Elsevier

Clinical Biomechanics

Volume 22, Issue 2, February 2007, Pages 165-175
Clinical Biomechanics

Kinematic analysis of unimanual reaching and grasping movements in children with hemiplegic cerebral palsy

https://doi.org/10.1016/j.clinbiomech.2006.09.004Get rights and content

Abstract

Background

Kinematic investigations of prehension movements made by children with cerebral palsy are few and mainly focus on the reaching phase. To increase understandings of how both reaching and grasping movements are organized in these children, the aim was to investigate their spatiotemporal characteristics and additionally, how different kinematic parameters are related to the level of hand functions.

Methods

Eleven children with hemiplegic cerebral palsy; categorized as “mild” and “moderate”, in their age of 5.8–12 years and eleven typically developing, “control” children participated. Reaching and grasping made with both the affected/non-preferred and unaffected/preferred sides were recorded and several kinematic parameters investigated.

Findings

In comparison to the control and the mild hemiplegic children, the moderate children exhibited more segmented reaches, longer reach- and grasp durations, and with no anticipatory shaping of the fingers when grasping with the affected hand. Their reaching path with the “unaffected” hand was also more segmented. The mild hemiplegic children showed ability for anticipatory hand closure and performed reaches with similar duration and trajectory as controls. The velocity at hand–object-contact and the quality of their grasping was however affected in comparison to the controls.

Interpretation

Findings from the investigated kinematics provide evidence of how spatiotemporal organization of reaching and grasping are affected in children with hemiplegia and related to the level of impaired hand functions. The outcomes clearly show that if these children are treated as one homogeneous group much information about their prehension capacity described from the kinematics will be concealed. Thus, observations of importance for developing effective, individual interventions adjusted to different level of impairments.

Introduction

Impaired hand function is often the most disabling symptom in children with hemiplegic cerebral palsy (Beckung and Hagberg, 2002), who use their affected hand with reduced frequency as well as quality compared to the unaffected hand. This asymmetrical development is caused by the brain damage and may also be amplified during development because of a “learned nonuse” effect (Taube et al., 1999).

While there is extensive knowledge about the control of reaching and grasping in typically developing children (see Forssberg, 1998 for a review), we still only have fragmentary knowledge about how children with hemiplegic cerebral palsy organize and control their reaching and grasping movements. An early description of “the grasping deficit in infantile spastic hemiparesis” was provided by Twitchell (1958) after he had visually observed and neurologically examined 25 children. He described their main problems as being a general movement slowness and muscular weakness especially in the hand and wrist. The ability to shape the fingers during the transport phase was impaired, and the children approached objects with overextended fingers. A similar observation was made by Jeannerod (1986) from kinematic data of two young children who both lacked anticipatory finger closure. To our knowledge this is the only data published of kinematic analysis made of grasping movements in young children with cerebral palsy. In a recent study however, kinematics from unimanual prehension movements of six young adults classified with a mild spastic hemiparesis were investigated (Steenbergen and van der Kamp, 2004). Only minor differences were presented related to fluency and speed on a group level and both the transport phase and the grasping were found to be remarkably similar between the contra- and the ipsi-lateral side of the participants with regard to the side of the lesion.

Some recent studies focusing on the reaching performance of children with cerebral palsy have shown that they exhibited longer reach durations and more segmented movement trajectories, both when reaching with the affected side (Chang et al., 2005) as well as with the dominant arm (Van der Heide et al., 2005) in comparison to typically developing children. That the prehension movements of the impaired side are slow has been confirmed lately (e.g., Utley and Sugden, 1998, Steenbergen et al., 2000, Volman et al., 2002a, Volman et al., 2002b, Van Thiel and Steenbergen, 2001). Moreover, this observed slowness seems to be more pronounced for the grasping phase than for the reaching phase, indicating that distal movement control is more impaired than the proximal. The final part of the prehension movement, when establishing the grasp, and/or in relation to lifting an object, is the most explored and has been the focus of interest in a series of studies of fingertip force. These studies show that most children with hemiplegia do not develop the parallel coordination of grip and load force found in non-disabled children, and that they generate an excessive grip force (Eliasson et al., 1991, Duque et al., 2003). Results further indicate that children with hemiplegia have a reduced capacity to anticipatory scale of the fingertip forces based on objects weight and surface texture (Eliasson et al., 1992, Eliasson et al., 1995) and need to repeat the lift several times before they are able to do so (Gordon and Duff, 1999). However, none of these studies have investigated the reaching and grasping movement by means of kinematics characteristics.

Thus, one aim of the present study was to evaluate kinematically the spatial and temporal organization of both reaching and grasping characteristics in children with hemiplegic cerebral palsy in comparison with typically developing children. In order to do so, we analysed a number of kinematic parameters when the children made unimanual prehension movements with both the unaffected/preferred and affected/non-preferred side. Another aim was to find out if and how the proximal and the distal movements may be affected differently, and/or related to the children’s different classifications of their impairments of hand functions (mild versus moderate). Additionally, the occurrence of mirror movements during the hemiplegic children’s reaching grasping performance were inspected and described from the video recordings made in addition to the kinematic recordings.

Section snippets

Participants

Eleven children with hemiplegic cerebral palsy, seven girls and four boys (aged 5.8–12 years, mean age: 8.5 years) and eleven typically developing “control” children, six girls and five boys (age 5.6–12 years, mean: 8.1), took part in this study. Impairment of hand function was rated according to the criteria described by Claeys et al. (1983) as mild (pincer grip: isolated finger movements present) or moderate (grasping with whole hand, few or no isolated finger movements). According to this

Results

Fig. 2 gives representative examples of reaching (1) and grasping movements (2) performed by three different children: a control (A), a mild (B), and a moderate child (C). While the velocity profiles of the reaching movements performed by the child with mild hemiplegia (B1) were comparable to those of the control child (A1), the reaching movements of the child with moderate hemiplegia (C1) systematically differed from the typical performance. The child with moderate hemiplegia exhibited high

Discussion

In this study, reaching and grasping movements in two different groups of children with hemiplegic cerebral palsy and a group of typically developing children were carefully investigated and analysed by means of an extensive number of kinematic parameters. We start here by discussing the temporal and spatial organization of the reaching and grasping movement in the two groups of children with hemiplegic cerebral palsy in comparison to the controls. We then discuss movement impairments of

Acknowledgements

We thank the children and their parents for their willingness to take part in this study. We also thank Erik Domellöf for his help with the video-coding and drawing Fig 1. This work was supported by grants from the Swedish Research Council (VR) to the first author, and from the Vårdal foundation to the second author.

References (33)

  • A.C. Eliasson et al.

    Basic co-ordination of manipulative forces of children with cerebral palsy

    Dev. Med. Child Neurol.

    (1991)
  • A.C. Eliasson et al.

    Impaired anticipatory control of isometric forces during grasping by children with cerebral palsy

    Dev. Med. Child Neurol.

    (1992)
  • A.C. Eliasson et al.

    Tactile control of isometric fingertip forces during grasping in children with cerebral palsy

    Dev. Med. Child Neurol.

    (1995)
  • P.M. Fitts

    The information capacity of the human motor system in controlling the amplitude of movement

    J. Exp. Psychol.

    (1954)
  • H. Forssberg

    The neurophysiology of manual skill development

  • A.W. Gordon et al.

    Fingertip forces during object manipulation in children with hemiplegic cerebral palsy. I: Anticipatory scaling

    Dev. Med. Child Neurol.

    (1999)
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