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Differentiation of Hand Posture in Children with Cerebral Palsy
Aviva Wolff, OTR, CHT, MA1; Howard Hillstrom, PhD1; Andrew Gordon, PhD2
1Hospital for Special Surgery, New York, NY; 2Teacher's College, Columbia University, New York, NY

Introduction: Hand posture emerges during reach and reflects object shape early in the reach trajectory, however, this shaping requires motor planning that may be compromised in children with hemiplegic cerebral palsy (CP). The aim of this study was to compare the evolution of hand shaping during reach in children with hemiplegic CP, and to determine how planning contributes to grasp shaping ability.
Materials and Methods: Two groups of children, age range 6-13: 10 typically developing (TD) children (mean age 9.7 + 2.3), 10 children with CP (mean 8.6 +2.7) grasped rectangular, concave, and convex objects with both the dominant/non-dominant and less-affected/affected hand (10 trials per shape, per hand), while fitted with reflective markers. Metacarpal and proximal interphalangeal joint flexion and digital abduction were calculated. To summarize hand posture across joint angles, discriminant analysis was performed at 5% intervals. Results from the discriminant analysis were used to construct a matrix and calculate a "visuomotor efficiency index" (VME, a score of 100 reflects perfect discrimination between objects), to summarize the extent to which hand posture reflects object shape. This methodology allows for subtle detection of changes in joint configuration.
Results: VME scores were analyzed using a mixed design ANOVA with a between subjects factor of group and a within subjects factor of time. Both CP and TD groups indicated an ability to differentiate posture during reach, main effect of time, F(1,19)=8.96, p=<.01.Overall, participants with CP demonstrated a lower visuomotor efficiency index (VME) than controls in the affected hand during reach, indicating less effective posture differentiation, main effect of group, F(1,18)=7.69, p=.013 There was also a difference in the evolution of VME throughout reach in the affected hand of CP children compared to controls; interaction of group and time, F(1,19) = 2.06, p=.006. Interestingly, there was no significant difference in hand pre-shaping in the less affected hand in the CP group compared to controls. All kinematic parameters were also non-significant between groups. Thus, VME is sensitive at detecting shaping differences otherwise not quantifiable.
Conclusions: These results indicate that children with CP are able to differentiate hand posture to object shape with both hands, yet demonstrate less effective shaping ability on the affected side, suggesting motor planning deficits that are specific to the affected side and independent of motor execution. These deficits require additional attention in rehabilitation approaches that typically focus on motor execution.


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