Planning and coordination of a reach-grasp-eat task in children with hemiplegia.
Kids with hemiplegia twist their trunk and mistime both arms during a simple snack reach, but bimanual training can re-set the clock.
01Research in Context
What this study did
Hung et al. (2012) watched kids eat a cookie. They used motion cameras to track every joint.
Kids with hemiplegia were compared to same-age peers. All kids reached, grasped, and brought food to mouth.
What they found
The hemiplegia group moved their trunk and head too much. Both arms started late and landed early.
Timing was off even in the less-affected arm. Kids used extra body parts to finish the job.
How this fits with other research
Cavézian et al. (2010) showed that eight weeks of CIMT plus bimanual play can fix planning deficits. Ya-Ching’s 2012 paper maps the exact timing errors that therapy needs to hit.
Bleyenheuft et al. (2013) review says sensory loss, not weakness, drives poor grip. Ya-Ching saw extra trunk motion, a clue that sensory feedback is also guiding the wrong body parts.
Hung et al. (2011) later proved HABIT beats CIMT for two-hand timing. The 2012 data explain why: kids already show bilateral timing errors, so both hands need practice together.
Why it matters
When you see a child with hemiplegia twist their trunk to reach, do not just cue “use your hand.” Add trunk support or start the task closer to midline. Then run short bimanual play blocks to re-time both arms at once. Check sensory thresholds first; if light touch is weak, add texture to the object so the hand gets clearer news.
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Join Free →Tape a cookie to a non-slip plate, place it at midline, and count trunk shifts for five trials; if >3, add a rolled towel against the ribs and re-count.
02At a glance
03Original abstract
Children with hemiplegia have deficits in motor planning in addition to their impairments in movement of their more-affected upper extremity (UE). However, little is known about the relationship between motor planning and multi-segment coordination during functional activities in this population. In the present study, motor planning strategies and multi-segment coordination of the head, trunk, and UE were examined during a functional reach-grasp-eat task in children with hemiplegia. Ten children with hemiplegia (age 4-10 years; MACS levels I-II) and ten age-matched, typically developing children participated in the study. Children were asked to reach, grasp and transport a cookie to the mouth with one hand while 3-D kinematic analyses were performed. A more extended wrist (p = 0.001) and higher end-point position of grasping (p = 0.001) were found for both UEs of children with hemiplegia. The less-affected UE had greater trunk contribution (p = 0.018) and greater shoulder flexion (p = 0.002) and elbow extension (p = 0.005) during reaching compared to the TDC. The more-affected UE had impaired movement control with greater head rotation (p = 0.011), higher variability of end-point location in space (p = 0.001), greater trunk contribution (p = 0.018), and reduced wrist rotation (p = 0.007) compared with the less-affected UE and TDC. Additionally, delayed timing of maximum shoulder (p = 0.03) and elbow flexion (p = 0.008) during reaching, and maximum wrist pronation (p = 0.004) during eating were found for the more-affected UE. The results showed different multi-segment control for both UEs in children with hemiplegia compared to TDC. They also reflect impaired motor planning since the same movement strategies were used for both UEs. Furthermore, we suggest that inefficient multi-segment coordination of the more-affected UE is used to compensate for impaired motor planning and control.
Research in developmental disabilities, 2012 · doi:10.1016/j.ridd.2012.04.003