Abstract
The main objective of this study was to quantify the effects ofweight bearing on upper limb function in children with hemiplegic cerebralpalsy. This study also sought to monitor the change in spasticity immediatelyfollowing weight bearing exercises. A quasi-experimental, one group pre-test,post-test design was used. Eleven children with hemiplegic type of cerebral palsyfrom a special school in KwaZulu Natal participated after fully informed consentof the caretaking guardian. The intervention consisted of a standardized programof weight bearing. The Melbourne A ssessment of Upper Extremity function wasused to quantify upper extremity function of reach, grasp and manipulation and the modified A shworth grading of spasticity was used to grade and monitor spasticity. The data was analysed using the Wilcoxon signed rank test. A significant decrease in spasticity during elbow extension (p= 0,004), wrist flexion (p=0,026) and extension (p=0,004)was noted. Statistically significant improvement in function, reach (p=0, 00), grasp (p=0, 02) manipulation (p=0, 05)and overall quality of function (p= 0,003) was also found. A n overall significant effect of weight bearing exercises onupper extremity function was noted providing evidence for practice.
Highlights
Weight bearing exercises have been used as a part of neurodevelopmental therapy (Chad et al 1999) and constraint induced movement therapy (De Luca et al 2003) to retrain upper extremity function in children and adults with neurological dysfunction. Erhardt (1974), Irwin-Carruthers (1982), and Boehme (1988) described extensively the significant role of weight bearing in developing upper extremity function and fine hand control
Chakerian and Larson (1993) quantified the effectiveness of weight bearing exercises on upper limb function, they did not focus on quantifying the quality of the function
The purpose of this study was to quantify the effects of upper extremity weight bearing exercises on the quality of upper extremity function, namely reach, grasp and manipulation in children with hemiplegic cerebral palsy
Summary
Weight bearing exercises have been used as a part of neurodevelopmental therapy (Chad et al 1999) and constraint induced movement therapy (De Luca et al 2003) to retrain upper extremity function in children and adults with neurological dysfunction. Erhardt (1974), Irwin-Carruthers (1982), and Boehme (1988) described extensively the significant role of weight bearing in developing upper extremity function and fine hand control. The evidence for the effectiveness of weight bearing exercises on the quality of upper limb motor function is to a large extent anecdotal rather than empirical. This is largely due to the fact that available tools such as the Bayley Motor Scales, the JebsenTaylor Test of Hand Function (Taylor et al 1973) and the Peabody Fine Motor Scale (Folio and Fewell 1983) are either not standardized for the cerebral palsy population or do not quantify quality of movement. The purpose of this study was to quantify the effects of upper extremity weight bearing exercises on the quality of upper extremity function, namely reach, grasp and manipulation in children with hemiplegic cerebral palsy. In addition spasticity was monitored due to its effects on function
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