidentale, 29200 Brest, France

    Pediatric Rehabilitation Department, Fondation ILDYS, 29200 Brest, France
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  • Isabelle Bonan
    Affiliations
    Department of Physical Medicine and Rehabilitation, Rennes University Hospital, 35000 Rennes, France

    Unité Empenn (ex-Visages) U1228 INSERM-INRIA, IRISA UMR CNRS 6074, Campus de Beaulieu, 35042 Rennes Cedex, France
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      Highlights

      • Three motor patterns were identified: mild, proximal-distal and with trunk.
      • Pronation-supination and wrist extension were decisive for classification.
      • Clinical ratings of impairment and function differed for each motor pattern.
      • The largest pathological deviations were for supination and wrist extension.

      Abstract

      Background

      Upper limb movement patterns have not yet been identified in bimanual conditions despite the difficulties children with unilateral cerebral palsy have performing bimanual activities. The aim was to identify specific motor patterns from kinematic deviations during bimanual tasks in this population.

      Methods

      Twenty children with unilateral cerebral palsy and 20 age-matched, typically developing children performed the five tasks of a 3D bimanual protocol. To evaluate upper limb kinematic deviations, 10 Arm Variable Scores were calculated for the affected /non-dominant upper limb of each participant for each task. Sparse K-means cluster analysis was applied to the 50 Arm Variable Scores of all the children to identify motor patterns and determining variables. Clinical tests of impairment (muscle strength, selectivity, spasticity) and function (Assisting hand assessment, Abilhand-Kids) were compared between the clusters obtained.

      Findings

      Three different motor patterns were identified using the data from all the children: mild, proximal-distal and proximal-distal with trunk. The most important cluster determinants were the Arm Variable Scores for pronation-supination and wrist extension. In the cerebral palsy group, scores of impairments (p < .01) and function (Assisting Hand Assessment [p < .001] and Abilhand-Kids [p = .004]) differed for each motor pattern. Supination and wrist extension deviations differed significantly between the groups (p < .001).

      Interpretation

      During performance of bimanual tasks, children with unilateral cerebral palsy used distinct motor patterns that each corresponded to a specific clinical profile. Elbow-wrist deviations were the largest and most decisive and were specific to the cerebral palsy group: they should be the target of interventions to enhance bimanual function.

      Keywords

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