"Be an Airplane Pilot": A Bimanual 3D Motion Analysis in Children With Unilateral Cerebral Palsy
Condition: Unilateral Spastic Cerebral Palsy
MeSH terms: Muscle Spasticity; Paralysis; Cerebral Palsy
Study type: Observational

Summary: 
      Cerebral Palsy, in particular in its unilateral spastic form (uCP), is the main cause of
      motor disability in children, with a prevalence of 2/1000 births. These children have upper
      limb motor impairments that hinder the realization of activities of daily life in bimanual
      situations. 3D motion analysis (3DMA) is an objective and precise tool, considered as the
      gold standard for gait analysis. The existing 3DMA protocols consist of movements too
      standardized, in unimanual situations away from gestures of everyday life, or have not been
      validated in bimanual situations.

      In a preliminary study, a 3DMA bimanual protocol was study. it was composed of 4 tasks
      integrated into a game scenario to have more spontaneity of movements, similar to those
      experienced by children in daily life. It allows the exploration of all degrees of freedom of
      the upper limb. Results showed an excellent acceptability and within day reliability on 20
      uCP children and 20 typically developing children (TDC) for funct
    

Detailed description: 
      This is a prospective study for evaluation of a diagnostic and therapeutic tool.

      "Be An Airplane Pilot" 3DMA:

      The protocol consists of 5 complementary bimanual tasks that are integrated into a scenario
      game of "becoming an airplane pilot". It allows the exploration of all degrees of freedom of
      the UL kinematics of the non-dominant/hemiplegic.

      The protocol will take place in a session that corresponds to the driving of an airplane and
      includes several tasks which consist of 5 repetitions of movements (= 5 cycles).

      The kinematics of the trunk (flexion-extension, lateral flexions and rotations), shoulder
      (elevation, plane of elevation, rotations), elbow (flexion-extension and pronosupination) and
      wrist (flexion-extension and adduction/abduction) will be explored. The calculated kinematic
      parameters are the range of motion (ROM) and the maximum angle (MAX) of the degrees of
      freedom (DoF) of interest.

      Group 1: uCP children without botulinum toxin injections

      The 3DMA protocol will be performed in two sessions separated from 2-4 weeks to explore the
      between day reliability in uCP children.

      During the first session, this will be associated to physiotherapist and occupational
      therapist evaluation in order to correlate kinematic parameters to clinical score. During the
      first session, this will be associated to clinical assessment (muscle strength and tone,
      pinch, grasp) by a physiotherapist and bimanual performance-based measures (Assisting Hand
      Assessment (AHA) and Abilhand-kids) by an occupational therapist.

      Group 2: uCP children with botulinum toxin injections

      Five uCP children will perform the BE-API protocol before and after botulinum toxin
      injections in the upper limb. This treatment is used for its effect on the local reduction of
      spasticity after intramuscular injection. It is usually proposed to these children every 6-8
      months.

      Visit 1 is similar to Group 1 with 3DMA, occupational therapy and physiotherapy.

      The second 3DMA will be done during the planned visit for toxin injections (2 to 4 weeks
      after visit 1) and before treatment administration. Injections of botulinum toxins will be
      followed by rehabilitation's intensification for 4 weeks (physiotherapy and home exercise)
      according to the usual care of treated patients.

      During Visit 3, 4 to 6 weeks after treatment by botulinum toxin injections, children will
      have 3D analysis for the third time, with assessment in physiotherapy and occupational
      therapy, comparable to the Visit 1.

      Group 3: healthy volunteers (TDC children)

      Their participation in the study will consist of a single visit, during which they will
      realize the 3DMA protocol only.

      Clinical measures

      For uCP children, with or without toxin injections, descriptive characteristics such as age,
      sex, hemiplegic side, as well as Manual Ability Classification System (MACS), Bimanual Fine
      Motor Function (BFMF) and Modified House Classification will be collected in consultation.

      The physiotherapy will do a clinical examination of the upper limbs: passive and active
      measurement of the range of motion by goniometry, muscle strength, motor selectivity,
      spasticity, grasp and pinch test, and sensitivity.

      The evaluation of the bimanual performance will be carried out by a certified occupational
      therapist with a validated scale: the Assisting Hand Assessment (AHA) and a questionnaire:
      the Abiland-Kids (10) which will be filled with the parents
    

Intervention name(s): Bimanual 3D Motion Analysis " Be-API "
Intervention type(s): Device
Intervention description(s): Movements will be measured using an optoelectronic system (12 cameras) which captures the displacement of 26 markers placed on the upper limbs and trunk of the child, according to the standards of the International Society of Biomechanics.
The child is installed on a chair and table height (equipment adapted and approved for pediatrics). A game board is installed in front of the child, with objects to handle, set and placed according to its anthropometry (joystick, steering wheel, buzzer, board, chip).
Observational model: Case-Control
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        -  Children with unilateral spastic Cerebral Palsy and a sufficient level of manipulation
             followed in Physical Medicine and Rehabilitation in Rennes University Hospital

          -  Safe volunteers will be recruited among children of the staff of the Rennes University
             Hospital (except children unit of Department of Physical Medicine and Rehabilitation)
             and the M2S laboratory.
      
Keywords: Unilateral cerebral palsy; three-dimensional movement analysis; upper limb; bimanual task; bimanual performance