The development and validation of a movement evaluation system for children with cerebral palsy

Sanchez Puccini, Maria Beatriz (2017) The development and validation of a movement evaluation system for children with cerebral palsy. Doctoral thesis (PhD), Manchester Metropolitan University.

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Abstract

The development of objective assessment tools for evaluation in physiotherapy is vital. Currently, the outcomes resulting from an intervention are generated by clinical assessments that are almost exclusively based on subjective criteria which rely upon the assessor’s expertise and consistency. The aim of this project was to develop an objective clinical tool to measure head and trunk postural control in sitting for children with cerebral palsy (CP). It is preferable for any objective measurement tool to be useable with as wide a range of patients and conditions as possible. Ideally, the tool should also be ‘clinically-friendly’ for both therapist and patient. This project took children with CP as a starting point, as representing one of the most challenging groups to assess and to quantify. The project was specifically focused on head-trunk control in sitting because of the importance of this posture for activities of daily living. The Literature Reviews confirmed that head-trunk control status in sitting could be defined by an aligned sitting posture without any external support for the head, trunk and upper limbs. The Method selected was video-based (Dartfish) to meet the requirement of ‘clinically-friendly’ and developed to quantify alignment (and deviations from alignment) of the head and trunk with small errors when compared to a 3D motion capture system (Vicon). The Dartfish method was also used to classify the positions of the upper limbs in comparison with the standard clinical classification; it showed that a simplified representation of the hands and elbows can reflect the clinical judgement. The combination of both these elements enabled the quantification of head/trunk control in children with CP for the first time. The work presented in this thesis makes a new and major contribution to postural assessment. It also provides the basis for the development of a fully automated system for the objective assessment of control using 2D-video recording. This work confirmed that clinical assessments can be objectively replicated, representing a major advance in the validation of physiotherapy interventions.