Selective Voluntary Motor Control Research Articles

Reference measures of lower-limb joint range of motion, muscle strength, and selective voluntary motor control of typically developing children aged 5–17 years

Background: Joint range of motion based on the neutral null method, muscle strength based on manual muscle testing, and selective voluntary motor control based on selective control assessment of the lower extremity are standard parameters of a pediatric three-dimensional clinical gait analysis. Lower-limb reference data of children are necessary to identify and quantify abnormalities, but these are limited and when present restricted to specific joints or muscles. Methods: This is the first study that encompasses the aforementioned parameters from a single group of 34 typically developing children aged 5–17 years. Left and right values were averaged for each participant, and then the mean and standard deviation calculated for the entire sample. The data set was tested for statistical significance ( p < 0.05). Results: Joint angle reference values are mostly consistent with previously published standards, although there is a large variability in the existing literature. All muscle strength distributions, except for M. quadriceps femoris, differ significantly from the maximum value of 5. The mean number of repetitions of heel-rise test is 12 ± 5. Selective voluntary motor control shows that all distributions, except for M. quadriceps femoris, differ significantly from the maximum value of 2. Conclusion: Since typically developing children do not match expectations and reference values from the available literature and clinical use, this study emphasizes the importance of normative data. Excessively high expectations lead to typically developing children being falsely underestimated and affected children being rated too low. This is of great relevance for therapists and clinicians. Level of evidence: 3.

Children with bilateral cerebral palsy use their hip joint to complete a step-up task.

Performance in stair-climbing is largely associated with disruptions to mobility and community participation in children with cerebral palsy (CP). It is important to understand the nature of motor impairments responsible for making stairs a challenge in children with bilateral CP to clarify underlying causes of impaired mobility. In pediatric clinical populations, sensitive measurements of movement quality can be captured during the initial step of stair ascent. Thus, the purpose of this study was to quantify the lower limb joint moments of children with bilateral CP during the stance phases of a step-up task. Participants performed multiple stepping trials in a university gait laboratory. Outcome measures included extensor support moments (the sum of hip, knee, and ankle sagittal plane moments), hip abduction moments, and their timing. We recruited seven participants per group. We found that peak support and hip abduction moments were similar in the bilateral CP group compared to the typical development (TD) group. We also found that children with bilateral CP timed their peak moments closer together and increasingly depended on the hip joint to complete the task, especially in their more affected (MA) lower limb. Our investigation highlights some underlying causes that may make stair climbing a challenge for the CP population, including a loss of selective voluntary motor control (SVMC), and provides a possible treatment approach to strengthen lower limb muscles.

Playfully Assessing Lower Extremity Selective Voluntary Motor Control in Children With Cerebral Palsy: Psychometric Study.

Objective measures specifically assessing selective voluntary motor control are scarce. Therefore, we have developed an interval-scaled assessment based on accelerometers. This study provided a preliminary evaluation of the validity and reliability of this novel gamelike assessment measuring lower limb selective voluntary motor control in children with cerebral palsy (CP). Children with CP and their neurologically intact peers were recruited for this psychometric evaluation of the assessgame. The participants played the assessgame and steered an avatar by selective hip, knee, or ankle joint movements captured with accelerometers. The assessgame's scores provide information about the accuracy of the selective movement of the target joint and the amplitude and frequency of involuntary movements occurring in uninvolved joints. We established discriminative validity by comparing the assessgame scores of the children with CP with those of the neurologically intact children, concurrent validity by correlations with clinical scores and therapists' opinions, and relative and absolute test-retest reliability. We included 20 children with CP (mean age 12 years and 5 months, SD 3 years and 4 months; Gross Motor Function Classification System levels I to IV) and 31 neurologically intact children (mean age 11 years and 1 month, SD 3 years and 6 months). The assessgame could distinguish between the children with CP and neurologically intact children. The correlations between the assessgame's involuntary movement score and the therapist's rating of the occurrence of involuntary movements during the game were moderate (Spearman ρ=0.56; P=.01), whereas the correlations of the assessgame outcomes with the Selective Control Assessment of the Lower Extremity and Gross Motor Function Classification System were low and not significant (|ρ|≤0.39). The intraclass correlation coefficients were >0.85 and indicated good relative test-retest reliability. Minimal detectable changes amounted to 25% (accuracy) and 44% (involuntary movement score) of the mean total scores. The percentage of children able to improve by the minimal detectable change without reaching the maximum score was 100% (17/17) for the accuracy score and 94% (16/17) for the involuntary movement score. The assessgame proved reliable and showed discriminative validity in this preliminary evaluation. Concurrent validity was moderate with the therapist's opinion but relatively poor with the Selective Control Assessment of the Lower Extremity. We assume that the assessment's gamelike character demanded various other motor control aspects that are less considered in current clinical assessments.

