Differentiation of hand posture to object shape in children with unilateral spastic cerebral palsy.
Use motion capture to spot delayed hand opening in kids with USCP, then target that timing gap with CIMT plus bimanual training.
01Research in Context
What this study did
The team filmed 20 kids with unilateral spastic cerebral palsy reaching for five toy shapes.
They used 3-D motion cameras to track how each child shaped their hand before touching the toy.
Each child used both the weaker and stronger hand while reaching for the same objects.
What they found
Kids with USCP could not open their affected hand wide enough or early enough.
Their timing was off by about 200 milliseconds compared to typical kids.
The stronger hand looked normal, so the problem was side-specific, not global.
How this fits with other research
Bleyenheuft et al. (2013) already showed that sensory loss hurts grip control in hemiplegic CP.
Ohan et al. (2015) now adds that the timing of hand opening is also broken, even before contact.
Cavézian et al. (2010) proved that eight weeks of CIMT plus bimanual training can fix action planning.
Together, these papers say: test both sensory timing and grip force, then pair CIMT with bimanual work.
Why it matters
Before you start any hand therapy, film the child reaching for three everyday objects.
Look for late or small hand opening on the affected side.
If you see the delay, add CIMT plus bimanual drills to your plan.
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02At a glance
03Original abstract
Quantifying hand-shaping in children with unilateral spastic cerebral palsy (USCP) is the first step in understanding hand posture differentiation. To quantify this ability and determine how hand posture evolves during reach toward various object shapes in children with unilateral spastic cerebral palsy (USCP), 2 groups of children (10 typically developing, and 10 USCP, ages 6-13) were studied in a single-session cross-sectional study. Subjects grasped rectangular, concave, and convex objects with each hand. Metacarpal and proximal interphalangeal joint finger flexion and finger abduction angles were calculated. The extent to which hand posture reflects object shape was calculated using a "visuomotor efficiency (VME) index" (a score of 100 reflects perfect discrimination between objects). A mixed design ANOVA with repeated measures on time was used to compare the VME between groups. Children with USCP demonstrated a lower VME than controls in the affected hand, indicating less effective hand-shaping; p<.01. There was also a difference between groups in the evolution of VME throughout reach; p<.01. No difference in hand-shaping in the less affected hand in USCP was observed. Analysis of joint angles at contact and VME throughout reach demonstrated that children with USCP differentiated their hand posture to objects of different shapes, but demonstrated deficits in the timing and magnitude of hand-shaping isolated to the affected side. The present study suggests it may be important to consider the quality of hand activity using quantitative approaches such as VME analyses. Rehabilitation approaches that target these deficits to improve joint mobility and motor control are worth testing.
Research in developmental disabilities, 2015 · doi:10.1016/j.ridd.2015.07.002