Mechanical load on the upper extremity during wheelchair activities

OBJECTIVE: To determine the net moments on the glenohumeral joint and elbow joint during wheelchair activities. DESIGN: Kinematics and external forces were measured during wheelchair activities of daily living (level propulsion, riding on a slope, weight-relief lifting, reaching, negotiating a curb) and processed in an inverse dynamics biomechanic model. SETTING: Biomechanics laboratory. PARTICIPANTS: Five able-bodied subjects, 8 subjects with paraplegia, and 4 subjects with tetraplegia. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Net moments on the glenohumeral joint and elbow joint. RESULTS: Peak shoulder and elbow moments were significantly higher for negotiating a curb and weight-relief lifting than for reaching, level propulsion, and riding on a slope. Overall, the elbow extension moments were significantly lower for subjects with tetraplegia than for those with paraplegia. CONCLUSIONS: The net moments during weight-relief lifting and negotiating a curb were high when compared with wheelchair propulsion tasks. Taking the effect of frequency and duration into account, these loads might imply a considerable risk for joint damage in the long term.     

Aided gait in rheumatoid arthritis following knee arthroplasty

A study is presented of a biomechanical comparison of two different aided gait patterns used by rheumatoid arthritis patients after knee joint surgery. Subjects using alternating and step-to gait patterns were compared when ambulating with forearm-support crutches. Data were collected via instrumented walking aids and 16mm cameras. Values were derived for load transmission through the crutches and for moments at the elbow and shoulder joints. The alternate gait was, on average, 87% faster than the step-to gait, and imposed average loads less than 80% of that in the step-to gait. Peak upper limb joint moments attained values approaching 12Nm at the shoulder joint in both gaits. Given the vulnerability of the upper limb joints in these patients, the load transmission through the upper limb may be unacceptably high in both aided gait patterns.     

Kinematic analysis of upper limbs and trunk movement during bilateral movement after stroke

OBJECTIVE: To compare the kinematics of the upper limbs and trunk during unilateral and parallel bilateral tasks in subjects with hemiparesis and control subjects. DESIGN: Comparative study. SETTING: Geriatric center offering rehabilitation services. PARTICIPANTS: Convenience sample of 15 persons (age, 69.4 +/- 12.0 y; > or = 3 mo poststroke) recruited in a geriatric center with rehabilitation services, and 13 control persons (67.8 +/- 7.5 y) participated in the study. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Unilateral and bilateral movements toward 1 or 2 targets located beyond arm's length and positioned in 3 directions. Angular changes of both upper limbs and trunk were characterized in the sagittal, frontal, and horizontal planes. RESULTS: During the bilateral task, the deficits of the kinematic joints of the paretic upper limb persisted in subjects with hemiparesis as compared with the corresponding upper limb in the control subjects (abduction shoulder: subjects with hemiparesis, 5.7 degrees +/- 5.3 degrees; control subjects, 0.7 degrees +/- 4.8 degrees; extension elbow: subjects with hemiparesis, 38.2 degrees +/- 14.2 degrees; control subjects, 52.8 degrees +/- 12.5 degrees) with a marked flexion of the trunk (subjects with hemiparesis, 33.7 degrees +/- 8.7 degrees; control subjects, 26.8 degrees +/- 5.8 degrees). The elbow extension of the nonparetic upper limb was reduced (subjects with hemiparesis, 41.0 degrees +/- 13.6 degrees; control subjects, 52.8 degrees +/- 12.5 degrees). CONCLUSIONS: The use of parallel bilateral reaching tasks and placing movements of the upper extremities in the subjects with hemiparesis contributed an increase in the trunk flexion rather than improve the motor performance of the paretic upper limb, especially with regard to increasing elbow extension.     

