Shoulder motor performance assessment in the sagittal plane in children with hemiplegia during single joint pointing tasks

BACKGROUND Pointing is a motor task extensively used during daily life activities and it requires complex visuo-motor transformation to select the appropriate movement strategy. The study of invariant characteristics of human movements has led to several theories on how the brain solves the redundancy problem, but the application of these theories on children affected by hemiplegia is limited. This study aims at giving a quantitative assessment of the shoulder motor behaviour in children with hemiplegia during pointing tasks. METHODS Eight children with hemiplegia were involved in the study and were asked to perform movements on the sagittal plane with both arms, at low and high speed. Subject movements were recorded using an optoelectronic system; a 4-DOF model of children arm has been developed to calculate kinematic and dynamic variables. A set of evaluation indexes has been extracted in order to quantitatively assess whether and how children modify their motor control strategies when perform movements with the more affected or less affected arm. RESULTS In low speed movements, no differences can be seen in terms of movement duration and peak velocity between the More Affected arm (MA) and the Less Affected arm (LA), as well as in the main characteristics of movement kinematics and dynamics. As regards fast movements, remarkable differences in terms of strategies of motor control can be observed: while movements with LA did not show any significant difference in Dimensionless Jerk Index (JI) and Dimensionless Torque-change Cost index (TC) between the elevation and lowering phases, suggesting that motor control optimization is similar for movements performed with or against gravity, movements with MA showed a statistically significant increase of both JI and TC during lowering phase. CONCLUSIONS Results suggest the presence of a different control strategy for fast movements in particular during lowering phase. Results suggest that motor control is not able to optimize Jerk and Torque-change cost functions in the same way when controls the two arms, suggesting that children with hemiplegia do not actively control MA lowering fast movements, in order to take advantage of the passive inertial body properties, rather than to attempt its optimal control.