Objective: To investigate the effect of task context on the quality of reaching movements in children with spastic hemiparesis.
Design: Randomized controlled experimental trial.
Setting: Institute for the Study of Education and Human Development (ISED).
Subjects: Twelve children (8–14 years of age) with spastic hemiplegic cerebral palsy.
Interventions: Subjects made fast reaching movements with the affected or nonaffected arm on a digitizer in three context conditions: (a) reach to press a light switch to turn on a red light (functional), (b) reach to press the light switch; no light (semi-functional), and (c) reach to a marker (nonfunctional).
Main outcome measures: Kinematics of reaching movements of affected and nonaffected arms: movement time (MT), peak velocity (PV), time to PV, percentage of MT where peak velocity occurred (PPV), and smoothness (i.e. number of movement units (MU)).
Results: The functional condition elicited better quality of reaching for the nonaffected, but particularly the affected arm. Reaching of the affected arm was faster (larger MT; F = 10.21, p < 0.01), smoother (fewer MU; F = 19.95, p < 0.001), and better-controlled (right shift of PPV; F = 16.03, p < 0.001) compared with the semi and nonfunctional condition. Reaching of the nonaffected arm was also faster (longer MT, F = 4.81, p < 0.05), and more smooth (fewer MU, F = 7.23, p < 0.05).
Conclusions: These findings suggest that providing a functional context to perform a task may enhance the quality of reaching movements of the affected arm in children with spastic hemiparesis.
Get full access to this article
View all access options for this article.
References
1.
Bobath K, Bobath B. The neurodevelopmental treatment. In: Scrutton D ed. Management of motor disorders in children with cerebral palsy. Oxford: Blackwell Scientific, 1984: 6–18.
2.
Fetters L. Measurement and treatment in cerebral palsy: an argument for a new approach. Phys Ther1991; 71: 244–247.
3.
Gordon J. Assumptions underlying physical therapy intervention: theoretical and historical perspectives. In: Carr JH, Shephard RB eds. Movement science: foundations for physical therapy in rehabilitation. Rockville, MD: Aspen, 1987: 1–30.
4.
Fetters L, Kluzik J. The effects of neurodevelopmental treatment versus practice on the reaching of children with spastic cerebral palsy. Phys Ther1996; 76: 346–358.
5.
Ketelaar M. Children with cerebral palsy: a functional approach to physical therapy. Dissertation. Delft: Eburon, 1999.
6.
Butler C, Darrah J. Effects of Neurodevelopmental Treatment (NDT) for cerebral palsy: An AACPDM evidence report. Dev Med Child Neurol2001; 41: 778–790.
7.
Hur JJ. Review of research on therapeutic interventions for children with cerebral palsy. Acta Neurol Scand1995; 91: 423–432.
8.
Siebes C, Wijnroks A, Vermeer A. Qualitative analysis of motor intervention programmes for children with cerebral palsy: an update. Dev Med Child Neurol (in press).
9.
Darrah JD. Clinical reasoning: Management of a child with cerebral palsy. Comparison of neurodevelopmental and dynamic systems approaches. Symposium-book of the American Physical Therapy Annual Conference. San Diego, CA: APTA, 1997: 25–29.
10.
Ketelaar M, Vermeer A, Hart H, Petegem-van Beek E, Helders PJM. Effects of a functional therapy programme on motor abilities of children with cerebral palsy. Phys Ther2001; 81: 1534–1545.
11.
American Occupational Therapy Association. Position paper: Purposeful activity. Am J Occup Ther1993; 47: 1081–1082.
12.
Lin KC, Wu CY, Tickle-Degen L, Coster W. Enhancing occupational performance through occupationally embedded exercise: a meta-analytic review. Occup Ther J Res1997; 17: 25–47.
13.
Kelso JAS. Dynamic patterns: the self-organization of brain and behavior. Cambridge, MA: MIT Press, 1995.
14.
Thelen E, Smith LB. A dynamic systems approach to the development of cognition and action. Cambridge, MA: MIT Press, 1994.
15.
Gibson JJ. The theory of affordances. In: Shaw R, Bransford J eds. Perceiving, acting and knowing. Hillsdale, NJ: Lawrence Erlbaum Associates, 1977: 67–82.
16.
Gibson JJ. The ecological approach to visual perception. Boston: Houghton Mifflin, 1979.
17.
Newell KM. Constraints on the development of coordination. In: Wade MG, Whiting HTA eds. Motor development in children: aspects of coordination and control. Dordrecht: Martinus-Nijhoff, 1986: 341–360.
18.
Mathiowetz V, Wade MG. Task constraints and functional motor performance of individuals with and without multiple sclerosis. Ecol Psychol1995; 7: 99–123.
