Fingertip force control during bimanual object lifting in hemiplegic cerebral palsy

Bert Steenbergen, Jeanne Charles, Andrew M Gordon, Bert Steenbergen, Jeanne Charles, Andrew M Gordon

Abstract

In the present study we examined unimanual and bimanual fingertip force control during grasping in children with hemiplegic cerebral palsy (CP). Participants lifted, transported and released an object with one hand or both hands together in order to examine the effect on fingertip force control for each hand separately and to determine whether any benefit exists for the affected hand when it performed the task concurrently with the less-affected hand. Seven children with hemiplegic CP performed the task while their movement and fingertip force control were measured. In the bimanual conditions, the weight of the instrumented objects was equal or unequal. The durations of the all temporal phases for the less-affected hand were prolonged during bimanual control compared to unimanual control. We observed close synchrony of both hands when the task was performed with both hands, despite large differences in duration between both hands when they performed separately. There was a marginal benefit for two of the five force related variables for the affected hand (grip force at onset of load force, and peak grip force) when it transported the object simultaneously with the less-affected hand. Collectively, these results corroborate earlier findings of reaching studies that showed slowing down of the less-affected hand when it moved together with the affected hand. A new finding that extends these studies is that bimanual tasks may have the potential to facilitate force control of the affected hand. The implications of these findings for recent rehabilitative therapies in children with CP that make use of bimanual training are discussed.

Figures

Fig. 1
Fig. 1
Grip force, load force, and position traces from the less-affected hand of a child with CP while performing the task, along with the measures examined: finger difference (T0-T1) preload phase (T1-T2), onset of positive load force increase (T2), loading phase (T2-T3), transport phase T3-T4), replacement phase (T4-5). Total movement time is defined as the duration between T0 and T5 and signifies the duration of the complete grasp, transport and release movement. For elaborate description of the phases, see text
Fig. 2
Fig. 2
Examples of force profiles for the affected hand (left panels) and less-affected hand (rightpanels) in the unimanual conditions (upper panels) and bimanual equal-weight conditions (lowerpanels) when lifting objects of 250 g. T0-T3 represents the isometric force increase, encompassing finger difference, preload, and load phases. T3-T4 represents transport phase, and T4-T5 represents the replacement phase. The total movement time is denoted T0-T5
Fig. 3
Fig. 3
Duration of the different movement phases for the affected and less-affected hand. Shown are the durations in the unimanual conditions (a), bimanual equal-weight conditions (b), and bimanual unequal-weight conditions (c). All durations are calculated relative to object contact (zero). These include load-force onset (a), peak grip-force rate (b), peak load-force rate (c), object lift-off (d), peak grip-force (e), replacement (f), and release (g). Error bars represent standard error
Fig. 4
Fig. 4
Graphical display of the hand × condition interaction that was found for Total Movement Time. Error bars represent standard error
Fig. 5
Fig. 5
Graphical display of the hand × condition interaction that was found for grip force at load force onset. Error bars represent standard error
Fig. 6
Fig. 6
Graphical display of the hand × condition interaction that was found for peak grip force rate. Error bars represent standard error

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