1st Joint ESMAC-GCMAS Meeting - Análise de Marcha

O-22
TOWARDS A NEW PROTOCOL FOR MOTION ANALYSIS OF THE UPPER
EXTREMITIES IN HEMIPLEGIC CEREBRAL PALSY
Gutierrez-Farewik, Elena, PhD 1,2,* , Munaretto, Joseph MSc 1 , Pontén, Eva MD, PhD 2
1 KTH Mechanics, Royal Institute of Technology, Stockholm, Sweden
2 Department of Woman and Child Health, Karolinska Institutet, Stockholm, Sweden
Summary/conclusions
This study describes a model and a testing protocol for motion analysis of the upper extremity
in persons with hemiplegic cerebral palsy as a tool in clinical evaluation. A 3D kinematic
model was designed and used in motion analysis in 3 subjects with hemiplegic cerebral palsy
before and after treatment, and in 3 normal subjects to describe the movement patterns in the
upper limb. A reaching task was defined for the subjects to reach, grasp, and retrieve an object
placed at various distances on a table directly in front of the subject.
Introduction
The damage to the brain in cerebral palsy (CP) can cause muscle spasticity, involuntary
movement, gait disturbance, and abnormal sensation and perception [1]. Spastic cerebral palsy,
when occuring in the upper extremities, may affect a person’s ability in common reaching and
grasping tasks [2]. Spasticity in the upper extremities in children with cerebral palsy can
generally upset the balance between antagonist and agonist muscles, wherein, for instance,
wrist flexors are often more severely affected than wrist extensors [3]. Treatment often has a
goal to restore the balance, and can include occupational therapy, botulinum toxin injections,
and orthopedic surgery.
Motion analysis has widespread use in interpretation of gait disorders [4], but no such
consensus exists in upper limb models and testing protocols for use in clinical assessment of
the consequences of CP on arm function. Furthermore, this tool has yet been used to evaluate
the efficacy of treatment in persons with CP.
Statement of clinical significance
A main challenge in upper extremity motion analysis is to define a task that is repeatable,
predictable, and functionally realistic, if the motion analysis is to be useful in treatment
decision-making or evaluation. If this challenge can be met, motion analysis of the upper
extremities may be as clinically useful as gait analysis is to clinicians
focusing on the lower extremities.
Methods
Subjects: Three subjects with spastic hemiplegia, (aged 10-13) and
three healthy adults participated in this study. Two subjects received
injections with botulinum toxin A, both in the biceps and one
additionally in the pectoralis, pronator teres, and flexor carpi ulnaris,
and were tested 3 weeks after treatment. The third subject with
hemiplegia underwent tendon transfer surgery of the hand and arm,
including pronator teres rerouting, flexor carpi ulnaris to extensor carpi
radialis brevis transfer as well as biceps tendon lengthening, and was
tested 2 months after treatment. Passive ROM was measured in elbow
flexion and wrist extension.
Model: Subjects performed reaching tasks and were analyzed using a 3-D motion capture
system (Vicon Peak). 26 markers were placed over bony landmarks to model the trunk, head,
clavicle, humerus, forearm, hand, 2 thumb, and 2 middle finger segments. Euler angle
- 96 -