Upper Limb Function In Children Research Articles

Upper limb function in children with attention-deficit/hyperactivity disorder (ADHD)

Upper limb function was investigated in children with ADHD using objective methods. We hypothesised that children with ADHD exhibit abnormal dexterity, force application during manipulation of a novel object, and movement rhythmicity. Two groups of age- and gender-matched children were investigated: 35 typically developing children (controls, 10.5±0.4years, 32M-3F) and 29 children (11.5±0.5years, 27M-2F) with formally diagnosed ADHD according to DSM-IV-TR criteria. Participants underwent a series of screening tests and tests of upper limb function while "off" medication. Objective quantification of upper limb function involved measurement of force during a grip and lift task, maximal finger tapping task, and maximal pinch grip. Acceleration at the index finger was also measured during rest, flexion and extension, and a postural task to quantify tremor. The Movement Assessment Battery for Children-2 (MABC-2) was also administered. Significant between-group differences were observed in movement rhythmicity, manipulation of a novel object, and performance of the MABC-2 dexterity and aiming and catching components. Children with ADHD lifted a novel object using a lower grip force (P=0.036), and held the object with a more variable grip force (P=0.003), than controls. Rhythmicity of finger tapping (P=0.008) and performance on the dexterity (P=0.007) and aiming and catching (P=0.042) components of the MABC-2 were also significantly poorer in the ADHD group than controls. Movement speed, maximum pinch grip strength, and tremor were unaffected. The results of the study show for the first time that ADHD is associated with deficits in multiple, but not all domains of upper limb function.

Understanding the relationship between brain and upper limb function in children with unilateral motor impairments: A multimodal approach.

15 children with unilateral CP (ages: 9.4±2.5 years) undertook hand function assessments and at least two additional neuroimaging and/or neurophysiological procedures: MRI/DTI/fMRI (n=13), TMS (n=11), and/or EEG/EMG (n=8). During the fMRI scans and EEG measurements, a motor task was performed to study cortical motor control activity during simple hand movements. DTI tractography analysis was used to study the corpus-callosum (CC) and cortico-spinal tracts (CST). TMS was used to study cortico-spinal connectivity pattern. Type and range of severity of brain injury was evident across all levels of manual ability with the highest radiological scores corresponded to children poorer manual ability. Evidence of MMs was found in 7 children, mostly detected when moving the affected hand, and not necessarily corresponding to bilateral brain activation. When moving the affected hand, bilateral brain activation was seen in 6/11 children while 3/11 demonstrated unilateral activation in the contralateral hemisphere, and one child demonstrated motor activation predominantly in the supplementary motor area (SMA). TMS revealed three types of connectivity patterns from the cortex to the affected hand: a contralateral (n=3), an ipsilateral (n=4) and a mixed (n=1) connectivity pattern; again without clear association with MMs. No differences were found between children with and without MMs in lesion scores, motor fMRI laterality indices, CST diffusivity values, and upper limb function. In the genu, midbody, and splenium of the CC, higher fractional anisotropy values were found in children with MMs compared to children without MMs. The EEG data indicated a stronger mu-restoration above the contralateral hemisphere in 6/8 children and above the ipsilateral hemisphere in 2/8 children. The current results demonstrate benefits from the use of different modalities when studying upper-limb function in children with CP; not least to accommodate to the variations in tolerance and feasibility of implementation of the differing methods. These exposed multiple individual brain-reorganization patterns corresponding to different functional motor abilities. Additional research is warranted to understand the transactional influences of early brain injury, neuroplasticity and developmental and environmental factors on hand function in order to develop targeted interventions.

