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