Characterization of upper arm synergies during reaching tasks in able-bodied and hemiparetic subjects

BACKGROUND: In the past, several studies showed the existence of a synergistic behavior between elbow and shoulder joints during reaching movements in able-bodied subjects. The aim of this paper was to characterize the modifications of upper arm synergies during reaching induced by stroke. METHODS: Ten able-bodied right-handed subjects, eight right-handed subjects with hemiparesis affecting the right (dominant) upper limb participated in the experiments. The kinematics of shoulder and elbow joints have been recorded in all the participants during selected reaching movements. From the eight-like plots characterizing the relationship between shoulder and elbow angular velocities, a topological parameter (named as C approximately ) representing the linear approximation of the synergy between the two angular velocities has been extracted. FINDINGS: The results of these experiments showed that C approximately could be used as a figure of merit for the comparison of performance in able-bodied and hemiparetic persons. The hemiparetic subjects showed a significantly higher spreading of the values of C approximately for the different reaching movements when compared with the performance of able-bodied subjects. INTERPRETATION: This work showed that hemiparesis modified upper arm synergies and could provide a protocol for the assessment of upper limb function. Moreover, important applications of this method could be found in the development of biomimetic algorithms for the control of upper extremities during reaching in humanoid robots, and in the design of customized "games" in neurorehabilitation procedures implemented by using robotic and mechatronic platforms.     

C5和C6脊髓损伤患者与正常人在伸肘活动中上肢的角位移及角速度比较

目的研究C5和C6脊髓损伤（SCI）患者在伸肘活动中上肢的运动策略。方法采用Peak Motus运动解析系统对15例C5和C6水平SCI患者和15例正常人在抓取杯子、触摸开关、驱动轮椅和利用上肢负重4项伸肘动作中肩、肘、腕关节的角位移及角速度进行分析。结果与正常人相比，SCI患者在抓取杯子、触摸开关、驱动轮椅动作中的运动时间明显延长（P〈0．05）；在触摸开关和驱动轮椅动作中的角速度明显减慢（P〈0．05）；在前3项伸肘活动中，SCI患者主要依靠增加或减小肩关节的角位移来完成运动任务，而在利用上肢负重的动作中，则通过改变肩、肘关节在矢状面上的运动方向来代偿其功能缺陷。结论C5和C6水平SCI患者采用与正常人不同的运动模式和策略来完成伸肘活动。     

Glenohumeral contact forces and muscle forces evaluated in wheelchair-related activities of daily living in able-bodied subjects versus subjects with paraplegia and tetraplegia

OBJECTIVE: To estimate the differences in glenohumeral contact forces and shoulder muscle forces between able-bodied subjects and subjects with paraplegia and tetraplegia during wheelchair-related activities of daily living (ADLs). DESIGN: Kinematics and external forces were measured during wheelchair ADLs (level propulsion, weight-relief lifting, reaching) and processed by using an inverse dynamics 3-dimensional biomechanical model. SETTING: Biomechanics laboratory. PARTICIPANTS: Five able-bodied subjects, 8 subjects with paraplegia, and 4 subjects with tetraplegia (N = 17). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Glenohumeral contact forces and shoulder muscle forces. RESULTS: Peak contact forces were significantly higher for weight-relief lifting compared with reaching and level propulsion (P < .001). High relative muscle force of the rotator cuff was seen, apparently needed to stabilize the joint. For weight-relief lifting, total relative muscle force was significantly higher for the tetraplegia group than for the able-bodied group (P = .022). CONCLUSIONS: Glenohumeral contact forces were significantly higher for weight-relief lifting and highest over the 3 tasks for the tetraplegia group. Without taking paralysis into account, more muscle force was estimated for the subjects with tetraplegia during weight-relief lifting.     

Analysis of the influence of rotator cuff impingements on upper limb kinematics in an elderly population during activities of daily living

Background

Despite a high prevalence of rotator cuff impingements or tears in the elderly population, little research has focused on how this injured population adapts to perform tasks of daily living. The current study investigated the influence of rotator cuff impingements in this population on kinematics and shoulder loading differences, while completing activities of daily living.

