Detection of pronator muscle overactivity in children with unilateral spastic cerebral palsy: Development of a semi-automatic method using EMG data.
BACKGROUND
The pronator teres and pronator quadratus muscles are frequently injected with neuromuscular blocking agents to improve supination in children with spastic cerebral palsy and limited active elbow supination. However, determining by simple clinical examination whether these muscles are overactive during active movement is difficult.


OBJECTIVE
This study aimed to develop a semi-automatic method to detect pronator muscle overactivity by using surface electromyography (EMG) during active supination movements in children with cerebral palsy.


METHODS
In total, 25 children with unilateral spastic cerebral palsy (10 males; mean [SD] age 10.6 [3.0] years) and 12 typically developing children (7 males; mean age 11.0 [3.0] years) performed pronation-supination movements at 0.50Hz. Kinematic parameters and surface EMG signals were recorded for both pronator muscles. Three experts visually assessed muscle overactivity in the EMG signals of the children with cerebral palsy, in comparison with the reference group. The reliability and discrimination ability of the visual assessments were analysed. Overactivity detection thresholds for the semi-automatic method were adjusted by using the visual assessment by the EMG experts. The positive and negative predictive values of the semi-automatic detection method were calculated.


RESULTS
Intra-rater reliability of visual assessment by EMG experts was excellent and inter-rater reliability was moderate. For the 25 children with unilateral spastic cerebral palsy, EMG experts could discriminate different profiles of pronator overactivity during active supination: no pronator overactivity, one overactive pronator, or overactivity of both pronators. The positive and negative predictive values were 96% and 91%, respectively, for this semi-automatic detection method.


CONCLUSIONS
Detection of pronator overactivity by using surface EMG provides an important complement to the clinical examination. This method can be used clinically, with the condition that clinicians be aware of surface EMG limitations. We believe use of this method can increase the accuracy of treatment for muscle overactivity, resulting in improved motor function and no worsening of paresis.
['Sarcher|Aurélie|A|', 'Brochard|Sylvain|S|', 'Perrouin-Verbe|Brigitte|B|', 'Raison|Maxime|M|', 'Letellier|Guy|G|', 'Leboeuf|Fabien|F|', 'Gross|Raphaël|R|']
D000293:Adolescent D001696:Biomechanical Phenomena D016022:Case-Control Studies D002547:Cerebral Palsy D002648:Child D004550:Elbow D004576:Electromyography D005260:Female D006801:Humans D008297:Male D009128:Muscle Spasticity D011237:Predictive Value of Tests D011403:Pronation D015203:Reproducibility of Results D013484:Supination
Pronators Overactivity Children Cerebral palsy Electromyography Forearm supination