Bimanual force coordination in children with spastic unilateral cerebral palsy

In this study bimanual grip–force coordination was quantified using a novel “Gripper” system that records grip forces produced while holding a lower and upper unit, in combination with the lift force necessary to separate these units. Children with unilateral cerebral palsy (CP) (aged 5–14 years, n = 12) were compared to age matched typically developing (TD) children (n = 23). Compared to TD, the CP-group is much slower and takes 50% more time to generate grip and lift forces with more fixating force before lifting the upper unit. In addition the coordination between forces in both hands is reduced. The CP-group increases the lift force in the upper hand 2.5 times more than the holding force when pulling the two units apart, while this is only 1.5 times in TD. Moreover, the correlation between forces generated in both hands in the CP-group is lower. The lack of fine tuning of the forces, measured by the linearity error is increased, especially when the magnet load keeping the unit together is low. The results indicate an impaired pull–hold synergy between upper and lower hand and the lift force. Bimanual tasks evaluating bimanual grip and lift forces in children with CP and can give us new insights in the underlying force control mechanisms of the spastic hand.

► Children with unilateral cerebral palsy have large bimanual limitations.
► Bimanual tasks are highly sensitive to differences between typically developing children and children with unilateral cerebral palsy.
► An instrumented test, like the gripper, may fill a gap that currently exists for a simple and clinically accessible objective test of grip force generation.
► Evaluating bimanual tasks can give us new insights in the underlying force control mechanisms of the spastic hand.