Methods

Upper limb and trunk movement was measured for thirteen asymptomatic elderly and ten elderly subjects with rotator cuff impingements during five range of motion tasks and six activities of daily living. Thoracohumeral kinematics was derived from this data.

Findings

Symptomatic populations showed significantly decreased ranges of flexion/extension, abduction and internal and external rotation when compared to the asymptomatic population. The asymptomatic population had a 44% larger range of angle of elevation than the symptomatic population. Task was found to be a main effect for most variables examined including angle of elevation. Participants with impingements had significantly lower ranges of humeral rotations during the tasks with ranges of 40° (SD 40°) and 51° (SD 36°) respectively. Perineal care, hair-combing and reaching tasks were the most demanding in terms of the required range of motion. The reaching tasks resulted in the highest shoulder moment.

Interpretation

Developing adaptations for perineal care, hair-combing and reaching tasks should be prioritized when working with persons with rotator cuff impingements, as these tasks demanded the largest ranges of motion while producing high shoulder moments. Substantial differences existed between the experimental groups for a number of kinematic measures.     

Normal functional range of motion of upper limb joints during performance of three feeding activities

This study was designed to quantify the range of upper limb joint motion required during the performance of a specific type of functional activity. Ten able-bodied men were studied as they performed three feeding tasks--eating with a spoon, eating with a fork, and drinking from a handled cup. Three shoulder joint rotations, one elbow joint rotation, one forearm joint rotation, and three wrist joint rotations were quantified simultaneously using a three-dimensional measurement system. It was found that the required ranges of motion for the feeding tasks were 5 degrees to 45 degrees shoulder flexion, 5 degrees to 35 degrees shoulder abduction, 5 degrees to 25 degrees shoulder internal rotation, 70 degrees to 130 degrees elbow flexion, from 40 degrees forearm pronation to 60 degrees forearm supination, from 10 degrees wrist flexion to 25 degrees wrist extension, and from 20 degrees wrist ulnar deviation to 5 degrees wrist radial deviation. Wrist rotation was also measured, but it was found to be negligible.     

Biomechanical model predicting electromyographic activity in three shoulder muscles from 3D kinematics and external forces during cleaning work

BACKGROUND: The shoulder region is a common site of work-related musculoskeletal disorders. Biomechanical models may reveal the relative importance of force, joint-moments, and angular velocity for predicting muscle activity, thereby contributing to identify risk factors. OBJECTIVE: The aim of the present study was to predict muscle activity patterns from joint kinetics during cleaning work and to identify the most important variables requesting muscle activity.Design. A comparative study of six cleaners performing five different floor cleaning tasks (combinations of tool and working method) in a laboratory setting. METHODS: Net forces and moments at the glenohumeral joint were estimated using a video-based 3D link segment model together with 3D force-transducers at each hand, separately. Angular velocities of the upper arm were calculated, and electromyographic activity was recorded bilaterally from the muscles trapezius, deltoideus, and infraspinatus. RESULTS: The biomechanical model revealed abduction moment in the glenohumeral joint to be the most important factor for development of muscle activity in m. deltoideus and m. infraspinatus, while for m. trapezius vertical force was most important. CONCLUSION: Muscle specific determinants for shoulder muscle activity could be identified from glenohumeral joint kinetics. RELEVANCE: This study documents that mechanical work requirements in terms of joint forces, moments of force and angular velocities can predict major fractions of muscle activity patterns in the upper extremities. The biomechanical model used for this prediction revealed different factors of importance for individual muscles. This knowledge is fundamental for work place interventions aiming at minimizing overloading of specific muscles to prevent or rehabilitate muscle disorders.     

Effect of elbow flexion on upper extremity impact forces during a fall

Objective. The overall objectives are to develop a biomechanical model for a simulated fall with outstretched hand.