Translation, reliability, and clinical utility of the Melbourne Assessment 2

Objective: The aims were to (i) provide a German translation of the Melbourne Assessment 2 (MA2), a quantitative test to measure unilateral upper limb function in children with neurological disabilities and (ii) to evaluate its reliability and aspects of clinical utility.Methods: After its translation into German and approval of the back translation by the original authors, the MA2 was performed and videotaped twice with 30 children with neuromotor disorders. For each participant, two raters scored the video of the first test for inter-rater reliability. To determine test–retest reliability, one rater additionally scored the video of the second test while the other rater repeated the scoring of the first video to evaluate intra-rater reliability. Time needed for rater training, test administration, and scoring was recorded.Results: The four subscale scores showed excellent intra-, inter-rater, and test–retest reliability with intraclass correlation coefficients of 0.90–1.00 (95%-confidence intervals 0.78–1.00). Score items revealed substantial to almost perfect intra-rater reliability (weighted kappa kw = 0.66–1.00) for the more affected side. Score item inter-rater and test–retest reliability of the same extremity were, with one exception, moderate to almost perfect (kw = 0.42–0.97; kw = 0.40–0.89). Furthermore, the MA2 was feasible and acceptable for patients and clinicians.Conclusions: The MA2 showed excellent subscale and moderate to almost perfect score item reliability.Implications for RehabilitationThere is a lack of high-quality studies about psychometric properties of upper limb measurement tools in the neuropediatric population.The Melbourne Assessment 2 is a promising tool for reliable measurement of unilateral upper limb movement quality in the neuropediatric population.The Melbourne Assessment 2 is acceptable and practicable to therapists and patients for routine use in clinical care.

New Rehabilitation Approaches for Upper Limb Function of Children With Hemiplegia

روش‌های نوین توانبخشی اندام فوقانی در کودکان دچار فلج‌مغزی نیمه بدن: مروری بر مطالعات گذشته , روش‌های نوین توانبخشی اندام فوقانی در کودکان دچار فلج‌مغزی نیمه بدن: مروری بر مطالعات گذشته , کتابخانه الکترونیک و دیجیتال - آذرسا

Measuring upper limb function in children with hemiparesis with 3D inertial sensors.

Upper limb assessments in children with hemiparesis rely on clinical measurements, which despite standardization are prone to error. Recently, 3D movement analysis using optoelectronic setups has been used to measure upper limb movement, but generalization is hindered by time and cost. Body worn inertial sensors may provide a simple, cost-effective alternative. We instrumented a subset of 30 participants in a mirror therapy clinical trial at baseline, post-treatment, and follow-up clinical assessments, with wireless inertial sensors positioned on the arms and trunk to monitor motion during reaching tasks. Inertial sensor measurements distinguished paretic and non-paretic limbs with significant differences (P < 0.01) in movement duration, power, range of angular velocity, elevation, and smoothness (normalized jerk index and spectral arc length). Inertial sensor measurements correlated with functional clinical tests (Melbourne Assessment 2); movement duration and complexity (Higuchi fractal dimension) showed moderate to strong negative correlations with clinical measures of amplitude, accuracy, and fluency. Inertial sensor measurements reliably identify paresis and correlate with clinical measurements; they can therefore provide a complementary dimension of assessment in clinical practice and during clinical trials aimed at improving upper limb function.

Upper limb function in children with unilateral cerebral palsy: a five‐year follow‐up study

Upper limb function in children with unilateral cerebral palsy: a five‐year follow‐up study

How does the interaction of presumed timing, location and extent of the underlying brain lesion relate to upper limb function in children with unilateral cerebral palsy?

Upper limb (UL) function in children with unilateral cerebral palsy (CP) vary largely depending on presumed timing, location and extent of brain lesions. These factors might exhibit a complex interaction and the combined prognostic value warrants further investigation. This study aimed to map lesion location and extent and assessed whether these differ according to presumed lesion timing and to determine the impact of structural brain damage on UL function within different lesion timing groups. Seventy-three children with unilateral CP (mean age 10 years 2 months) were classified according to lesion timing: malformations (N=2), periventricular white matter (PWM, N=42) and cortical and deep grey matter (CDGM, N=29) lesions. Neuroanatomical damage was scored using a semi-quantitative MRI scale. UL function was assessed at body function and activity level. CDGM lesions were more pronounced compared to PWM lesions (p=0.0003). Neuroanatomical scores were correlated with a higher degree to UL function in the CDGM group (rs=-0.39 to rs=-0.84) compared to the PWM group (rrb=-0.42 to rs=-0.61). Regression analysis found lesion location and extent to explain 75% and 65% (p<0.02) respectively, of the variance in AHA performance in the CDGM group, but only 24% and 12% (p<0.03) in the PWM group. In the CDGM group, lesion location and extent seems to impact more on UL function compared to the PWM group. In children with PWM lesions, other factors like corticospinal tract (re)organization and structural connectivity may play an additional role.