Reference measures of lower-limb muscle strength and selective voluntary motor control (SMVC) in children aged 5–17 years

Reference measures of lower-limb muscle strength and selective voluntary motor control (SMVC) in children aged 5–17 years

Causal factors affecting gross motor function in children diagnosed with cerebral palsy.

Cerebral palsy (CP) is a complex neuromuscular condition that may negatively influence gross motor function. Children diagnosed with CP often exhibit spasticity, weakness, reduced motor control, contracture, and bony malalignment. Despite many previous association studies, the causal impact of these impairments on motor function is unknown. In this study, we proposed a causal model which estimated the effects of common impairments on motor function in children with spastic CP as measured by the 66-item Gross Motor Function Measure (GMFM-66). We estimated both direct and total effect sizes of all included variables using linear regression based on covariate adjustment sets implied by the minimally sufficient adjustment sets. In addition, we estimated bivariate effect sizes of all measures for comparison. We retrospectively evaluated 300 consecutive subjects with spastic cerebral palsy who underwent routine clinical gait analysis. Model data included standard information collected during this analysis. The largest causal effect sizes, as measured by standardized regression coefficients, were found for selective voluntary motor control and dynamic motor control, followed by strength, then gait deviations. In contrast, common treatment targets, such as spasticity and orthopedic deformity, had relatively small effects. Effect sizes estimated from bivariate models, which cannot appropriately adjust for other causal factors, substantially overestimated the total effect of spasticity, strength, and orthopedic deformity. Understanding the effects of impairments on gross motor function will allow clinicians to direct treatments at those impairments with the greatest potential to influence gross motor function and provide realistic expectations of the anticipated changes.

Reliability and validity of the Turkish version of the Selective Control Assessment of the Lower Extremity (SCALE) in children with spastic cerebral palsy

Purpose This study aims to translate the Selective Control Assessment of the Lower Extremity (SCALE) into Turkish language, assess its reliability and validity in children with spastic cerebral palsy. Materials and methods Fifty-two children with CP (mean age 9 years 8 months, range 4–18 years) included in this cross-sectional study. Intra- and interrater reliability was assessed by intraclass correlation coefficient (ICC). The SCALE was correlated with the Gross Motor Function Classification System (GMFCS), the Physician’s Rating Scale (PRS), and Gross Motor Function Measurement (GMFM) to assess validity. Results Intra- and interrater reliability of the SCALE were excellent (ICC > 0.75). SCALE and GMFCS (r = −0.786, p < 0.001), SCALE and PRS (r = 0.761, p < 0.001), SCALE and GMFM (r = 0.863, p < 0.001) were highly correlated. SCALE scores differed significantly between GMFCS levels and between types of spastic CP. Conclusions The Turkish version of the SCALE appears to be a valid and reliable tool to assess selective voluntary motor control of the lower limbs in children with spastic CP. IMPLICATIONS FOR REHABILITATION The Turkish version of the Selective Control Assessment of the Lower Extremity is a valid and reliable assessment for children with spastic CP. The SCALE scores differed significantly between Gross Motor Function Classification System levels I versus II and levels II versus III as well as between types of spastic CP. The current study suggests that the SCALE is a quick and easy outcome measure to assess selective motor control in patients with spastic CP.

