Impaired upper limb movements are a key feature in dyskinetic cerebral palsy (CP). However, information on how specific movement patterns relate to manual ability, performance and underlying movement disorders is lacking. Insight in these associations may contribute to targeted upper limb management in dyskinetic CP. This study aimed to explore associations between deviant upper limb movement patterns and (1) manual ability, (2) severity of dystonia/choreoathetosis, and (3) movement time/trajectory deviation during reaching and grasping. Participants underwent three-dimensional upper limb analysis during reaching forwards (RF), reaching sideways (RS) and reach-and-grasp vertical (RGV) as well as clinical assessment. Canonical correlation and regression analysis with statistical parametric mapping were used to explore associations between clinical/performance parameters and movement patterns (mean and variability). Thirty individuals with dyskinetic CP participated (mean age 16±5 y; 20 girls). Lower manual ability was related to higher variability in wrist flexion/extension during RF and RS early in the reaching cycle (p < 0.05). Higher dystonia severity was associated with higher mean wrist flexion (40–82 % of the reaching cycle; p = 0.004) and higher variability in wrist flexion/extension (31–75 %; p < 0.001) and deviation (2–14 %; p = 0.007/60–73 %; p = 0.006) during RF. Choreoathetosis severity was associated with higher elbow pro/supination variability (12–19 %; p = 0.009) during RGV. Trajectory deviation was associated with wrist and elbow movement variability (p < 0.05). Current novel analysis of upper limb movement patterns and respective timings allows to detect joint angles and periods in the movement cycle wherein associations with clinical parameters occur. These associations are not present at each joint level, nor during the full movement cycle. This knowledge should be considered for individualized treatment strategies.

中文翻译：

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运动障碍性脑瘫儿童和青少年的手动能力、肌张力障碍和舞蹈手足徐动症严重程度与上肢运动模式之间的关系

上肢运动受损是运动障碍性脑瘫（CP）的一个关键特征。然而，缺乏关于特定运动模式如何与手动能力、表现和潜在运动障碍相关的信息。对这些关联的深入了解可能有助于对运动障碍性脑瘫患者进行有针对性的上肢治疗。本研究旨在探讨异常上肢运动模式与（1）手动能力、（2）肌张力障碍/舞蹈手足徐动症的严重程度以及（3）伸手和抓握过程中的运动时间/轨迹偏差之间的关联。参与者在向前伸手（RF）、侧向伸手（RS）和垂直抓握（RGV）过程中接受三维上肢分析以及临床评估。使用统计参数映射的典型相关性和回归分析来探索临床/性能参数和运动模式（平均值和变异性）之间的关联。 30 名运动障碍性 CP 患者参与其中（平均年龄 16±5 岁；20 名女孩）。较低的手动能力与在到达周期早期 RF 和 RS 期间腕部屈曲/伸展的较高变异性相关（p < 0.05）。较高的肌张力障碍严重程度与较高的平均腕部屈曲（到达周期的 40-82%；p = 0.004）以及较高的腕部屈曲/伸展变异性（31-75%；p < 0.001）和偏差（2-14%；p < 0.001）相关。 RF 期间，p = 0.007/60–73 %；p = 0.006)。 RGV 期间舞蹈手足徐动症的严重程度与较高的肘部前旋/旋后变异性相关（12-19%；p = 0.009）。轨迹偏差与手腕和肘部运动变异性相关（p < 0.05）。目前对上肢运动模式和相应计时的新颖分析允许检测运动周期中的关节角度和周期，其中与临床参数发生关联。这些关联并不存在于每个关节级别，也不存在于整个运动周期中。个体化治疗策略应考虑这些知识。