Design. Cross-sectional study involving young healthy volunteers in a university research laboratory setting.

Background. Little is known about the factors which influence fracture risk during a fall on outstretched hand.

Methods. A group of 11 male subjects volunteered for this investigation. A set of eight reflective markers was placed bilaterally on selected anatomic landmarks. Subjects were suspended with both elbows extended and wrists dorsiflexed, preparing to impact the ground and force plates from two different fall heights: 3 and 6 cm. Two different postures for the elbows were employed. In the elbow extension experiment, the elbows were extended at all times. In the elbow flexion experiment, the elbows were extended at impact, but then flexed immediately, as though in the initial downward phase of a push-up exercise.

Result. Increasing the fall height significantly increased the upper extremity axial forces by 10% and 5%. No significantly different differences were found in the axial forces applied to the wrist, elbow or shoulder between the elbow flexion and elbow extension trials, but the elbow mediolateral shear force was 68% larger (P=0.002) in the extension trials.

Conclusions. Performing an elbow flexion movement at impact reduces the first peak impact force value and postpones the maximum peak value. Although changing the fall arrest strategy from elbow extension to elbow flexion did not affect the peak impact force on the hand, it did require substantially greater elbow and shoulder muscle strengths.Relevance

This paper yields insights into how the physical demands of arresting mild falls may relate to upper extremity muscle capacity, joint dislocation and bony fracture.     

Biomechanical analysis of a weight-relief maneuver in C5 and C6 quadriplegia

OBJECTIVE: To determine the kinematics and kinetics of performing a weight-relief maneuver in persons with C5 and C6 quadriplegia. STUDY DESIGN: A three-dimensional kinematic and kinetic analysis was performed on the upward phase of a weight-relief maneuver with the use of a motion analysis system, two force platforms, and an instrumented seat. Electromyography (EMG) data were collected from the upper pectoralis, anterior deltoid, latissimus dorsi, and biceps brachii muscles of the right upper limb. SETTING: Biomechanics laboratory. SUBJECTS: Seven persons with C5 and C6 quadriplegia (ASIA A and B) with "flickers" (grade 1/5) or less in wrist flexor and triceps brachii muscles. MAIN OUTCOME MEASURES: Angular displacements and associated moments of the shoulder, elbow, and wrist, kinematic variables describing the position and displacement of the trunk and upper limbs, and EMG data. RESULTS: Subjects lifted from a forward flexed posture with their arms adducted against their trunks. During the course of lifting, they flexed their shoulders and wrists and extended their elbows. They generated peak mean (+/- SE) shoulder and elbow flexor moments of .65 (+/-.04) and .41 (+/-.06) N x m x kg(-1), respectively. Shoulder adductor moments increased over the course of the lift. The median (and interquartile range) mean EMG activity in the upper pectoralis and the anterior deltoid muscles were 63% (35%-76%) and 44% (36%-49%) of EMG obtained during maximal voluntary contractions, respectively. CONCLUSION: Persons with quadriplegia with paralysis of the triceps brachii muscles lift themselves by generating active shoulder flexor and adductor moments. They also rely on wrist flexor moments that are generated by the stretch of the wrist flexor muscles.     

Biomechanical differences in landing with and without shoe wear after anterior cruciate ligament reconstruction