Validity and reliability of an electromyography-based similarity index to quantify lower extremity selective voluntary motor control in children with cerebral palsy

ObjectiveTo quantify selective voluntary motor control (SVMC) objectively and more precisely, we combined the “Selective Control Assessment of the Lower Extremity” (SCALE) with surface electromyography. The resulting Similarity Index (SI) measures the similarity of muscle activation patterns. This study evaluated the preliminary validity and reliability of this novel SISCALE measure in children with cerebral palsy (CP). MethodsWe investigated concurrent validity by correlating the SISCALE of 24 children with CP (median age 10.6 years) with comparator assessments. For discriminative validity, the patients’ SISCALE scores were compared to 31 neurologically intact age-matched peers. Test-retest reliability was quantified using intraclass correlation coefficients (ICC) and minimal detectable change (MDC) values. ResultsThe SISCALE correlated strongly with the SCALE (ρ = 0.90, p < .001) and the Gross Motor Function Classification System (ρ = −0.74, p < .001). SISCALE scores were significantly lower in children with CP compared to healthy peers. Test-retest reliability appeared good (for the more and less affected leg, ICC ≥ 0.84, and MDC ≤ 0.17). ConclusionsValidity and reliability of the SISCALE leg and total scores lay within clinically acceptable ranges. Further clinimetric analyses should include responsiveness. SignificanceA neurophysiology-based assessment could contribute to a more refined assessment of SVMC impairments.

Game-based training of selective voluntary motor control in children and youth with upper motor neuron lesions: protocol for a multiple baseline design study

BackgroundImpairments of selective control of joint movements can have consequences for many activities of daily life, but there are only a few interventions to improve selective voluntary motor control (SVMC). We have developed a treatment option to specifically enhance SVMC exploiting the advantages of interactive computer play technology. It targets SVMC by training selective activation of a muscle or a selective joint movement while it provides immediate feedback about involuntary muscle activations/movements at an (unwanted) joint. This study aims to investigate the effectiveness of this game-based intervention to enhance SVMC in children and youth with upper motor neuron lesions.MethodsWe will conduct a randomized, non-concurrent, multiple baseline design study. Patients aged between 6 and 20 years with reduced SVMC due to an upper motor neuron lesion will be included. During the baseline phase of random length, participants will attend their regular intensive rehabilitation program, and in the intervention phase, they will additionally complete 10 therapy sessions (à 40 min) of the game-based SVMC training. The primary outcome will be a short SVMC assessment conducted repeatedly throughout both phases, which quantifies movement accuracy and involuntary movements. Changes in clinical SVMC measures, muscle strength, cortical excitability, motor control of the inhibited/unwanted movement, and functional independence will be assessed as secondary outcomes. We will use a mixed-effect model to determine the change in the course of the primary outcome when the intervention is introduced, and we will compare changes between phases for secondary outcomes with paired tests.DiscussionThis study will provide first evidence whether SVMC can be improved with our game-based training. The single-case design takes into account the individualization required for this intervention, and it can help to address the challenges of intervention trials in our setting.Trial registrationGerman Clinical Trials Register: DRKS00025184, registered on 28.04.2021.

Determining the relationship between the impairment of selective voluntary motor control and gait deviations in children with cerebral palsy using simple video-based analyses.

