Neuropediatrics 2015; 46 - FV01-09
DOI: 10.1055/s-0035-1550645

The Objective Measurement of Diadochokinesis in Children with Bilateral Spastic Cerebral Palsy

M. Niklasch 1, S. Mattner 1, B. Krautwurst 1, M. Maier 1, M. Klotz 1, O. Rettig 1, S. Wolf 1, T. Dreher 1
  • 1Universitätsklinik Heidelberg, Heidelberg, Germany

Aim: More than 80% of children with infantile cerebral palsy (ICP) have limitations in upper limb movements (MACS > 2) and more than 35% already acquire contractures during childhood.1, 2

The development of successful treatment strategies requires a better understanding of the modified movement patterns.

The aim of this project is to study the diadochokinesis, that is, the sequence of fast active antagonistic movements, to measure the range of movement, velocities, and accelerations of antagonistic movements in children with ICP and MACS 1 to 2.

Methods: A total of 20 typically developing (10 ? 2 years) and 14 children (8 * MACS 1, 6 * MACS 2) with bilateral spastic ICP (11 ? 2 years) were prospectively included in this study.

Exclusion criteria were a history of interventions in the upper limbs and contractures in the pro/supination. Three-dimensional motion analysis was used to record the diadochokinesis of pronation and supination objectively.


Typically, developing children performed the agonistic and antagonistic movement with the same velocity. In contrast, among children with MACS 1 pronation was significantly slower, whereas among the children with MACS 2 pronation significantly faster than supination.

Conclusion: The reduced speed when performing manual tasks at MACS 1 does not result from an actual reduction of the maximum movement velocity and acceleration.

The imbalance of agonistic and antagonistic movement velocity and acceleration—caused by spasticity results in reduced speed and accuracy while handling objects.

Keywords: cerebral palsy, upper limb, motion analysis, diadochokinesis.



1 Eliasson AC, Krumlinde-Sundholm L, Rösblad B, et al. The Manual Ability Classification System (MACS) for children with cerebral palsy: scale development and evidence of validity and reliability. Dev Med Child Neurol 2006;48(7):549–554

2 Makki D, Duodu J, Nixon M. Prevalence and pattern of upper limb involvement in cerebral palsy. J Child Orthop 2014;8(3):215–219