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Classification of upper limb disability levels of children with spastic unilateral cerebral palsy using K-means algorithm

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Abstract

Treatment for cerebral palsy depends upon the severity of the child’s condition and requires knowledge about upper limb disability. The aim of this study was to develop a systematic quantitative classification method of the upper limb disability levels for children with spastic unilateral cerebral palsy based on upper limb movements and muscle activation. Thirteen children with spastic unilateral cerebral palsy and six typically developing children participated in this study. Patients were matched on age and manual ability classification system levels I to III. Twenty-three kinematic and electromyographic variables were collected from two tasks. Discriminative analysis and K-means clustering algorithm were applied using 23 kinematic and EMG variables of each participant. Among the 23 kinematic and electromyographic variables, only two variables containing the most relevant information for the prediction of the four levels of severity of spastic unilateral cerebral palsy, which are fixed by manual ability classification system, were identified by discriminant analysis: (1) the Falconer index (CAI E ) which represents the ratio of biceps to triceps brachii activity during extension and (2) the maximal angle extension (θ Extension,max). A good correlation (Kendall Rank correlation coefficient = −0.53, p = 0.01) was found between levels fixed by manual ability classification system and the obtained classes. These findings suggest that the cost and effort needed to assess and characterize the disability level of a child can be further reduced.

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Abbreviations

AROM:

Active range of motion

AHA:

Assisting hand assessment

CAI:

Co-activation index

CFCS:

Communication function classification system

DUL:

Dominant upper limb

EMG:

Electromyography

IUL:

Involved upper limb

GMFCS:

Gross motor function classification system

MACS:

Manual ability classification system

MCC:

Multiple correlation coefficients

PS:

Pronation/supination

SENIAM:

Surface electromyography for the noninvasive assessment of muscles

SUCP:

Spastic unilateral cerebral palsy

TD:

Typically developing

QUEST:

The quality of upper extremity skills test

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Authors and Affiliations

  1. Institute of Biomedical Engineering, École Polytechnique de Montréal, Montreal, QC, Canada

    Sana Raouafi

  2. Department of Mechanical Engineering, Machine Design Section, École Polytechnique de Montréal, Montreal, Canada

    Sofiane Achiche & Maxime Raison

  3. Department of Kinesiology, Université de Montréal, Montreal, QC, Canada

    Mickael Begon

  4. Motion Analysis Laboratory, Physical Medicine and Rehabilitation, Saint Jacques Hospital, University Hospital of Nantes, Nantes, France

    Aurélie Sarcher

  5. CRME – Research Center, Office GR-123, 5200, East Bélanger Street, H1T 1C9, Montreal, QC, Canada

    Sana Raouafi & Maxime Raison

Authors
  1. Sana Raouafi
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  2. Sofiane Achiche
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  3. Mickael Begon
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  4. Aurélie Sarcher
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  5. Maxime Raison
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Correspondence to Sana Raouafi.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study were in accordance with the Research Ethics Boards of Ste. Justine Hospital. The authorization was written and approved by the parents or guardians of the children involved, and informed assent was obtained from all children.

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Raouafi, S., Achiche, S., Begon, M. et al. Classification of upper limb disability levels of children with spastic unilateral cerebral palsy using K-means algorithm. Med Biol Eng Comput 56, 49–59 (2018). https://doi.org/10.1007/s11517-017-1678-y

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  • DOI: https://doi.org/10.1007/s11517-017-1678-y

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