Analysis of dynamic elbow flexion deformity in children with hemiplegic cerebral palsy
Elsa Povedano1, Irene Gallardo-Calero2, Manel Navarrete3
1Occupational Therapy Department, Rehabilitation and Physical Medicine, Sant Joan de Dèu Barcelona Children's Hospital, Passeig de Sant Joan de Déu, 2, 08950 Barcelona, Spain.
Insights
Dynamic elbow flexion deformity is common in children with hemiplegic cerebral palsy, increasing with activity effort. Despite this, children maintain independence in most daily activities, showing resilience in upper extremity function.
Area of Science:
- Pediatric Neurology
- Movement Disorders
- Rehabilitation Medicine
Background:
- Cerebral palsy (CP) impacts 1 in 1,000 children, with 83% experiencing upper extremity involvement.
- Dynamic elbow flexion deformity is a specific movement disorder in hemiparesis secondary to CP.
- This study investigates the prevalence and functional impact of this deformity in children's daily activities.
Purpose of the Study:
- To determine if children with hemiplegic cerebral palsy exhibit dynamic elbow flexion deformity during daily activities.
- To assess the influence of this deformity on reaching function.
- To correlate deformity severity with functional assessments.
Main Methods:
- Observational descriptive study of 16 children with hemiplegic CP (GMFCS level I-II).
- Evaluated upper extremity function using standardized tools (MACS, CHEQ, SHUEE) and spasticity with the Modified Ashworth Scale.
- Recorded involuntary elbow flexion during 8 daily activities and measured elbow motion during reaching tasks.
Main Results:
- Dynamic elbow flexion deformity was present in 15 of 16 children, increasing with activity demands.
- Elbow flexion increased significantly across most activities, except high-speed stair climbing.
- Children demonstrated independence in 21 of 29 daily activities (CHEQ), with limited correlation between deformity and upper extremity function (SHUEE).
Conclusions:
- Dynamic elbow flexion deformity is highly prevalent in hemiplegic cerebral palsy.
- The deformity's occurrence correlates with activity-specific effort.
- Despite the deformity, children with hemiplegic cerebral palsy generally maintain participation and independence in daily activities.
Background:
Cerebral palsy affects 1 per 1.000 children, and in 83% of the cases upper extremity is involved. Dynamic elbow flexion deformity is a movement disorder observed in individuals with hemiparesis secondary to cerebral palsy. We sought to determine whether children with hemiplegic cerebral palsy exhibit dynamic elbow flexion deformity during daily activities and its influence to reaching function.
Methods:
Sixteen children with upper limb hemiparesis and cerebral palsy (age 11y 7mo (SD 3y 2mo); 11 boys, 5 girls; Gross Motor Function Classification System level I or II) were included in this observational descriptive study. Manual Ability Classification System, Children's Hand-use Experience Questionnaire and Shriners Hospital for Children Upper Extremity Evaluation were used to evaluate affected upper extremity function. Spasticity was assessed with Modified Ashworth scale. Involuntary elbow flexion was recorded in eight daily activities. Elbow motion during reach function was measured.
Findings:
Fifteen out of 16 individuals showed dynamic elbow flexion deformity. There was a significative increase of involved median elbow flexion in all the activities studied, except for "high speed stairs climbing" evaluation. Children's Hand-use Experience Questionnaire showed that children were independent in most of the daily activities (21 out of 29). Correlation between dynamic elbow flexion deformity and Shriners Hospital for Children Upper Extremity Evaluation was observed only in sitting-standing activity (Spearman's ρ 0.549, P = 0.028).
Interpretation:
Dynamic elbow flexion deformity is very common in hemiplegic cerebral palsy and occurs proportionally to the degree of the effort demanded by the activities. Despite of presenting this movement disorder, it does not affect in children participation in daily activities.