19.
Newell KM. On task and theory specificity. J Mot Behav1989; 21: 92–96.
20.
Reed ES. An outline of a theory of action systems. J Mot Behav1992; 14: 98–134.
21.
Burton AW, Davis WE. Optimizing the involvement and performance of children with physical impairments in movement activities. Ped Exerc Sci1992; 4: 236–248.
22.
Teasdale N, Stelmach GE. Movement disorders: the importance of the movement context. J Mot Behav1988; 20: 186–191.
23.
Van der Weel FR, van der Meer ALH, Lee DN. Measuring dysfunction of basic movement control in cerebral palsy. Hum Mov Sci1996; 15: 253–283.
24.
Trombly CA, Wu C. Effect of rehabilitation tasks on organization of movement after stroke. Am J Occup Ther1999; 53: 333–344.
25.
Wu C, Trombly CA, Lin KC. The relationship between occupational form and occupational performance: a kinematic perspective. Am J Occup Ther1994; 48: 679–687.
26.
Lin KC, Wu C, Trombly CA. Effects of task-goal on movement kinematics and line bisection performance in adults without disabilities. Am J Occup Ther1998; 52: 179–187.
27.
Poizner H, Clark M, Merians AS, Macauly B, Rothi LJG, Heilman KM. Joint coordination deficits in limb apraxia. Brain1995; 118: 227–242.
28.
Wu C, Trombly CA, Lin K, Tickle-Degnen L. Effects of object affordances on reaching performance in persons with and without cerebrovascular accident. Am Occup Ther1998; 52: 447–456.
29.
Wu C, Trombly CA, Lin K, Tickle-Degnen L. A kinematic study of contextual effects on reaching performance in persons with and without stroke: influences of object availability. Arch Phys Med Rehabil2000; 81: 95–101.
30.
Van der Weel FR, van der Meer ALH, Lee DN. Effects of task on movement control in cerebral palsy: Implications for assessment and therapy. Dev Med Child Neurol1991; 33: 419–426.
31.
Kluzik J, Fetters L, Coryell K. Quantification of control: a preliminary study of effects of neurodevelopmental treatment on reaching in children with spastic cerebral palsy. Phys Ther1990; 70: 65–76.
32.
Steenbergen B, Van Thiel E, Hulstijn W, Meulenbroek RJG. The coordination of reaching and grasping in spastic hemiparesis. Hum Mov Sci2000; 19: 75–105.
33.
Utley A, Sugden DA. Interlimb coupling in children with hemiplegic cerebral palsy during reaching and grasping at speed. Dev Med Child Neurol1998; 40: 396–404.
34.
Ingram TTS. A historical review of the definition and classification of the cerebral palsies. In: Stanley FJ, Alberman E eds. The epidemiology of cerebral palsy. London: Heinemann, 1984: 1–11.
35.
Fitts PM. The information capacity of the human motor system in controlling the amplitude of the movement. J Exp Psych1954; 47: 381–391.
36.
de Jong WP, Hulstijn W, Kosterman BJM, Smits-Engelsman BCM. OASIS software and its application in experimental handwriting research. In: Simner ML, Leedham CG, Thomassen AJWM eds. Handwriting and drawing research: basic and applied issues. Amsterdam: IOS, 1996: 429–440.
37.
Nagasaki H. Asymmetric velocity and acceleration profiles of human arm movements. Exp Brain Res1989; 74: 319–326.
38.
Cohen J. Statistical power analysis for the behavioral sciences. Hillsdale, NJ: Erlbaum, 1988.
39.
Martiniuk RG, MacKenzie CL, Jeannerod M, Athenes S, Dugas C. Constraints on human arm movement trajectories. Can J Psychol1987; 41: 365–378.
40.
Hay L, Bard C, Fleury M, Teasdale N. Kinematics of aiming in direction and amplitude: a developmental study. Acta Psychol1991; 77: 203–217.
41.
Kelso JAS, Schöner G. Self-organisation of coordinative movement patterns. Hum Mov Sci1988; 7: 27–46.
42.
Saltzman EL, Kelso JAS. Skilled actions: A task dynamic approach. Psychol Rev1987; 94: 84–106.
43.
Rizzolatti G, Gallese V. Mechanisms and theories of spatial neglect. In: Boller F, Grafman J eds. Handbook of neuropsychology. Amsterdam: Elsevier, 1988: 223–246.
44.
Rizzolatti G, Camarda R, Fogassi L, Gentilucci M, Luppino G, Matelli M. Functional organization of inferior area 6 in the macaque monkey. II. Area F5 and the control of distal movements. Exp Brain Res1988; 71: 491–507.
