Upper Limb Motion Analysis

Upper Limb Motion Analysis
By Kimberly Wesdock, PT, MS, PCS, Pediat= ric Physical Therapist

Treatment plans are challenging to establish in individuals with complex upper limb involvement, such as cerebral palsy (CP), brachial plexus birth palsy (BPBP), spinal cord injury or arthrogryposis. Evaluation for upper limb surgery or treatment to imp= rove function in these individuals is not always easily accomplished within a physician office setting. Rushed clinic appointme= nts, inability of the individual to relax during physician examination, as well = as complexity of upper limb functional problems all combine to render pre-treatment assessment quite difficult.

Conversely, the motion analysis laboratory setting lends itself to a more comprehensive evaluation in order to differentiate among such problems as spasticity, impaired sensation, contractures (loss of joint motion), muscle tightness, poor motor control and abnormal muscle firing patterns in the upper limbs. In individuals with BPBP, accurate documentation of scapular (should= er blade), shoulder, elbow, forearm and hand movements vs. compensation patterns is crucial when designing treatment strategies. When indicated, the use of surface and/or fine wire electromyography (EMG), which tests electrical activity of muscles, can be synchronized with upper limb kinematics (technology involving special motion cameras and reflective mark= ers strategically placed on anatomic landmarks of the arms and hands to track movement) and videography (visual images recorded using high-definition DVD cameras) during standardized functional upper limb tests. This comprehensive evaluation tool provides more optimal treatment planning prior to surgical, pharmacological (management using medications or drugs) or therapy interven= tions for individuals with upper limb dysfunction. A detailed musculoskeletal and neuromuscular examination, activities of daily living (ADL) assessment, and parental and child goal-setting are also part of the evaluation and treatme= nt planning process.

Accurate evaluation of upper limb impairments and functional skill sets = is important. A comprehensive upper limb motion ana= lysis evaluation performed pre- and post-intervention:

1= .      allows physicians and treating clinicians to plan upper limb surgical, pharmacolog= ical or therapy procedures more appropriately,

2= .      permits documentation of baseline and post-treatment function in order to record clinical outcomes,

3= .      assists in the establishment of treatment plans for specific interventions,

4= .      enables clinicians to conduct outcomes-based research to add to the literature on t= he management of upper limb dysfunction and

5= .      assists third party payors in establishing reimburseme= nt guidelines for treatment interventions.

The comprehensive upper limb protocol was developed in the Motion Analys= is Laboratory at Children’s Hospital after consultation with the current literature, pediatric orthopaedic and hand surgeons, physiatrists, pediatric occupational and physical therapists experienced with CP and BPBP, certified hand therapists (CHTs), and the few motion analysis laboratories and centers across the country currently performing upper limb analysis. Depending on t= he diagnosis of the individual referred for an upper limb analysis, the testing protocol may include the following: Pediatric Evaluation of Disability Inventory (PEDI)-Self-Care section; active and passive goniometric (joint angle) measurements of shoulder, elbow, forearm, wrist and finger movements; specific manual muscle testing; sensibility (including stereognosis and 2-p= oint discrimination); grip and pinch strength; spasticity scales and hypertonia classification; associated reactions; resting position; and surface or fine wire EMG (when indicated) during the Jebson-Taylor Test of Hand Function synchronized with upper limb= kinematics. Upper limb kinematics during the Mallet classification scale maneuvers are collected in individuals with BPBP.

All functional testing and activities are videotaped using high-definition DVD cameras, often with split-scr= een views. Both the pa= rents and the individual referred for motion analysis assist with establishing th= eir own goals for treatment. After the patient testing session, the Motion Analysis Laboratory physical therapist carefully analyzes the data and comp= iles a comprehensive report, which may include video clips of the individual performing both unilateral and bimanual= functional task= s using the hands and arms. The Motion Analysis Laboratory Medical Direc= tor, Chester Sharps, MD, a pediatric orthopaedic surgeon, reviews all reports and includes treatment or surgical recommendations. A DVD may accompany the rep= ort so that the referring physician can view the videotaped activities. <= /p>
Referrals for Upper Limb Motion Analysis or Gait Analysis are accepted f= rom in-state as well as out-of-state physicians. W= e can also evaluate for the SaeboFlex Orthosis, which can help achieve improved g= rasp and release function of the hand, in conjunction with a therapy program. While mostly children, adolescents and teenagers are evaluated in the Motion Analysis Laboratory, referrals for adults are also accepted. Referrals are accepted via fa= x at (804) 321-2728 (Attention: Motion Analysis Lab).

If you have questions about Upper Limb Motion Analysis, or about serv= ices offered by the Motion Analysis Laboratory, contact Kimberly Wesdock, Pediat= ric Physical Therapist, at (804) 228-5824 or kwesdock@chva.org.