Kinematic characteristics of arm and trunk when drinking from a glass in children with and without cerebral palsy.

BACKGROUND: Children with cerebral palsy (CP) often have difficulty with activities that require the upper extremities secondary to deficits in strength and range of motion, spasticity, and poor timing and coordination of movement. This study aimed to identify and compare timing and coordination of the trunk and upper extremity in children with and without CP during a functional task. METHODS: Eighteen children, N = 9 with CP and N = 9 with typical development were enrolled. Participants were seated in a standard chair and instructed to drink from a glass placed at a distance of 75% of available arm length. The task was divided into 3 Phases: 1) reaching to the glass, 2) transporting the glass to the mouth, and 3) returning the glass to the table. The spatiotemporal and angular variables were analyzed with 3D kinematics of movement using a 4-camera Qualysis Motion System. FINDINGS: Children with CP demonstrated poor upper extremity timing and coordination. Despite significant trunk displacement used as a compensation in Phase 1, children with CP demonstrated a significantly lower mean velocity and velocity peak during Phases 2 and 3; and demonstrated less straight motion which required more time and movement units in all phases. INTERPRETATION: Children with CP demonstrated poor upper extremity timing and coordination when drinking (even when they successfully completed the task) measured by more trunk displacement, slower, less straight movements, and more movement units. Current rehabilitation strategies could consider training speed and use functional tasks that require different strategies across multiple phases.

Characterization and intervention for upper extremity exploration & reaching behaviors in infancy.

This article aims to: 1) highlight general exploration, reaching, and object exploration behaviors as key activities of daily living in infancy, 2) describe how knowledge of early warning signs for these behaviors may improve early assessment, and 3) discuss interventions that may advance performance of these behaviors. Early intervention should focus on improving performance of these behaviors because: a) these early, interrelated upper extremity behaviors serve an integral role in global learning and development in infancy, b) among at-risk populations, differences have been observed in the quantity and quality of performance of these behaviors and, in many cases, these differences are associated with related perceptual-motor and cognitive delays. This article highlights how early assessment and intervention can target these key early behaviors in populations at risk for upper extremity disabilities, such as those born preterm, with Down syndrome, brachial plexus palsy, or arthrogryposis multiplex congentia.

A parallel process seminar for use in programs of Clinical Pastoral Education (CPE).

A seminar model is developed and used for students in Clinical Pastoral Education to explore parallel process dynamics operative in their ministry. One of the key assumptions on which this seminar is designed is that students will present material from their work with patients that carry relational dynamics that parallel the students' intra-psychic dynamics. Verbatim material presented is used in the learning group to identify and respond to the presenter's intra-psychic dynamics and their implication for ministry--to provide support, clarification, and/or confrontation with the intent of facilitating personal and professional growth.

Shoulder and elbow joint power differ as a general feature of vertical arm movements.

Consistent patterns of joint power underlie coordinated lower extremity behaviors such as running and walking. Recent work found that shoulder and elbow power consistently differed during reaching movements in the horizontal plane. Moreover, joint power during horizontal reaching appears correlated with motor cortical activity. It is not known if the feature of differential joint power extends to vertical plane reaches or to reaches of different movement conditions. The purpose of this study was to test for differential shoulder and elbow power during the acceleratory and deceleratory phases of fast and normal speed vertical reaches in sitting and supine positions. Our results suggest that shoulder and elbow power typically differed both within and across conditions. First, shoulder power values were positive or negative dependent largely on movement direction and movement phase. That is, for each direction and phase, the shoulder either generated or absorbed energy independent of speed or body position. Second, and unexpectedly, reaches of certain condition combinations had similar shoulder power magnitudes across directions. In contrast, elbow power values for each direction varied between positive and negative values depending on phase, speed and position, and no two condition combinations overlapped across directions. Third, as target direction, movement phase and body position varied, shoulder power at fast and normal speeds were linearly correlated, as was shoulder power in sitting and in supine. In contrast, elbow power was linearly correlated only between speeds. These results join other studies to suggest that the neuromotor control of the shoulder may be less complex as compared to the elbow as a general feature of reaching movements. This differential control has important implications for the study of reaching impairments in neurorehabilitation populations, and provides a potentially important variable in the study of cortical firing patterns.