Prevalence and pattern of upper limb involvement in cerebral palsy
Daoud Makki1, J Duodu, Matthew Nixon
1Department of Trauma and Orthopaedics, Countess of Chester Hospital NHS Foundation Trust, Liverpool Road, Chester, CH2 1UL, UK, daoudmakki@yahoo.co.uk.
Insights
Most children with cerebral palsy (CP) experience upper limb issues, impacting function and appearance. Specific contracture patterns, like thumb-in-palm, cause greater disability, highlighting the need for targeted interventions.
Area of Science:
- Pediatric Neurology
- Rehabilitation Medicine
- Orthopedic Surgery
Background:
- Cerebral palsy (CP) frequently involves upper limb dysfunction.
- Understanding the patterns and functional impact of upper limb involvement is crucial for effective management.
Purpose of the Study:
- To determine the prevalence and patterns of upper limb involvement in children with CP.
- To correlate upper limb involvement with functional outcomes.
- To assess the recognition and treatment of these issues.
Main Methods:
- Assessed 100 consecutive pediatric CP patients.
- Utilized GMFCS, MACS, and ABILHAND-Kids for functional assessment.
- Examined for contractures and assessed cosmetic concerns in older children.
Main Results:
- 83% of patients had upper limb involvement; 36% had contractures.
- Thumb-in-palm and wrist flexion contractures were most common and disabling.
- Reduced hand control was prevalent (69%), with cosmetic concerns noted in older children.
Conclusions:
- Upper limb involvement in CP presents diverse patterns with significant functional and cosmetic implications.
- Specific contracture patterns correlate with increased disability.
- Cosmetic concerns are more pronounced in older children and require attention.
Purpose:
The aim of this study was to determine the prevalence and pattern of upper limb involvement in children with cerebral palsy (CP), how this relates to function and how well these problems are recognised and treated.
Methods:
One hundred consecutive patients with CP attending non-hand-related clinics were assessed. Function was assessed according to the Gross Motor Functional Classification System (GMFCS), the Manual Ability Classification System (MACS) and the ABILHAND-Kids system, and correlated to age and pattern of upper limb involvement. Patients were examined for contractures in the shoulder, elbow, wrist and hand. Concerns about the appearance of the hand were also assessed in older children.
Results:
Overall, 83 % of patients had upper limb involvement, 36 % had a demonstrable contracture and 69 % had reduced hand control. The most common contracture patterns were the thumb in palm with clasp hand, shoulder adduction with internal rotation and wrist flexion with pronation. The thumb in palm with clasp hand pattern was associated with the greatest functional disability, followed by wrist flexion with pronation. Single contractures such as elbow flexion caused significant disability, whereas swan-neck contractures were, by far, less debilitating. Children aged 12 years and older had more concerns about the appearance of their hand. The ABILHAND score was strongly correlated to both the GMFCS and the MACS score.
Conclusion:
Different patterns of upper limb involvement exist in CP and some have a significant impact on function and cause cosmetic concerns that should not be underestimated, particularly in older children.
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