The effect of neoprene thumb abduction splints on upper limb function in children with cerebral palsy

INTRODUCTION: Children with cerebral palsy (CP) have limitations in hand function due to weakness and spasticity, with long term effects causing shortening and stiffness of muscles in the hand and arm. The soft neoprene thumb abductor splint is prescribed by occupational therapists to correct these impairments. There is insufficient evidence for the effectiveness of this splint on upper limb function in children with CP with a thumb-in-palm deformity within the South African public health context. METHODS: A non-blinded randomised intervention study was carried out in a CP clinic at a tertiary level public hospital. Twenty-eight CP children between the age of 18 and 68 months, presenting with thumb-in-palm deformity, functioning on a Level II to IV on the Gross Motor Function Classification Scale (GMFCS) participated in the study. The Quality of Upper Extremity Skills Test (QUEST) was used to assess upper limb function in terms of dissociated movement, grasps, weight bearing and protective extension to obtain baseline information. Both the intervention and control groups received monthly individual occupational therapy and a home programme over a three month period. The intervention group additionally received a soft neoprene thumb abduction splint. RESULTS: No statistically significant differences between the intervention and control groups were found. Clinically relevant between group differences indicated by effect sizes were found however with large effect sizes the for the total QUEST score and weight bearing. The effect size for improvement within the intervention group was large for dissociated movement and weight bearing with and without the splint on as well as for grasps with the splint on. Only dissociated movement showed a clinically relevant medium effect size for change within the control group. Protective extension decreased within both groups except for the intervention group with the splint on. The caregivers/parents perceived the home programme as easy to follow, and those who were prescribed the splint mostly reported that it was easy to use. CONCLUSION: Soft neoprene thumb abduction splints have a positive effect on weight bearing and upper limb function in children with thumb-in-palm deformity, particularly with the splint on. Further research is recommended in the area of splinting in CP. Key words: Cerebral palsy, thumb-in-palm deformity, neoprene thumb abductor splint, QUEST

Safety and effectiveness of early intramuscular botulinum toxin injections to prevent shoulder deformity in babies with obstetrical brachial plexus palsy: Presentation of a multicentre randomised double-blind placebo-controlled trial

In children with obstetrical brachial plexus palsy (OBPP), shoulder musculoskeletal deformity is the main cause of morbidity, with a loss of range of shoulder motion, pain and a reduction in social participation. Some uncontrolled studies show that early injections of botulinum toxin (BTI) in the internal shoulder rotator muscles (which cause the deformity) are one of the most promising treatments for the prevention of bony deformity. The main objective of this study will be the evaluation of the effectiveness of BTI in the internal shoulder rotator muscles at the age of 6 months in preventing an increase in posterior subluxation of the glenohumeral joint in babies with OBPP (evaluated at the ages of 5 and 12 months), compared with a placebo. Secondary objectives will be (1) to compare the effectiveness of BTI with placebo in preventing an increase in glenoid retroversion and three-dimensional deformity, and in improving active and passive joint range of motion and upper limb function and (2) to confirm good tolerance of BTI treatment. A randomised, controlled, double-blind study will be conducted. Sixty-two babies with unilateral OBPP at risk of posterior humeral head subluxation will be included and will have a MRI at 5 months of age. Only children with more than 5% posterior subluxation of the humeral head compared with the contralateral shoulder will be randomised in two groups: “toxin” and “placebo”. In the toxin group, the babies will receive BOTOX injections at the age of 6 months. A total of 8UI/kg will be injected in the internal shoulder rotator muscles. In the placebo group an inactive product will be injected. Evaluations will be carried out at 9 and 12 months of age. The parents will be contacted by telephone monthly between 6 and 12 months of the baby's age in order to record any adverse events. The children will undergo repeat shoulder MRI at 12 months of age. / The major expected benefit is improvement in the prevention of shoulder deformity and upper limb function in children with OBPP. The presentation will focus on clinical and bibliographic rationale that led to this trial construction.