OBJECTIVE: To determine biomechanical differences during single limb landing performed with and without shoe wear in anterior cruciate ligament reconstruction subjects. DESIGN: Barefoot and shod conditions were compared for both operated and contralateral limbs. BACKGROUND: Biomechanical analysis has been used to better understand the functional changes associated with anterior cruciate ligament reconstruction. However, no studies have investigated whether routine testing of patients should be performed barefoot or shod. METHODS: A three-dimensional motion analysis and force plate system were used to obtain kinematic and kinetic data from eight anterior cruciate ligament reconstruction subjects during single-limb landings from a 15 cm vertical height. RESULTS: Peak knee flexion angles and moments were significantly reduced during barefoot testing in all eight subjects for the operated limb only (p < 0.01). The differences were however small; mean angular difference 3 degrees and mean moment difference 0.2 Nm/kg. Knee flexion angles at initial contact and peak vertical ground-reaction forces were not affected by shoe wear. CONCLUSIONS: These results show that shoe wear does affect some biomechanical variables on landing but not so as to affect comparisons between operated and contralateral limbs. RELEVANCE: Given the comparable results between conditions, biomechanical testing following anterior cruciate ligament reconstruction can be performed either barefoot or shod. Testing subjects barefoot has the advantage of easier marker placement, and alleviates the need for shoe wear standardization.     

Arm motion and load analysis of sit-to-stand, stand-to-sit, cane walking and lifting

OBJECTIVE: To conduct a pilot study to characterize the hand loads, arm joint angles and external moments corresponding to five activities of daily living demanding of the shoulder, for healthy subjects over 50 years of age. DESIGN: The tasks were sit-to-stand, stand-to-sit, cane walking, lifting a 5 kg box with both hands, and lifting a 10 kg suitcase. BACKGROUND: Arm motion and loading have not been previously studied for functional daily-living tasks involving substantial external loads.Methods. Motion was tracked using an optoelectronic system. Loads were measured using an instrumented chair arm, a force plate, and gravitational and acceleration loads. Six healthy volunteers (3 male, 3 female), mean age 55, with no history of shoulder problems participated in the study. RESULTS: Average peak external moments ranged from 12.3 N m for sitting down into a chair to 27.9 N m for lifting a suitcase. Except for lifting the box, which had much lower loads, average peak hand loads varied from 16% to 19% of body weight (114-134 N). The arcs of motion were larger than for seated activities of daily-living studied previously. CONCLUSIONS: The five tasks studied are commonly performed, yet involve large external moments. Lifting represents the greatest potential loading at the shoulder as it resulted in the highest external moments; furthermore, loads larger than those used in this study might be commonly lifted. RELEVANCE: External moments at the shoulder should not be underestimated, even for activities of daily living.     

Biomechanical changes in the low back following reduction mammaplasty surgery

Objective. To give evidence of the mechanical consequences of reduction mammaplasty (RM) on the low back.

Design. A repeated-measures analysis was implemented to test the effect of RM on the external loads and angular velocity of the back during both static and dynamic lifting tasks.

Background. Patient follow-up surveys have documented a decrease in the frequency of low back pain following RM, but there is no quantitative data regarding biomechanical changes following surgery.

Methods. Patients were evaluated before and 4–8 weeks following RM. Flexion moment, compression and shear forces at L3-L4 were quantified for isometric flexion angles between 0 and 40 °. External loads and angular velocities of the back were studied during rapid dynamic lifting tasks.

Results. Isometric external flexion moments at L3-L4 decreased following RM. RM did not effect the applied flexion moment in the lumbar spine, but a trend suggested that RM resulted in increased lifting velocity.

Conclusions. RM does act to reduce the loads on the lumbar spine during simple isometric tasks. During dynamic tasks, subjects may be able to lift faster without generating larger loads.     