The impairment of selective voluntary motor control (SVMC) in children with cerebral palsy (CP) has been shown to correlate with their gait characteristics using complex 3D gait analysis systems (3DGA); however, this relationship has not been investigated using simple video-based observational gait analysis (VBOGA). The aim of this study was to determine the relationship between VBOGA and SVMC of the lower extremities in children with CP. Forty-two CP children 10.9 ± 5.7 years old with Gross Motor Function Classification System (GMFCS) levels I-III participated in the study. Their gait characteristics were assessed using the Edinburgh Visual Gait Score (EVGS), and selective voluntary motor control was tested using the Selective Control Assessment of the Lower Extremity (SCALE). Spearman's rho correlation test with Cohen's classification were used in the statistical analyses. The GMFCS levels (r = 0.604, p < 0.001), foot clearance (r = -0.584. p < 0.001), and maximum ankle dorsiflexion (r =-0.567, p < 0.001) during the swing phase had strong correlations with total SCALE scores. There was also a moderate correlation between total SCALE scores and total EVGS (r =-0.494, p < 0.001), knee extension in the terminal swing phase (r = -0.353, p < 0.001), peak sagittal trunk position (r = -0.316, p < 0.005), and maximum lateral shift (r = -0.37, p < 0.001). Impaired lower extremity SVMC was noticeably related to the foot and ankle movements in the swing phase and initial stance during walking as well as the total EVGS scores and sagittal and frontal trunk movements. The SCALE correlations with VBOGA were similar those observed in the complex 3DGA in the literature; therefore, we suggest that SVMC impairment of gait could be evaluated using simple VBOGA. These findings may help to tailor physical therapy programs for CP children to increase their motor control and walking quality.

Selective Motor Control is a Clinical Correlate of Brain Motor Tract Impairment in Children with Spastic Bilateral Cerebral Palsy.

Selective voluntary motor control is an important factor influencing gross motor function, interjoint coordination, and the outcome of hamstring-lengthening surgery in spastic cerebral palsy. Using DTI, we investigated whether selective voluntary motor control would show strong correlations with WM motor tract microstructure and whether selective voluntary motor control is more sensitive to global WM impairment than gross motor function. Children with spastic bilateral cerebral palsy born preterm and typically developing children were recruited. The Selective Control Assessment of the Lower Extremity (SCALE) and Gross Motor Function Measure (GMFM) were assessed in participants with cerebral palsy. Participants underwent brain MR imaging to collect DWI data. Tract-Based Spatial Statistics was used to analyze the WM for between-group differences and correlations with SCALE and GMFM. ROI analyses compared motor regions. Twelve children with cerebral palsy (mean age, 11.5 years) and 12 typically developing children (mean age, 10.3 years) participated. Altered DTI outcomes were found throughout the whole brain for the cerebral palsy group. SCALE, developed to evaluate selective voluntary motor control in cerebral palsy, showed significant positive correlations with fractional anisotropy in more WM voxels throughout the whole brain and for motor regions, including the corticospinal tract and corpus callosum, compared with GMFM. A significant negative correlation between radial diffusivity and SCALE, but not GMFM, was found within the corpus callosum. SCALE was a more sensitive clinical correlate of motor and whole-brain WM tract impairment in children with spastic bilateral cerebral palsy, suggesting greater anisotropy and myelination in these regions for those with higher selective voluntary motor control.

An Interactive Computer Game for Improving Selective Voluntary Motor Control in Children With Upper Motor Neuron Lesions: Development and Preliminary Feasibility Study

BackgroundComputer game–based interventions are emerging in pediatric neurorehabilitation, as they can provide two key elements for motor learning—motivating environments that enable long-term compliance, which is particularly relevant for children, and augmented feedback for improving movement performance.ObjectiveThe overall aim of this study is to develop an interactive computer play for children with upper motor neuron lesions to train selective voluntary motor control and give particular attention to motivation and feedback. We also aim to determine features that make games engaging, investigate which sensory feedback modality is noticed the fastest during play, develop an interactive game, and evaluate its feasibility.MethodsWe identified engaging game features by interviewing 19 children and adolescents undergoing rehabilitation. By using a test version of the game, we determined the response times of 10 patients who had to react to visual, auditory, or combined feedback signals. On the basis of the results of these two subprojects, we developed and designed a game environment. Feasibility was studied in terms of the practicability and acceptability of the intervention among 5 children with upper motor neuron lesions.ResultsThe game features deemed the most important by pediatric patients were strategic gameplay (13/29, 45% of answers) and choice (6/29, 21%). While playing the game, an acoustic alarm signal (reaction time: median 2.8 seconds) was detected significantly faster (P=.01) than conditions with other feedback modalities (avatar velocity reduction: median 7.8 seconds; color desaturation: median 5.7 seconds). Most children enjoyed playing the game, despite some technical issues.ConclusionsThe careful identification of game features that increase motivation and feedback modalities that inform children quickly led to the development of an interactive computer play for training selective voluntary motor control in children and adolescents with upper motor neuron lesions.

