Can mastication in children with cerebral palsy be analyzed by clinical observation, dynamic ultrasound and 3D kinematics? L. Remijn, B.E. Groen, R.

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Can mastication in children with cerebral palsy be analyzed by clinical observation, dynamic ultrasound and 3D kinematics? L. Remijn, B.E. Groen, R. Speyer, J. van Limbeek, J.A. Vermaire, L. van den Engel-Hoek, M.W.G. Nijhuis-van der Sanden Journal of Electromyography and Kinesiology Volume 32, Pages 22-29 (February 2017) DOI: 10.1016/j.jelekin.2016.11.005 Copyright © 2016 Elsevier Ltd Terms and Conditions

Fig. 1 Ultrasound and 3D kinematic measurements. (a) The position of the transducer for ultrasound measurement (left). Illustration of a B-mode frame. The highlighted point indicates the highest point of the tongue contour (right). (b) Set-up of the marker frames for recording of the 3D kinematics (left). Illustration of the 3D reconstruction of the markers in Vicon (right). Journal of Electromyography and Kinesiology 2017 32, 22-29DOI: (10.1016/j.jelekin.2016.11.005) Copyright © 2016 Elsevier Ltd Terms and Conditions

Fig. 2 Profile of the MOE instrument of typically developing children (n=14) and individual profiles of children with spastic cerebral palsy (CP), based on the median score of five trials. The points on the outside of the plot correspond with MOE items: 1=Tongue protrusion; 2=Lateral tongue movement; 3=Munching; 4=Jaw movement; 5=Chewing duration; 6=Loss of food or saliva; 7=Number of swallows; 8=Fluency and coordination. The dark solid line in the plot corresponds with the scores per item. Score 4 indicates best (mature) performance and score 1 indicates poor performance. GMFCS: Gross Motor Functioning Classification System. IQ: Intelligence Quotient. Journal of Electromyography and Kinesiology 2017 32, 22-29DOI: (10.1016/j.jelekin.2016.11.005) Copyright © 2016 Elsevier Ltd Terms and Conditions

Fig. 3 Results for the typically developing (TD) group (n=14) and individual children with spastic cerebral palsy (CP) for ultrasound and kinematic measurements. a. Displacement of the tongue in left-right (LR) and up-down (UD) direction. (b) Frequency of the LR and UD tongue displacement. (c) Mandible movement in horizontal, vertical and anterior direction. Bold horizontal line=95% CI. Journal of Electromyography and Kinesiology 2017 32, 22-29DOI: (10.1016/j.jelekin.2016.11.005) Copyright © 2016 Elsevier Ltd Terms and Conditions