Abstract
Neurophysiological development of selective voluntary motor control (SVMC) is assumed but has not been quantified objectively. We assessed SVMC with (i) clinical assessments, (ii) a combination of these assessments with surface electromyography (sEMG) and, (iii) a playful computer game. The aim of this study was to describe and compare age-related differences in SVMC, quantified with these tools, in neurologically intact children, adolescents, and adults. We measured upper and lower extremity SVMC with three assessments in 31 children and adolescents. A sample of 33 and 31 adults provided reference values for the upper and lower extremity assessments, respectively. The Selective Control of the Upper Extremity Scale (SCUES) or the Selective Control Assessment of the Lower Extremity (SCALE) were combined with simultaneous sEMG recordings. We quantified SVMC by a similarity index that compared an individual's muscle activation pattern with those of an adult reference group. The SVMC Assessgame required isolated joint movements to steer an avatar and quantified the accuracy of the selective movement and the extent of involuntary movements occurring in not involved joints. Results from the conventional clinical assessments correlated low to moderately with age (SCUES: r=0.55, p=0.013; SCALE: r=0.44, p=0.001), while the correlation between the sEMG based similarity index and age was negligible (r≤0.25). The outcomes of the Assessgame correlated highly with age (r≥0.80, p≤0.001). Older children and adolescents performed movements more accurately and with fewer involuntary movements compared to younger participants. The tools assess and quantify SVMC differently, affecting the way they capture age-related differences in SVMC. Some assessments require reference values from neurologically intact children and adolescents to correctly classify impairments of SVMC in patients with neuromotor disorders.
Highlights
Selective voluntary motor control (SVMC) is an essential component of human functional movement skills and refers to the ability to perform isolated joint movements deliberately (Cahill-Rowley & Rose, 2014)
We considered the age where children/adolescents reached the level of adults as the intersection of the 95% confidence interval (CI) of the fitted line and the lower or upper limit of the 95% CI of the mean for healthy adults
We proposed two new assessments for quantifying selective voluntary motor control (SVMC), first, by complementing existing clinical assessments with surface electromyography (sEMG) re cordings and, second, by developing a kinematic movement analysis with accelerometers integrated into a computer game
Summary
Selective voluntary motor control (SVMC) is an essential component of human functional movement skills and refers to the ability to perform isolated joint movements deliberately (Cahill-Rowley & Rose, 2014). Patients clinically present mass flexion/extension patterns or synergies of muscle activation, which interfere with many functional movements such as walking (Fowler & Goldberg, 2009; Kuhtz-Buschbeck, Sundholm, Eliasson, & Forssberg, 2000; Perry, 1993). Another pathological movement pattern typically occurring in patients with impaired SVMC are mirror movements (Fowler, Staudt, Greenberg, & Oppenheim, 2009). Some assessments require reference values from neurologically intact children and adolescents to correctly classify impairments of SVMC in patients with neu romotor disorders
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