Robotic-assisted rehabilitation of the upper limb after acute stroke

OBJECTIVE: To investigate whether early therapy with a novel robotic device can reduce motor impairment and enhance functional recovery of poststroke patients with hemiparetic and hemiplegic upper limb. DESIGN: A single-blind randomized controlled trial, with an 8-month follow-up. SETTING: Neurologic department and rehabilitation hospital. PARTICIPANTS: Thirty-five patients with acute (< or =1 wk of onset), unilateral, ischemic embolic, or thrombotic stroke. INTERVENTIONS: Patients of both groups received the same dose and length per day of standard poststroke multidisciplinary rehabilitation. Patients were randomly assigned to 2 groups. The experimental group (n=17) received additional early sensorimotor robotic training, 4 hours a week for 5 weeks; the control group (n=18) was exposed to the robotic device, 30 minutes a week, twice a week, but the exercises were performed with the unimpaired upper limb. Training by robot consisted of peripheral manipulation of the shoulder and elbow of the impaired limb, correlated with visual stimuli. MAIN OUTCOME MEASURES: The Fugl-Meyer Assessment (FMA) of upper-extremity function (shoulder/elbow and coordination and wrist/hand subsections) to measure each trained limb segment; the Medical Research Council (MRC) score to measure the strength of muscle force during 3 actions: shoulder abduction (MRC deltoid), elbow flexion (MRC biceps), and wrist flexion (MRC wrist flexors); the FIM instrument and its motor component; and the Trunk Control Test (TCT) and Modified Ashworth Scale (MAS). RESULTS: Compared with the patients in the control group, the experimental group showed significant gains in motor impairment and functional recovery of the upper limb after robot therapy, as measured by the MRC deltoid (P< or =.05) and biceps (P<.05) scores, the FMA for the proximal upper arm (P<.05), the FIM instrument (P<.05), and the FIM motor score (P<.01); these gains were also sustained at the 3- and 8-month follow-up. The FMA and MRC wrist flexor test findings did not differ statistically either at the end of training or at the follow-up sessions. We found no significant differences in MAS and TCT in either group in any of the evaluations. No adverse effects occurred and the robotic approach was very well accepted. CONCLUSIONS: Patients who received robotic therapy in addition to conventional therapy showed greater reductions in motor impairment and improvements in functional abilities. Robotic therapy may therefore effectively complement standard rehabilitation from the start, by providing therapeutic support for patients with poststroke plegic and paretic upper limb.     

Effect of bilateral reaching on affected arm motor control in stroke – with and without loading on unaffected arm

Purpose.?To investigate the effect of bilateral reaching, with/without inertial loading on the unaffected arm, on hemiparetic arm motor control in stroke.

Methods.?Twenty unilateral stroke patients were recruited. A three-dimensional optical motion capture system was used to measure the movement trajectory of the hemiparetic arm while performing three tasks: affected limb reaching forward; two-limb reaching forward; and two-limb reaching forward with inertia loading of 25% upper limb weight on the unaffected limb, respectively. Kinematical parameters were utilized to quantify the reaching performance of the affected arm.

Results.?No matter whether loading was applied on the unaffected arm or not, the bilateral reaching task did not significantly facilitate smoother and faster movement. Furthermore, during bilateral reaching task with/without loading on the unaffected arm, stroke patients showed slower movement, lower maximal movement velocity, feedback control dominant and discontinuous movements in the affected arm than the same task with unilateral reaching. Subjects showed the greatest active upper extremity range of motion in proximal joints during the bilateral reaching task without unaffected arm loading. The amount of trunk movement also increased during bilateral reaching either with or without loading on the unaffected arm. Patients with moderate upper extremity motor impairment performed more discontinuous movements and less active elbow range of motion during bilateral reaching tasks; however, those with mild upper extremity motor impairment performed smoother movements and demonstrated greater active elbow range of motion during bilateral reaching tasks.

Conclusions.?Bilateral reaching tasks with/without loading on the unaffected arm could be considered as adding challenges during motor control training. Training with bilateral arm movements may be considered as a treatment strategy, and can be incorporated in stroke rehabilitation to facilitate greater arm active movement and improve motor control performance in the affected arm.     

Effect of bilateral reaching on affected arm motor control in stroke--with and without loading on unaffected arm

Purpose. To investigate the effect of bilateral reaching, with/without inertial loading on the unaffected arm, on hemiparetic arm motor control in stroke.

Methods. Twenty unilateral stroke patients were recruited. A three-dimensional optical motion capture system was used to measure the movement trajectory of the hemiparetic arm while performing three tasks: affected limb reaching forward; two-limb reaching forward; and two-limb reaching forward with inertia loading of 25% upper limb weight on the unaffected limb, respectively. Kinematical parameters were utilized to quantify the reaching performance of the affected arm.

