Upper Extremity Muscle Strength in Children With Unilateral Spastic Cerebral Palsy: A Bilateral Problem?
Koen J F M Dekkers1, Eugene A A Rameckers2, Rob J E M Smeets3
1Revant Rehabilitation Centers, Revant Centre Breda, Brabantlaan 1, 4817 JW Breda, the Netherlands; Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, the Netherlands; and University for Professionals for Pediatric Physical Therapy, AVANSplus, Breda, the Netherlands.
Insights
Children with unilateral spastic cerebral palsy (USCP) show muscle weakness in both upper extremities (UEs) compared to typically developing peers. This highlights the need to assess nonaffected UEs in USCP evaluations.
Area of Science:
- Pediatric Rehabilitation
- Neuromuscular Disorders
- Movement Science
Background:
- Unilateral spastic cerebral palsy (USCP) affects motor function in one side of the body.
- Muscle strength deficits are common in individuals with USCP, but the extent in both affected and nonaffected limbs requires further investigation.
- Understanding these differences is crucial for targeted interventions.
Purpose of the Study:
- To compare upper extremity (UE) muscle strength between children with USCP and typically developing (TD) children.
- To identify differences in both affected and nonaffected UEs in children with USCP.
- To inform clinical assessments and rehabilitation strategies for USCP.
Main Methods:
- A cross-sectional study involving children aged 7-12 years.
- Isometric arm, grip, and pinch strength were measured using hand-held dynamometers and grip meters.
- Comparisons were made between the affected/nonaffected UEs of children with USCP and the preferred/nonpreferred UEs of TD children.
Main Results:
- Children with USCP demonstrated weaker muscle strength than TD children across most measurements.
- This weakness was observed in both the affected and nonaffected upper extremities of children with USCP.
- An exception was noted in the grip strength of the preferred UE, where no significant difference was found.
Conclusions:
- Muscle strength weakness is present in both upper extremities of children with USCP.
- The nonaffected upper extremity should be included in the assessment of children with USCP, especially when unimanual or bimanual limitations are present.
- These findings underscore the pervasive impact of USCP on motor function.
Objective:
The objective was to investigate whether muscle strength in the nonaffected and affected upper extremities (UEs) in children (7-12 years) with unilateral spastic cerebral palsy (USCP) differs from that in children with typical development (TD).
Methods:
A cross-sectional study design was used. Isometric arm strength (wrist flexion, wrist extension with flexed and extended fingers, elbow flexion/extension) was assessed in 72 children (mean age = 9.3 [SD = 1.9] years) with USCP, and isometric grip/pinch strength was assessed in 86 children (mean age = 9.3 [SD = 1.8] years) with USCP. Arm/grip/pinch strength was assessed in 120 children (mean age = 9.5 [SD = 1.7] years) with TD. Arm strength was measured with a hand-held dynamometer, and grip/pinch strength was measured with a calibrated, modified (digitized) grip dynamometer and a pinch meter. The nonaffected UE of children with USCP was compared with the preferred UE of children with TD because both sides represent the preferred UE. The affected UE was compared with the nonpreferred UE of children with TD, as both sides represent the nonpreferred UE.
Results:
In all measurements except for grip strength of the preferred UE, children with USCP were weaker than children with TD.
Conclusions:
In children with USCP, muscle strength weakness exists in both UEs.
Impact:
When unimanual or bimanual ability limitations are present in children with unilateral cerebral palsy, investigation of the muscle strength of the nonaffected UE should be part of the assessment.
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