Correlation between the Korean Version of the Trunk Control Measurement Scale and the Selective Control Assessment of the Lower Extremity Scores in Children with Cerebral Palsy.

Background and Objectives: The purpose of this study was to investigate the correlation between the Korean version of the trunk control measurement scale (K-TCMS) and the selective control assessment of the lower extremity (SCALE). Through this, we tried to find out the effect of proximal stabilization on distal motor development. Materials and Methods: Fifty-one children with gross motor function classification system level I–III, diagnosed with cerebral palsy (CP), were studied. The K-TCMS was used to evaluate the body control ability of the children. SCALE was used to quantify selective voluntary motor control (SVMC). Results: Analysis of SCALE and K-TCMS showed a significant positive correlation in all items. Multiple regression analysis showed that the SCALE score decreased as age increased, and that it increased as the static sitting balance ability score and the dynamic sitting balance ability score of the K-TCMS increased significantly (p < 0.05). Conclusions: In children with cerebral palsy, there was a close correlation between trunk control and selective voluntary motor control of the lower extremities. Therefore, when trying to improve the lower extremity function of a child with cerebral palsy, a trunk control intervention should be considered.

Reliability and Validity of the Turkish Version of the Selective Control of the Upper Extremity Scale in Children with Cerebral Palsy

Aims To investigate the psychometric properties of the Selective Control of the Upper Extremity Scale (SCUES). Methods Fifty-two children (27 females and 25 males; mean age 9.8 ± 4.4 years) with spastic type of cerebral palsy (CP) participated in the study. Psychometric analyses included reliability, concurrent validity, construct validity, and discriminant validity. Upper Limb Physician’s Rating Scale (ULPRS), Modified Ashworth Scale (MAS), Quality of Upper Extremity Skills Test (QUEST) were used for concurrent validity. Manual Ability Classification System (MACS) was used for construct validity. Differences in SCUES scores were determined between participants categorized according to their limb distribution and MACS levels. Results Intra-rater reliability (intraclass correlation coefficient [ICC] = 0.98) of the SCUES was excellent. SCUES and ULPRS (r = 0.87, p < 0.001), SCUES and MAS (r=-0.93, p < 0.001), SCUES and QUEST (r=0.81, p < 0.001) were highly correlated. SCUES and MACS (r=-0.67, p < 0.001) was moderately correlated. SCUES scores differed significantly between children classifed as MACS levels I versus II and III and between children with hemiparetic and diparetic CP. Conclusion The SCUES appears to be a valid and reliable tool to assess selective voluntary motor control of the upper extremities in children with spastic CP, which may be useful in selecting and planning interventions.

Impact of Upper Extremity Impairment and Trunk Control on Self-Care Independence in Children With Upper Motor Neuron Lesions.

ObjectiveThe purpose of this study was to evaluate the relative importance of different approaches to measure upper extremity selective voluntary motor control (SVMC), spasticity, strength, and trunk control for explaining self-care independence in children affected by upper motor neuron lesions.MethodsThirty-one patients (mean [SD] age = 12.5 [3.2] years) with mild to moderate arm function impairments participated in this observational study. Self-care independence was evaluated with the Functional Independence Measure for children (WeeFIM). Upper extremity SVMC was quantified with the Selective Control of the Upper Extremity Scale (SCUES), a similarity index (SISCUES) calculated from simultaneously recorded surface electromyography muscle activity patterns, and an accuracy and involuntary movement score derived from an inertial-measurement-unit–based assessgame. The Trunk Control Measurement Scale was applied and upper extremity spasticity (Modified Ashworth Scale) and strength (dynamometry) were assessed. To determine the relative importance of these factors for self-care independence, 3 regression models were created: 1 included only upper extremity SVMC measures, 1 included upper extremity and trunk SVMC measures (overall SVMC model), and 1 included all measures (final self-care model).ResultsIn the upper extremity SVMC model (total variance explained 52.5%), the assessgame (30.7%) and SCUES (16.5%) were more important than the SISCUES (4.5%). In the overall SVMC model (75.0%), trunk SVMC (39.0%) was followed by the assessgame (21.1%), SCUES (11.0%), and SISCUES (4.5%). In the final self-care model (82.1%), trunk control explained 43.2%, upper extremity SVMC explained 23.1%, spasticity explained 12.3%, and strength explained 2.3%.ConclusionAlthough upper extremity SVMC explains a substantial portion of self-care independence, overall trunk control was even more important. Whether training trunk control and SVMC can translate to improved self-care independence should be the subject of future research.ImpactThis study highlights the importance of trunk control and selective voluntary motor control for self-care independence in children with upper motor neuron lesions.