Results. No matter whether loading was applied on the unaffected arm or not, the bilateral reaching task did not significantly facilitate smoother and faster movement. Furthermore, during bilateral reaching task with/without loading on the unaffected arm, stroke patients showed slower movement, lower maximal movement velocity, feedback control dominant and discontinuous movements in the affected arm than the same task with unilateral reaching. Subjects showed the greatest active upper extremity range of motion in proximal joints during the bilateral reaching task without unaffected arm loading. The amount of trunk movement also increased during bilateral reaching either with or without loading on the unaffected arm. Patients with moderate upper extremity motor impairment performed more discontinuous movements and less active elbow range of motion during bilateral reaching tasks; however, those with mild upper extremity motor impairment performed smoother movements and demonstrated greater active elbow range of motion during bilateral reaching tasks.

Conclusions. Bilateral reaching tasks with/without loading on the unaffected arm could be considered as adding challenges during motor control training. Training with bilateral arm movements may be considered as a treatment strategy, and can be incorporated in stroke rehabilitation to facilitate greater arm active movement and improve motor control performance in the affected arm.     

Shoulder and elbow range of motion for the performance of activities of daily living: A systematic review

The loss of range of motion (ROM) in the upper extremities can interfere with activities of daily living (ADL) and, therefore, many interventions focus on improving impaired ROM. The question, however, is what joint angles are needed to naturally perform ADL. The present review aimed to compile and synthesize data from literature on shoulder and elbow angles that unimpaired participants used when performing ADL tasks. A search was conducted in PubMed, Cochrane, Scopus, CINAHL, and PEDro. Studies were eligible when shoulder (flexion, extension, abduction, adduction) and/or elbow (flexion, extension) angles were measured in unimpaired participants who were naturally performing ADL tasks, and angles were provided per task. Thirty-six studies involving a total of 66 ADL tasks were included. Results demonstrated that unimpaired participants used up to full elbow flexion (150°) in personal care, eating, and drinking tasks. For shoulder flexion and abduction approximately 130° was necessary. Specific ADL tasks were measured often, however, almost never for tasks such as dressing. The synthesized information can be used to interpret impairments on the individual level and to establish rehabilitation goals in terms of function and prevention of secondary conditions due to excessive use of compensatory movements.     

Deficits in upper-limb task performance in children with hemiplegic cerebral palsy as defined by 3-dimensional kinematics

OBJECTIVE: To define upper-limb movement deficits in children with hemiplegia using 3-dimensional (3-D) kinematic analysis of functional tasks. DESIGN: Cohort study. SETTING: University gait laboratory. PARTICIPANTS: Ten children with hemiplegic cerebral palsy (mean age, 13.3y; range, 10-17y) and 10 control children (mean age, 9.8y; range, 6-12y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: 3-D upper-limb movement analysis. RESULTS: 3-D kinematics detected clinically significant between-group differences. Children with hemiplegia were significantly slower than control children in time taken to complete tasks (P<.05) and achieved slower movement velocities (P<.05). Group differences in range of motion (ROM) occurred in all 3 tasks examined (hand to mouth, hand to head, reach). Children with hemiplegia had significantly less supination (P<.03) and shoulder flexion (P<.03) and increased compensatory trunk flexion (P<.01) compared with control data (hand-to-mouth task). The reach task highlighted restriction of elbow extension in children with hemiplegia (minimum elbow extension: hemiplegia, 24+/-18 degrees ; control, 3+/-7 degrees ). Completing tasks bilaterally did not alter performance of the tasks in children with hemiplegia. CONCLUSIONS: 3-D kinematics detected deficits in timing, ROM, and proximal compensatory strategies during upper-limb functional task performance in children with hemiplegia.