Quantification of Bilateral Coordination Patterns & Relationship to Activities of Daily Living Performance in Children With Hemiparetic Cerebral Palsy

Bilateral coordination (BC) involves movement of both upper extremities (UE) for functional tasks. In symmetric BC, both UEs perform the same movement; in asymmetric BC, each UE performs a different movement, which may be a more challenging form of BC relative to symmetric BC. Children with hemiparetic cerebral palsy (HCP) may struggle with BC, thus impeding ADLs. The aim of this study is to compare symmetric and asymmetric BC patterns in children with HCP and their relationship to ADL performance. Children (n=6) with HCP ages 7-17 were screened and recruited from an academic hospital for an on-going cross-sectional study with a one-time visit to a research laboratory. Children with UE hemiparesis due to brain injury before age 1 and who could ambulate independently were included. BC was quantified using a custom cycling apparatus. UE cycling was performed at 45 rpm with symmetric in-phase (SYM) or asymmetric antiphase (ASYM) patterns. The ABILHand-Kids Questionnaire assessed ADL performance and the Speed Stacks cup-stacking game simulated a functional task. Mean phase error (μE) for SYM-BC (50.47°±20.59°) was lower than ASYM-BC (101.04°±34.20°). Standard deviation of phase error (σE) of SYM-BC (39.32°±14.16°) was lower than ASYM-BC (48.46°±8.02°). There was a moderate correlation between Speed Stacks time and μE for SYM-BC (ρ=−0.5) and strong correlation for ASYM-BC (ρ=−0.9). There were moderate correlations between ABILHand-Kids scores and μE (ρ=−0.6 SYM, ρ=−0.5 ASYM). Asymmetric BC appears more challenging than symmetric BC. Measures of BC during a cycling task are related to functional tasks. Greater ADL independence was associated with better BC performance. Impact Statement: Objective assessments of BC provide evidence-based performance measures that are critical for client-centered treatment to optimize occupational performance. Future work aims to link BC patterns to neural pathways for a mechanistic understanding of BC.

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