Validity and reliability of an electromyography-based upper limb assessment quantifying selective voluntary motor control in children with upper motor neuron lesions.

Current clinical assessments evaluating selective voluntary motor control are measured on an ordinal scale. We combined the Selective Control of the Upper Extremity Scale (SCUES) with surface electromyography to develop a more objective and interval-scaled assessment of selective voluntary motor control. The resulting Similarity Index (SI) quantifies the similarity of muscle activation patterns. We aimed to evaluate the validity and reliability of this new assessment named SISCUES (Similarity Index of the SCUES) in children with upper motor neuron lesions. Thirty-three patients (12.2 years [8.8;14.9]) affected by upper motor neuron lesions with mild to moderate impairments and 31 typically developing children (11.6 years [8.5;13.9]) participated. We calculated reference muscle activation patterns for the SISCUES using data of 33 neurologically healthy adults (median [1st; 3rd quantile]: 32.5 [27.9; 38.3]). We calculated Spearman correlations (ρ) between the SISCUES and the SCUES and the Manual Ability Classification System (MACS) to establish concurrent validity. Discriminative validity was tested by comparing scores of patients and healthy peers with a robust ANCOVA. Intraclass correlation coefficients2,1 and minimal detectable changes indicated relative and absolute reliability. The SISCUES correlates strongly with SCUES (ρ = 0.76, p < 0.001) and moderately with the MACS (ρ = -0.58, p < 0.001). The average SISCUES can discriminate between patients and peers. The intraclass correlation coefficient2,1 was 0.90 and the minimal detectable change was 0.07 (8% of patients' median score). Concurrent validity, discriminative validity, and reliability of the SISCUES were established. Further studies are needed to evaluate whether it is responsive enough to detect changes from therapeutic interventions.

Quantifying age-related differences in selective voluntary motor control in children and adolescents with three assessments.

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.

Validity and reliability of the Selective Control of the Upper Extremity Scale in children with upper motor neuron lesions

Purpose We evaluated the validity and intra-, inter-, and test–retest reliability of the Selective Control of the Upper Extremity Scale (SCUES) sum and item scores in patients with upper motor neuron lesions. Methods Thirty-one boys and 15 girls (mean age ± SD: 11 years 1 month ± 3 years 9 month) with upper motor neuron lesions participated. We correlated SCUES scores with the range of motion items of the Melbourne Assessment 2 (MA2) and Box and Block Test (BBT) to establish concurrent validity and compared scores between the more and less affected side for discriminative validity. Intra-class correlation coefficients (ICC) and smallest detectable changes (SDC) indicated relative and absolute reliability. Results For the more affected side, SCUES sum scores correlated well with MA2 (ρ = 0.83) and BBT (ρ = 0.77), and reliability proved high for intra-rater (ICC = 0.93, SDC = 2.55), inter-rater (ICC = 0.86, SDC = 3.58), and test–retest (ICC = 0.98, SDC = 1.41) reliability. Reliability of single items varied from 0.64 (inter-rater elbow) to 0.98 (intra-rater elbow). Limb and item scores were lower for the more affected side. Conclusion The SCUES limb and item scores seem valid and reliable in children with upper motor neuron lesions. While future studies should evaluate the responsiveness of the SCUES, we recommend that the same rater should score a patient twice. Implications for rehabilitation The SCUES assesses selective voluntary motor control and appears valid and reliable in patients with upper motor neuron lesions. Test–retest reliability of the SCUES seems excellent. SCUES single item scores show concurrent validity and acceptable reliability. Limb and item scores are significantly lower for the more affected side.

