Prevalence and pattern of upper limb involvement in cerebral palsy.

Daoud Makki,J Duodu,Matthew Nixon

doi:10.1007/s11832-014-0593-0

Abstract

PurposeThe 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.MethodsOne 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.ResultsOverall, 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.ConclusionDifferent 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.

Highlights

The incidence of cerebral palsy (CP) is around 1 per 1,000 children [1]
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, in older children
Certain contractures coexisted, producing different patterns, the most common being the thumb in palm with clasp hand, shoulder adduction with internal rotation and wrist flexion with pronation

Summary

Introduction

The incidence of cerebral palsy (CP) is around 1 per 1,000 children [1]. an accurate prevalence of motor dysfunction and contractures in the upper limb and how this correlates with function has not been properly described.Patterns of upper limb motor involvement varies according to the muscles affected, the degree of spasticity or dystonia present and the patient’s age. An accurate prevalence of motor dysfunction and contractures in the upper limb and how this correlates with function has not been properly described. A thumb in palm deformity may be due to intrinsic or extrinsic muscle contracture; in the fingers, attempts to counter-act wrist flexion by recruiting long finger extensors or hand intrinsic spasticity may result in a swan-neck deformity; alternatively, the fingers may become clasped. Together, these problems prevent accurate positioning of the hand in space, appropriate grip and release

Objectives

Methods

Results

Discussion

Conclusion