The effect of lower body stabilization and different writing tools on writing biomechanics in children with cerebral palsy. 2013

Hsin-Yi Kathy Cheng, and Yueh-Ju Lien, and Yu-Chun Yu, and Yan-Ying Ju, and Yu-Cheng Pei, and Chih-Hsiu Cheng, and David Bin-Chia Wu
Graduate Institute of Early Intervention, Medical College, Chang Gung University, 259 Wen-Hua 1st Rd., Kwei-Shan, Tao-Yuan 333, Taiwan. kcheng@mail.cgu.edu.tw

A high percentage of children with cerebral palsy (CP) have difficulty keeping up with the handwriting demands at school. Previous studies have addressed the effects of proper sitting and writing tool on writing performance, but less on body biomechanics. The aim of this study was to investigate the influence of lower body stabilization and pencil design on body biomechanics in children with CP. Fourteen children (12.31±4.13 years old) with CP were recruited for this study. A crossover repeated measures design was employed, with two independent variables: lower body stabilization (with/without) and pencil (regular/assigned grip height/biaxial). The writing task was to trace the Archimedean spiral mazes. Electromyography (EMG) of the upper extremity, the wrist flexion/extension movements, and the whole body photography were recorded to quantify the changes in posture and upper extremity biomechanics. Two-way repeated measures ANOVA was used for statistical analysis. No significant main effects were revealed in the EMG and wrist kinematics. The lower body stabilization significantly decreased the trunk lateral and forward deviations, and the visual focus-vertical angle. The biaxial pencil and the assigned grip height design significantly decreased the head, shoulder, trunk, and pelvic deviations compared with the regular design. The results indicated that the lower body positioning was effective in improving the trunk posture. A pencil with an assigned grip height or with a biaxial design could improve head, shoulder, trunk and pelvic alignment, but did not influence the muscle exertion of the upper extremity. This study could provide guidelines for parents, teachers and clinicians regarding the selection of writing tools and the knowledge of proper positioning for the children with handwriting difficulties. Further analyses can focus on the design, modification and clinical application of assitive sitting and writing devices for the use in children with handwriting difficulties.

UI MeSH Term Description Entries
D008297 Male Males
D011187 Posture The position or physical attitude of the body. Postures
D002547 Cerebral Palsy A heterogeneous group of nonprogressive motor disorders caused by chronic brain injuries that originate in the prenatal period, perinatal period, or first few years of life. The four major subtypes are spastic, athetoid, ataxic, and mixed cerebral palsy, with spastic forms being the most common. The motor disorder may range from difficulties with fine motor control to severe spasticity (see MUSCLE SPASTICITY) in all limbs. Spastic diplegia (Little disease) is the most common subtype, and is characterized by spasticity that is more prominent in the legs than in the arms. Pathologically, this condition may be associated with LEUKOMALACIA, PERIVENTRICULAR. (From Dev Med Child Neurol 1998 Aug;40(8):520-7) Diplegic Infantile Cerebral Palsy,Little Disease,Monoplegic Cerebral Palsy,Quadriplegic Infantile Cerebral Palsy,Spastic Diplegia,CP (Cerebral Palsy),Cerebral Palsy, Athetoid,Cerebral Palsy, Atonic,Cerebral Palsy, Congenital,Cerebral Palsy, Diplegic, Infantile,Cerebral Palsy, Dyskinetic,Cerebral Palsy, Dystonic-Rigid,Cerebral Palsy, Hypotonic,Cerebral Palsy, Mixed,Cerebral Palsy, Monoplegic, Infantile,Cerebral Palsy, Quadriplegic, Infantile,Cerebral Palsy, Rolandic Type,Cerebral Palsy, Spastic,Congenital Cerebral Palsy,Diplegia, Spastic,Infantile Cerebral Palsy, Diplegic,Infantile Cerebral Palsy, Monoplegic,Infantile Cerebral Palsy, Quadriplegic,Little's Disease,Monoplegic Infantile Cerebral Palsy,Rolandic Type Cerebral Palsy,Athetoid Cerebral Palsy,Atonic Cerebral Palsy,Cerebral Palsies, Athetoid,Cerebral Palsies, Dyskinetic,Cerebral Palsies, Dystonic-Rigid,Cerebral Palsies, Monoplegic,Cerebral Palsy, Dystonic Rigid,Cerebral Palsy, Monoplegic,Diplegias, Spastic,Dyskinetic Cerebral Palsy,Dystonic-Rigid Cerebral Palsies,Dystonic-Rigid Cerebral Palsy,Hypotonic Cerebral Palsies,Hypotonic Cerebral Palsy,Mixed Cerebral Palsies,Mixed Cerebral Palsy,Monoplegic Cerebral Palsies,Spastic Cerebral Palsies,Spastic Cerebral Palsy,Spastic Diplegias
D002648 Child A person 6 to 12 years of age. An individual 2 to 5 years old is CHILD, PRESCHOOL. Children
D004576 Electromyography Recording of the changes in electric potential of muscle by means of surface or needle electrodes. Electromyogram,Surface Electromyography,Electromyograms,Electromyographies,Electromyographies, Surface,Electromyography, Surface,Surface Electromyographies
D005260 Female Females
D006236 Handwriting Manual writing with a pen or pencil.
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000293 Adolescent A person 13 to 18 years of age. Adolescence,Youth,Adolescents,Adolescents, Female,Adolescents, Male,Teenagers,Teens,Adolescent, Female,Adolescent, Male,Female Adolescent,Female Adolescents,Male Adolescent,Male Adolescents,Teen,Teenager,Youths
D000704 Analysis of Variance A statistical technique that isolates and assesses the contributions of categorical independent variables to variation in the mean of a continuous dependent variable. ANOVA,Analysis, Variance,Variance Analysis,Analyses, Variance,Variance Analyses

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