Review of Therapeutic Interventions for the Upper Limb Classified by Manual Ability in Children with Cerebral Palsy.

The aim of this literature review was to assemble an inventory of intervention strategies utilized for children diagnosed with cerebral palsy (CP) based on the Manual Ability Classification System (MACS). The purpose of the inventory is to guide physicians and therapists in intervention selection aimed at improving upper limb function in children with CP. The following databases were searched: CINAHL (Cumulative Index to Nursing and Allied Health Literature), Cochrane Database of Systematic Reviews, ERIC (Educational Research Information Center), Google Scholar, OTSeeker (Occupational Therapy Systematic Evaluation of Evidence), OVID (Ovid Technologies, Inc.), and PubMed. Inclusion criteria were whether the study (1) identified MACS levels of participants, and (2) addressed the effectiveness of intervention on upper limb function. Overall, 74 articles met the inclusion criteria. The summarized data identified 10 categories of intervention. The majority of participants across studies were MACS level II. The most frequently cited interventions were constraint-induced movement therapy (CIMT), bimanual training, and virtual reality and computer-based training. Multiple interventions demonstrated effectiveness for upper limb improvement at each MACS level. However, there is a need for additional research for interventions appropriate for MACS levels IV and V. To fully develop an intervention inventory based on manual ability, future studies need to report MACS levels of participants, particularly for splinting and therapy interventions used in combination with surgery.

A web-based therapy program enhances occupational performance and visual perception in children with unilateral cerebral palsy [commentary

The efficacy of high-intensity therapy programs in improving upper limb function in children with unilateral spastic cerebral palsy has previously been established. However, these programs can be labour-intensive and are not feasible for all families. The use of interactive computer play to augment face-to-face therapy is appealing as it may afford a low-cost means of intensive therapy delivery, typically in the home setting. This trial was well designed, conducted and reported. The observed differences between the intervention and control groups in motor and processing skills, occupational performance and visual perception validates the proposal that web-based training permits repetitive practice of the perceptual, cognitive and motor control components of a task. The absence of improvement in the Assisting Hand Assessment and the Melbourne Assessment of Unilateral Upper Limb function scores for the impaired limb could be due to the lack of specificity of the training: it was neither goal-directed nor task-specific. Alternatively, the program may not have been sufficiently intense to achieve experience-dependent neuroplastic changes. Participants completed an average of 32 hours (of the recommended 40 to 60 hours) over 20 weeks, with six participants completing ≤ 10 hours. These training hours were substantially less and were distributed over a longer period than typically advocated for other efficacious ‘high-dose’ therapy programs. The efficacy of home programs for children with cerebral palsy has been demonstrated and is a central component of service provision for this client population. Web-based programs afford another mode of service delivery for therapists that may, by their tech-based nature, be of greater appeal to children and adolescents than more traditional approaches to home program prescription. Web-based programs facilitate repetitive practice and can improve the quality of performance of activities of living, motor and processing skills. Clinicians should consider the intensity, duration and specificity of training when considering implementing such programs in practice. Provenance: Invited. Not peer-reviewed.

Visual perception and upper limb function in children with Developmental Coordination Disorder

Visual perception and upper limb function in children with Developmental Coordination Disorder

The impact of anatomical characterization of the brain lesion on upper limb function in children with unilateral cerebral palsy

The impact of anatomical characterization of the brain lesion on upper limb function in children with unilateral cerebral palsy

Implementation of a hybrid CIMT intervention to improve upper limb function in children with unilateral CP: does duration matter?

Implementation of a hybrid CIMT intervention to improve upper limb function in children with unilateral CP: does duration matter?

