Assessment of upper and lower extremity movements in hemiplegic children

Upper and lower extremity movements were assessed in 26 children with spastic hemiplegia according to the modified Brunnstrom method. Of the upper extremity movements, supinating the forearm was most difficult, followed in order by pronating the forearm, flexing the shoulder to 90 degrees, flexing the shoulder to 180 degrees, abducting the shoulder to 90 degrees or putting the hand on the lumbar spine, putting the hand behind the ipsilateral ear (flexor synergy), and putting the hand on the contralateral knee (extensor synergy). The extensor and flexor synergies were easier than the other movements in the hemiplegic children as well as in hemiplegic adults, but the order of difficulty in the other movements in children was not the same as in adults. The difficulty in the lower extremity movements was uniform in the subjects. None of the children could dorsi-flex the ankles and many could not rotate the hips internally. A small number of the children could not flex the knees or perform straight leg raising. All children could flex the hips and knees, extend the hips and knees, and abduct the hips. The difficulty in isolated hip abduction and flexion was less prominent in the hemiplegic children, compared to in hemiplegic adults.