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Updated: Jun 28, 2026
Event-related Potentials During Target-response Tasks to Study Cognitive Processes of Upper Limb Use in Children with Unilateral Cerebral Palsy
Published on: January 11, 2016
Hand function in cerebral palsy. Report of 367 children in a population-based longitudinal health care program
Marianne Arner1, A-C Eliasson, S Nicklasson
1Department of Hand Surgery, Stockholm South Hospital, Stockholm, Sweden. marianne.arner@sodersjukhuset.se
Insights
Hand function limitations are prevalent in children with cerebral palsy (CP), varying by subtype. Classifications like MACS and House aid in assessing daily activities and grip function, crucial for care programs.
Area of Science:
- Pediatric Neurology
- Rehabilitation Medicine
- Developmental Pediatrics
Background:
- Cerebral palsy (CP) significantly impacts motor function, affecting hand use in affected children.
- Understanding the spectrum of hand function limitations is vital for targeted interventions and support.
Purpose of the Study:
- To comprehensively describe hand function across a population-based cohort of children with cerebral palsy (CP).
- To evaluate the utility of established classification systems in characterizing hand impairments in CP.
Main Methods:
- Population-based data collection from 367 children with CP (born 1992-2001).
- Assessment of upper extremity function using Manual Ability Classification System (MACS), House functional classification, and Zancolli classification.
- Evaluation of spastic thumb-in-palm deformity using the House classification.
Main Results:
- 60% of children with CP experienced significant hand function limitations (MACS > I).
- Independence in daily manual activities varied by CP subtype: 87% (unilateral spastic), 63% (bilateral spastic), and 20% (dyskinetic).
- Prevalence of spastic thumb-in-palm deformity was 25% (one hand) and 15% (both hands).
Conclusions:
- Hand function impairments are common in all CP types, with distinct characteristics across subtypes.
- MACS, House, and Zancolli classifications are valuable tools for assessing daily activities, grip, and spasticity in children with CP.
- These classifications support population-based healthcare programs, though further psychometric validation is recommended.
Purpose:
To describe aspects of hand function in a total population of children with cerebral palsy (CP).
Methods:
Upper extremity data were collected for 367 children who were born between 1992 and 2001 and were registered in a population-based health care program for children with CP. Hand function was classified according to the Manual Ability Classification System (MACS), the House functional classification, and the Zancolli classification. The type of spastic thumb-in-palm deformity was evaluated according to House.
Results:
In the total population of children with CP aged 4 to 14 years, 60% had more than minor problems with hand function (>MACS I). Independence in age-relevant, daily manual activities (MACS I-II) was noted in 87% of children with spastic unilateral CP and in 63% of children with spastic bilateral CP, but in only 20% of children with dyskinetic CP. According to the House functional classification, both hands were spontaneously and independently used in 55% of children (House 7-8), whereas 5% did not use either of their hands (House 0). Minor increase of flexor muscle tone (Zancolli level 1) was found in 69% of all children. Only 2% were in level 3 in both hands. Spastic thumb-in-palm deformity in 1 hand was found in 25% and in both hands in another 15%.
Conclusions:
Limitations in hand function are common in all types of CP, but characteristics of the disability vary considerably between different CP subtypes. The MACS classification is useful to evaluate how well children can handle objects in daily activities. The House functional classification describes grip function in each hand separately; the Zancolli classification of finger and wrist extension and the classification of thumb-in-palm deformity according to House give an estimate of dynamic spasticity. All these classifications were shown to be useful in a population-based health care program, but further studies of the psychometric properties are required.
