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Grading and Quantification of Upper Extremity Function in Children with Spasticity
Margaret Wallen1, Kirsty Stewart1
1Cerebral Palsy Alliance, Allambie Heights, Australia.
Insights
This review outlines assessments for pediatric upper extremity function in spasticity, using the ICF framework. It aids in understanding dysfunction, guiding interventions, and measuring outcomes for improved child function.
Area of Science:
- Pediatric rehabilitation
- Neuroscience
- Biomedical engineering
Background:
- Spasticity significantly impacts upper extremity function in children.
- The World Health Organization's International Classification of Functioning, Disability and Health (ICF) offers a comprehensive framework for assessing disability.
- Effective management of pediatric spasticity requires precise evaluation of upper extremity function.
Purpose of the Study:
- To provide an overview of assessments and classification tools for upper extremity function in children with spasticity.
- To highlight the utility of the ICF framework in this context.
- To guide the selection of interventions and measurement of outcomes.
Main Methods:
- Review of existing assessments and classification tools for upper extremity function.
- Categorization of assessments based on ability measured (best vs. actual performance), administration (clinician vs. self/proxy report), purpose (intervention planning/outcome measurement), and scope (unimanual vs. bimanual).
- Summary of spasticity/hypertonicity measures and posture classifications.
Main Results:
- Various assessments exist to evaluate different facets of upper extremity function in pediatric spasticity.
- Tools can differentiate between capacity and performance, and between clinician- or patient-reported outcomes.
- Classifications aid in understanding static and dynamic postural challenges.
Conclusions:
- The ICF framework is ideal for conceptualizing and quantifying upper extremity function in pediatric spasticity.
- A range of assessment tools are available to inform clinical decision-making, intervention selection, and outcome evaluation.
- Comprehensive assessment is crucial for optimizing treatment strategies and improving functional outcomes.
Abstract:
The World Health Organization's International Classification of Functioning, Disability and Health (ICF) provides an ideal framework within which to conceptualize grading and quantification of upper extremity function for children with spasticity. In this article the authors provide an overview of assessments and classification tools used to (1) understand upper extremity function associated with spasticity and the factors that contribute to dysfunction, (2) guide the selection of appropriate interventions, (3) identify specific muscles to target using surgical interventions and botulinum toxin-A injections, and (4) measure the outcomes of upper extremity interventions. Assessments of upper extremity function are briefly described and categorized as to whether they (1) measure children's best ability or actual performance in daily life, (2) are clinician administered or are a child/proxy report, (3) assist in planning intervention and/or measuring outcomes, and (4) evaluate unimanual or bimanual ability. In addition, measures of spasticity and hypertonicity, and classifications of static and dynamic upper extremity postures are summarized.
