Instrumented assessment of motor function in dyskinetic cerebral palsy: a systematic review

Authors:

Haberfehlner, H., Goudriaan, M., Bonouvrié, L. A., Jansma, E. P., Harlaar, J., Vermeulen, R. J., van der Krogt, M. M., and Buizer, A. I.

Abstract:

BACKGROUND: In this systematic review we investigate which instrumented measurements are available to assess motor impairments, related activity limitations and participation restrictions in children and young adults with dyskinetic cerebral palsy. We aim to classify these instrumented measurements using the categories of the international classification of functioning, disability and health for children and youth (ICF-CY) and provide an overview of the outcome parameters.

METHODS: A systematic literature search was performed in November 2019. We electronically searched Pubmed, Embase and Scopus databases. Search blocks included (a) cerebral palsy, (b) athetosis, dystonia and/or dyskinesia, (c) age 2-24 years and (d) instrumented measurements (using keywords such as biomechanics, sensors, smartphone, and robot).

RESULTS: Our search yielded 4537 articles. After inspection of titles and abstracts, a full text of 245 of those articles were included and assessed for further eligibility. A total of 49 articles met our inclusion criteria. A broad spectrum of instruments and technologies are used to assess motor function in dyskinetic cerebral palsy, with the majority using 3D motion capture and surface electromyography. Only for a small number of instruments methodological quality was assessed, with only one study showing an adequate assessment of test-retest reliability. The majority of studies was at ICF-CY function and structure level and assessed control of voluntary movement (29 of 49) mainly in the upper extremity, followed by assessment of involuntary movements (15 of 49), muscle tone/motor reflex (6 of 49), gait pattern (5 of 49) and muscle power (2 of 49). At ICF-CY level of activities and participation hand and arm use (9 of 49), fine hand use (5 of 49), lifting and carrying objects (3 of 49), maintaining a body position (2 of 49), walking (1 of 49) and moving around using equipment (1 of 49) was assessed. Only a few methods are potentially suitable outside the clinical environment (e.g. inertial sensors, accelerometers).

CONCLUSION: Although the current review shows the potential of several instrumented methods to be used as objective outcome measures in dyskinetic cerebral palsy, their methodological quality is still unknown. Future development should focus on evaluating clinimetrics, including validating against clinical meaningfulness. New technological developments should aim for measurements that can be applied outside the laboratory.

DOI:

10.1186/s12984-020-00658-6

URL:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7057465/pdf/12984_2020_Article_658.pdf

Journal:

J Neuroeng Rehabil

issn:

1743-0003

Publication year:

2020

pages:

39

Biological and physiological variables:

Biological and physiological variables

Functional status:

Physical functioning

Age:

Adults (18-65)
Children (0-18)

Disease:

Certain conditions originating in the perinatal period and related symptoms
Congenital malformations, deformations and chromosomal abnormalities and related symptoms

PRO / non-PRO:

Non-patient Reported Outcome

Type of measurement instrument:

4 - Performance-based tests
6 - Clinical rating scales
8 - Imaging tests
9 - Laboratory tests

Instrument:

3D motion analysis
Accelerometry [alias: accelerometer] (versions: AM accelerometer - Ambulatory Monitoring; Biaxial; Caltrac; triaxial; RT3; Cervical accelerometry; Smartphone version; AX3; Axivity; MOX Accelerometry; GT1M; Actical)
Biodex chair
Custom made cuff/brace
Electrogoniometry
Force sense/sensor
Inertial sensors
Motion-tracking system
Resistance position measure
SEMG - surface electromyography
Touch screen/activated switch
Virtual environment task/game