Clinical Characteristics Associated with Reduced Selective Voluntary Motor Control in the Upper Extremity of Individuals with Spastic Cerebral Palsy

ABSTRACT Background Selective voluntary motor control (SVMC) in the upper extremity is often impaired in individuals with cerebral palsy (CP) and can be assessed quantitatively and qualitatively using the Test of Arm Selective Control (TASC). Methods Fifty-six individuals with spastic CP (5–18 years old) were included. Descriptors associated with administration of the TASC were analyzed according to the type of CP and arm joint using Chi-square and Kruskal-Wallis tests. ABILHAND-Kids scores were compared between participants with and without mirror movements using a t-test. Results All groups of children with spastic CP had incidence of TASC movement descriptors. There was a main effect of topography of CP on extra movements, decreased active range of motion, tightness, spasticity, and mirroring, and an additional main effect of joint on mirroring. Participants with mirroring had lower ABILHAND-Kids scores than those without mirroring. Conclusions Systematically observing arm movements using the TASC revealed differences across participants.

Effect of Robot-Assisted Gait Training on Selective Voluntary Motor Control in Ambulatory Children with Cerebral Palsy

This pilot study investigated the efficacy of a four week robot-assisted gait training in twelve children with spastic diparesis. Short-term results and a 3-month follow-up showed statistically significantly increased selective motor control, walking farther distances, gross motor score, and decreased joint contractures.

Validity and reliability of an accelerometer-based assessgame to quantify upper limb selective voluntary motor control

IntroductionCurrent clinical assessments measure selective voluntary motor control (SVMC) on an ordinal scale. We introduce a playful, interval-scaled method to assess SVMC in children with brain lesions and evaluate its validity and reliability.MethodsThirty-one neurologically intact children (median [1st-3rd quartile]: 11.6 years [8.5–13.9]) and 33 patients (12.2 years [8.8–14.9]) affected by upper motor neuron lesions with mild to moderate impairments participated. Using accelerometers, they played a movement tracking game (assessgame) with isolated joint movements (shoulder, elbow, lower arm [pro−/supination], wrist, and fingers), yielding an accuracy score. Involuntary movements were recorded simultaneously and resulted in an involuntary movement score. Both scores were normalized to the performance of 33 neurologically intact adults (32.5 years [27.9; 38.3]), which represented physiological movement patterns.We correlated the assessgame outcomes with the Manual Ability Classification System, Selective Control of the Upper Extremity Scale, and a therapist rating of involuntary movements. Furthermore, a robust ANCOVA was performed with age as covariate, comparing patients to their healthy peers at the age levels of 7.5, 9, 10.5, 12, and 15 years.Intraclass correlation coefficients and smallest real differences indicated relative and absolute reliability.ResultsCorrelations (Kendall/Spearman) for the accuracy score were τ = 0.29 (p = 0.035; Manual Ability Classification System), ρ = − 0.37 (p = 0.035; Selective Control of the Upper Extremity Scale), and ρ = 0.64 (p < 0.001; therapist rating). Correlations for the involuntary movement metric were τ = 0.37 (p = 0.008), ρ = − 0.55 (p = 0.001), and ρ = 0.79 (p < 0.001), respectively. The robust ANCOVAs revealed that patients performed significantly poorer than their healthy peers in both outcomes and at all age levels except for the dominant/less affected arm, where the youngest age group did not differ significantly. Robust intraclass correlation coefficients and smallest real differences were 0.80 and 1.02 (46% of median patient score) for the accuracy and 0.92 and 2.55 (58%) for involuntary movements, respectively.ConclusionWhile this novel assessgame is valid, the reliability might need to be improved. Further studies are needed to determine whether the assessgame is sensitive enough to detect changes in SVMC after a surgical or therapeutic intervention.