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Published on: January 11, 2016
Relationship between neuromuscular body functions and upper extremity activity in children with cerebral palsy
Siri M Braendvik1, Ann-Kristin G Elvrum, Beatrix Vereijken
1Clinical Services, St Olav's University Hospital, Trondheim, Norway. siri.brendvik@stolav.no
Insights
In children with spastic cerebral palsy (CP), limited arm movement and force control significantly impact hand function. Improving supination range and strength enhances actual and instructed hand use.
Area of Science:
- Neurology
- Rehabilitation Medicine
- Pediatric Physical Therapy
Background:
- Spastic cerebral palsy (CP) affects motor function in children and adolescents.
- Upper extremity involvement, particularly in the elbow, forearm, and hand, is common in CP.
- Understanding the link between neuromuscular function and hand activity is crucial for targeted interventions.
Purpose of the Study:
- To investigate the relationship between neuromuscular body function and upper extremity activity in children and adolescents with spastic CP.
- To analyze how muscle strength, tone, range of motion, and force control relate to hand use.
- To frame these relationships within the World Health Organization International Classification of Functioning, Disability and Health (ICF) model.
Main Methods:
- Study included 23 participants (mean age 13 years) with spastic CP (Manual Ability Classification System levels I-III).
- Neuromuscular measures: elbow/forearm/grip strength, elbow flexor/forearm supinator muscle tone, active supination/elbow extension range, and elbow flexion force control.
- Activity measures: Assisting Hand Assessment (actual use) and Melbourne Assessment of Unilateral Upper Limb Function (instructed use).
Main Results:
- Significant correlations were found between most neuromuscular body function variables and activity measures.
- Active supination range and strength together explained 74% of the variance in actual hand use.
- Active supination range and force control together explained 74% of the variance in instructed hand use.
Conclusions:
- In high-functioning children and adolescents with CP, limited active supination range and force control difficulties are strongly associated with reduced hand activity.
- These findings highlight specific neuromuscular deficits impacting functional use of the upper limb.
- Further research is necessary to establish causality and inform therapeutic strategies.
Aim:
Our aim was to investigate the relationship between the dimensions of neuromuscular body function and elbow, forearm, and hand activity in the upper extremities in children/adolescents with spastic cerebral palsy (CP), within the framework of the World Health Organization International Classification of Functioning, Disability and Health.
Method:
Twenty-three participants (10 males, 13 females, mean age 13y, SD 3y, range 8-18y) with spastic CP (21 with hemiplegia, two with diplegia) at Manual Ability Classification System levels I to III participated in the study. Neuromuscular body function measures were (1) muscle strength in the elbow, forearm, and grip, (2) muscle tone in elbow flexors and forearm supinators, (3) active supination range and elbow extension range, and (4) force control at submaximal level in elbow flexion. Activity measures were actual use of the affected hand in bimanual activities (Assisting Hand Assessment) and instructed use of the affected hand (Melbourne Assessment of Unilateral Upper Limb Function).
Results:
Nearly all the neuromuscular body function variables were significantly correlated with activity. The combination of active supination range and strength explained 74% of the variance in actual use, and the combination of active supination range and force control explained 74% of the variance in instructed use.
Interpretation:
In high-functioning children and adolescents with CP, limited active supination range and difficulties in generating and modulating force are strongly related to limitations in hand activity. Further studies are needed to establish cause and effect in this relationship.
