The Dynamic Thumb-in-Palm Pattern in Children with Spastic Cerebral Palsy and Its Effects on Upper Limb Function.

Ja Young Choi,Seon Ah Kim,Dong-Wook Rha,Eun Sook Park

doi:10.3390/children8010017

Abstract

The thumb-in-palm (TIP) pattern is one of the most common upper limb deformities in cerebral palsy (CP). This study was designed to investigate the effect of the dynamic TIP pattern on upper limb function in children with spastic CP. This prospective observational study included a total of 106 children with CP with dynamic TIP. The House TIP classification while grasping small or large objects, Melbourne Assessment of Unilateral Upper Limb Function (MUUL), Shriners Hospital Upper Extremity Evaluation (SHUEE), Zancolli classification for wrist–finger flexor deformity, and degree of swan neck deformity were assessed. Type I was the most common and highest functioning House TIP classification type. However, there were no significant differences in upper arm function between types II, III, and IV. The three components of the SHUEE showed stronger association with MUUL than House TIP and Zancolli classifications. After multivariable analysis, functional use of the wrist–finger and the thumb played a more significant role than the dynamic alignment of the thumb. In conclusion, the House TIP classification is useful to describe the TIP pattern. The SHUEE thumb assessment is a useful tool for reflecting upper arm function. The upper arm function was related more with the associated wrist flexor deformity than dynamic TIP.

Highlights

Type IV of the House TIP classification was observed in two children while grasping a large object and in six children while grasping a small object
Types I, II, and IV of the House TIP classification were more evident while the child was grasping a small object rather than a large object
This study demonstrates that dynamic TIP is more evident when grasping a small object than a large object, except in the type III pattern of the House TIP classification

Summary

Introduction

Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. Cerebral palsy (CP) is the most prevalent childhood disorder involving movement and postural control [1]. Spastic CP is the most common form. CP demonstrate spasticity of the upper limbs, which produces characteristic postures and deformities such as shoulder internal rotation, elbow flexion, forearm pronation, and thumb-in-palm (TIP) or finger flexion [2]. The TIP deformity is one of the most common upper limb deformities in CP. 40.6–53.4% of patients with spastic CP have a TIP deformity in at least one hand [3,4]

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Discussion

Conclusion