Sensitivity of an Upper Limb Motion Analysis Protocol to Changes in Kinematics and Muscle Activity After Constraint Induced Therapy in Children With Hemiplegia
Condition: Unilateral Cerebral Palsy
MeSH terms: Cerebral Palsy
Study type: Interventional

Summary: 
      In France, Cerebral Palsy (CP) affects 1 in 450 births. It results from lesions of the brain,
      before, during, or shortly after birth. These non-progressive lesions cause muscle
      impairments, responsible for activity limitations. These muscle impairments include muscle
      stiffness, and muscle weakness. Children with Unilateral CP (UCP) have these impairments on
      only one side of the body. To compensate for activity limitations with their impaired arm,
      these children over-use their non-impaired arm. The objective of constraint-induced therapy
      (CIT) is to minimize this asymmetry which deteriorates mobility on the impaired side, by
      forcing the child to only use its impaired arm several hours a day during several weeks of
      therapy. It is known using clinical tests that this therapy improves the overall motor
      function of the impaired arm. However, the underlying mechanisms are yet unknown. An
      understanding of these mechanisms would suggest ways to maximize the effectiveness of this
      therapy, which requires a significant commitment from the child and its family. The
      investigaors propose in this project a quantitative and objective evaluation of the effect of
      CIT on the movements of the impaired arm of children with UCP. The investogators focus their
      analysis on muscle activation, to assess which aspect of muscle impairments is modified by
      CIT. To this end, the investigators will use sensors identical to those already used in
      clinics for the Quantified Gait Analysis of children with CP, recognized since 2006 by the
      Haute Autorité de Santé as providing key supplementary data in the evaluation of complex gait
      disorders. Results from this study will provide leads to optimize CIT. Some children could
      for example benefit from CIT paired with treatments to reduce muscle stiffness or to
      strengthen muscles
    

Detailed description: 
      Quantitative and objective evaluation of upper limb movements will take place in a motion
      analysis laboratory and will take place as follow:

        -  A clinical exam of the participant will be performed by the physician to collect maximal
           passive joint amplitudes with a goniometer and anatomical measures (length,
           circumference) of the upper limb.

        -  The participant will be equipped with surface electromyographic electrodes to measure
           the activation of his superficial muscles, and with retroreflective markers placed on
           anatomical landmarks of his thorax, shoulder, and arm, to measure upper limb kinematics
           with a 3D motion capture system composed of 8 VICON cameras.

        -  Maximal forces of elbow pronosupination and flexion-extension will be measured with a
           portable dynamometer.

        -  The participant will be placed on a height adjustable bench, in the center of the
           laboratory. He will be asked to perform upper limb movements:

             -  A few movements not measured, to familiarize with the equipment;

             -  Recorded movements: a trial is composed of a few consecutive cycles of a movement
                such as elbow flexion-extension. A trial usually last about 10seconds. A few
                seconds-time of rest is imposed between each trial. The required movements are the
                following: elbow flexion-extension, elbow pronosupination, and "hand to mouth".

        -  Finally, the participant will be asked to lie down on an exam table and to rest relax,
           in order to measure the electromyographic signal of his muscles at rest.

      Duration of the protocol is about 1h30, with less than 30seconds of effort, and a few minutes
      of performing simple upper limb movements.
    

Intervention name(s): Measurement of maximal forces of elbow pronosupination and flexion-extension
Intervention type(s): Other
Intervention description(s): Maximal forces of elbow pronosupination and flexion-extension will be measured with a portable dynamometer.
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Other
Keywords: Unilateral cerebral palsy; kinematics; electromyography; constraint-induced therapy; muscle activation; upper limb; child