1st Joint ESMAC-GCMAS Meeting - Análise de Marcha

O-23
KINEMATIC ANALYSIS OF UPPER LIMBS IN CEREBRAL PALSY SUBJECTS
Menegoni Francesco, PhD Student 1 , Galli Manuela, PhD 1 , Cimolin Veronica, PhD Student 1 ,
Tenore Nunzio, PT 2 , Crivellini Marcello, Prof 1 , Albertini Giorgio, Prof 2
1 Bioeng. Dept. Politechnic of Milan, Milan, Italy
2 IRCCS “San Raffaele” – Tosinvest Sanità, Roma, Italy
Summary/conclusions
The aim of this study was to define a protocol for the quantification of upper limb movements
in normal subjects and Cerebral Palsy (CP) patients. The defined protocol in terms of marker
positions, upper limb movements, and significant indexes, permitted to characterize the upper
limb movements of patients with CP. Furthermore its simplicity let it be suitable for clinical
application.
Introduction
CP is characterized by a disruption of motor skills, with symptoms such as spasticity, paralysis,
or seizures. Disorders paired with CP include disorders of walking, hearing, eyesight, epilepsy,
perception of obstacles, speech difficulties, and eating and drinking difficulties [1]. Functional
evaluation of subject movement disorders is very useful in order to define subject status and
treatment results [2]. The 3D multifactorial and integrated analysis of movement allows to
define quantitatively the motion pattern of a subject in a non-invasive way. This kind of
analysis is well known in gait [2], while it is not well defined in upper limb movements, that
are not repeatable or cyclic as gait [3].
Statement of clinical significance
The analysis of upper limb movements is useful for the evaluation of pathologies that have as
consequence a limited functional movement or kinematical abnormalities in upper limbs, such
as CP. Not only this analysis is applicable on non walking subjects – i.e. can be applied when
gait analysis cannot - but also it takes in account daily life movements thus resulting very
interesting in upper limb functional evaluation.
Methods
The study participants consisted of 14 normal subjects with no history of musculoskeletal or
neurological problems, representing a control group (6 males, 8 females; age: 23.2 ± 3.0 years)
and 13 patients (6 males, 7 females; age: 14.8 ± 6.2 years) with a diagnosis of CP (6
hemiplegics, 4 tetraplegics, and 2 diplegics). Upper limb movement analysis was conducted
using a 12-camera optoelectronic system with passive markers (ELITE2002, BTS, Milan,
Italy) working at a sampling rate of 100 Hz, to measure the kinematics of movement [4] and a
synchronic Video system (BTS, Milan, Italy). 21 retroreflective markers were placed on each
subject’s head, trunk and upper limbs. A total of 8 body segments were defined: trunk, right
and left upper arm, right and left forearm, right and left hand, and head. Two upper-limb
functional tasks were examined: frontal reaching movement and lateral reaching movement.
Each subject was seated on an adjustable stool with a table positioned in front of him/her with
elbow flexed to 90°. The target was a button to push at a distance. This distance was measured
individually for each subject as the 80% of subject arm length for frontal movement and 90%
of subject arm length for lateral movement. Each movement was repeated 3 times for each arm,
thus each subject completed 12 trials (6 frontal and 6 lateral, right and left).
Trajectory and velocity data of shoulders and hands were studied. We computed index of
trajectory deviation from a straight line (IC), as the ratio of the actual three-dimensional length
of the path travelled by the endpoint (Ltr) to the length of the straight line joining the initial and
final endpoint positions (L0): IC = Ltr / L0. Other considered values were movement
segmentation, finger covered distance, angles between upper limb segments and their range of
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