Background Good control of trunk and pelvic movements is necessary for
September 5, 2017
Background Good control of trunk and pelvic movements is necessary for well controlled leg movements required to perform activities of daily living. captured in real-time by a Vicon 612 optoelectronic system tracking two clusters of three markers attached to the sacrum and thoracic spine. Results Convex hull areas calculated from angle-angle plots of pelvic and trunk rotations showed that coupling increased over game training (p?=?0.478, Mean – 2??STD p?=?0.002). Physique 4 The reducing means of convex hull areas show increased 1352608-82-2 IC50 coupling 1352608-82-2 IC50 between the trunk and pelvis over the 13 game sessions. Due to their spatial distribution, reaching half of the balloon targets required less pelvic rotation (Near targets) than reaching the other half (Much targets), Physique?1. Separating the means of logArea for Near and Much targets for all the Sessions, a paired showed that trunk to pelvis in-phase coupling is usually stronger for Much targets than for Near targets (Physique?5), t12?=?3.259, p?=?0.007. Physique 5 The convex hull areas indicate increased coupling (smaller logArea) between the trunk and pelvis when navigating to Much targets as compared to Near targets. Discussion Over the period of six weeks while targeting movement training to the pelvis in a patient with cerebral KIAA0937 palsy, a progressive development of increased coupling of the pelvis to the trunk was found. This strategy improved overall performance during gameplay which we have reported elsewhere  but improved selective movement control of pelvic rotation was not achieved. Previous findings show better movement control of the trunk in comparison to the pelvis in children with cerebral palsy during computer based game-play . The tighter coupling of the pelvis to the trunk appears to be a compensatory mechanism which enables the child to improve control of the pelvis indirectly by locking it to the better controlled trunk. Co-contraction, that is simultaneous activation of agonist and antagonist muscle tissue, is usually a common motor control strategy used to improve stability and accuracy when performing an unpractised task . Levels of co-contraction decrease over time with practice. Playing the training game twice a week for 30?minutes over 6?weeks appears 1352608-82-2 IC50 to have resulted in the interlocking of the trunk and pelvis, representing the initial response to the new game task. Intensifying exposure to 1352608-82-2 IC50 the game by means of increased frequency or duration of play, or both, may lead to reduced coupling between the trunk and pelvis as selective control enhances. Development of strategies compensating for impaired movement can be prevented by constraint induced movement therapy which actually inhibits the compensation thereby forcing use of the targeted movement . Such a constraint preventing the use of trunk rotation while driving the GPO game with pelvic rotation can be provided by the game software and may be a means to facilitate use of the pelvis independent of the trunk. The GPO game can be set to either give a visual warning in case of trunk rotation or to be driven by the difference between pelvic and trunk rotation thereby preventing coupled motion. Initial tests however showed that typically developing children found it more difficult to play the game with such control techniques so they were not examined in the present study. An increased level of coupling was found when using a big range of pelvic rotation needed to reach targets far from the midline. The child was able to move the pelvis with less in-phase coupling when small ranges were required (indicated by higher logArea) but pelvic movement was aided by in-phase coupled trunk rotation when reaching targets further away from the midline (confirmed by lower logArea). Over the period of six weeks training the level of coupling increased but the difference of coupling over small and large ranges of pelvic rotations remained (Physique?5). Functional steps of the patient showed mixed results when comparing overall performance before and after game training. On one hand the Segmental Assessment of Trunk Control scores increased (SATCo Static:2??4 Active:1??1 Reactive:NA??2 ), the childs parents commented on improved sitting posture and the swimming coach reported improvements in swimming. On the 1352608-82-2 IC50 other hand an objective evaluation of the patients deviation from normality using the Gait Deviation Index  showed negligible changes in gait (75.6??75.0). Conclusions Our case study of a child with cerebral palsy diplegia exhibited that control was translated from your trunk to the pelvis through tighter coupling over six weeks training consisting of thirteen game sessions. Increased exposure to the game is usually expected to lead to reduction of.