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Sensibility deficiencies in the hands of children with spastic hemiplegia
A E Van Heest1, J House, M Putnam
1Department of Orthopaedics, University of Minnesota, Minneapolis.
Insights
Sensory deficits are common in children with spastic hemiplegia cerebral palsy. Severe deficits correlate with smaller limb size, aiding surgeons in setting realistic goals for hand surgery.
Area of Science:
- Neurology
- Orthopedics
- Developmental Pediatrics
Background:
- Spastic hemiplegia, a common form of cerebral palsy, significantly impacts affected limbs.
- Understanding sensory function and limb size is crucial for managing affected children.
Purpose of the Study:
- To assess sensory function and limb size in children with spastic hemiplegia.
- To determine the relationship between sensory deficits and limb dimensions.
- To identify predictive tools for severe sensory deficits in preoperative evaluations.
Main Methods:
- Evaluated 40 children with spastic hemiplegia.
- Assessed sensory function: stereognosis, two-point discrimination, and proprioception.
- Measured limb size: arm/forearm circumference and forearm/forearm-hand length.
Main Results:
- 97% of spastic limbs showed stereognosis deficits.
- 90% had two-point discrimination deficits.
- 46% exhibited proprioception deficits.
- Severe stereognosis deficits correlated with significantly smaller limb measurements.
- Limb size discrepancy predicted severe sensory deficits.
Conclusions:
- Sensory deficits are prevalent in pediatric spastic hemiplegia.
- Limb size discrepancy serves as a valuable preoperative predictor of sensory deficits.
- Findings assist hand surgeons in establishing realistic surgical expectations.
Abstract:
We evaluated 40 children with spastic hemiplegia due to cerebral palsy for sensory function and relative limb size in the affected and unaffected upper extremities. Sensory function of each limb was evaluated with respect to stereognosis (12 objects), two-point discrimination, and proprioception. Four size measurements of each limb were made: arm and forearm circumference and forearm and forearm-hand length. This study showed that 97% of the spastic limbs had a stereognosis deficit, 90% had a two-point discrimination deficit, and 46% had a proprioception deficit. Thus sensory deficits are the rule rather than the exception in children with spastic hemiplegia. Those children with severe stereognosis deficits had significantly smaller limbs in all four measurement parameters than the children with mild or moderate stereognosis deficits. In the preoperative evaluation of children with spastic hemiplegia, severe size discrepancy is a physical examination tool that can be used as a predictor of severe sensory deficits. This information is helpful for the hand surgeon in establishing realistic surgical goals.