A Case Study of Product Usability of a Pelvic Device used by Children with Neuromotor Impairments

On assistive technology targeted for people with activity limitations and participation, usability issues becomes an essential tool to ensure that the product has the appropriate ergonomics characteristics, in other words, ensure that it fits the specific user's needs. The aim of this study was to analyze the usability of an adaptive seating device for children with neuromotor impairments, by using kinematic indicators of the reaching movement. The study sample consisted of 13 children with associated neurologic conditions. The tests were developed by using a wooden bench height adjustable, integrated with the adaptive seating device under study, and a system to capture three-dimensional image, called Qualisys Track Manager. The following reaching kinematics variables were measured: maximum reaching velocity, movement duration, index of curvature, and unit movements. It was found that the use of the adaptive seating device had a positive impact on upper limb function in children with neuromotor impairments. It was also noticed an improvement in the reaching movement kinematics, which was statistical significant for the index of curvature and unit movements. As main conclusions, it is possible to point out some positive effects that the product under study seems to have on users’ movements, such as the improved movement quality of the upper limb, which could mean a better postural adjustments and higher trunk postural control. By identifying new measures of usability in terms of effectiveness and efficiency for the analyzed device, the results obtained may serve also as performance indicators, providing new data that may help to improve the product and eventually modifying it, in order to turn it more compatible with the needs of the considered target population.

A more definitive measure of upper limb capacity for children with unilateral cerebral palsy

This commentary is on the original article by Geerdink et al. on pages 580–586 of this issue. As studies that examine upper limb function in children with cerebral palsy (CP) proliferate, so have classification systems that describe the capabilities of individuals with CP as well as tools that measure performance of hand and arm use. Researchers and clinicians alike seek reliable and valid measures to make recommendations for practice and to develop questions for future research. Not so long ago, there were few valid and reliable measures that defined the type of impairment or the capacity of the involved upper extremities in children with CP. Thus, making the examination of upper limb use and subsequent design of interventions that might improve hand and arm function not as effective as they could be. However, recent reviews1 conclude that more valid and reliable tools are available that provide evaluation of upper limb performance, function, and participation for children with CP. The aim of the paper by Geerdink et al. was to develop a validated instrument to evaluate maximal capacity of the more affected hand in bimanual activities. The authors recognize the importance of measuring treatment effects of upper limb performance, as well as measuring the ability to use the limb in optimal conditions in a standardized environment, i.e. capacity.2 In a brief review in this paper of existing valid measures of upper limb function, the limitations of the more frequently used assessments all suggested that none captured the functional capacity of the affected hand, especially while performing bimanual activities. Interestingly, the authors refined a reliable and valid evaluation of upper extremity function, the Modified House Classification (MHC)3 in order to develop a valid tool that measures the manual capacity of children with unilateral CP. The refined measure defined a new uni-dimensional 14-item set from the MHC indicating that the 14 items worked well together to measure an upper extremity construct. In addition, the new model correlated well with two validated measures of arm and hand function: the Manual Abilities Classification System (MACS)4 and Abilhand-Kids.5 The authors of this paper recognized a gap in the evaluation of upper limb function for children with unilateral CP. Specifically, the authors addressed the lack of a valid and reliable measure to examine functional capacity of the involved hand and arm in children with unilateral CP. As more studies are designed to examine the efficacy of therapeutic interventions, extensive descriptions of arm and hand function need to be obtained. Rather than ‘re-inventing the wheel’, appropriate statistical analysis was used to refine an existing measurement tool that can provide a more extensive evaluation of upper limb function in children with unilateral CP.

Psychometric properties of outcome measures for children and adolescents with brachial plexus birth palsy: a systematic review

The aim of this review was to evaluate the psychometric properties of outcome measures used to quantify upper limb function in children and adolescents with brachial plexus birth palsy (BPBP). Eleven electronic databases were searched to identify studies on the effects of conservative management to improve upper limb function in young people with BPBP. Outcome measures used in these studies were extracted and used in a subsequent search to identify studies that evaluated the psychometric properties of these measures. The methodological quality of these studies was rated using a standardized critical appraisal tool. Thirty-three outcome measures and 12 psychometric studies were identified. Nine outcome measures had some psychometric evidence, which was variable in quality. The outcome measures which seem to have the most robust psychometric properties include the Active Movement Scale, Assisting Hand Assessment, Pediatric Evaluation of Disability Index, and the Pediatric Outcomes Data Collection Instrument. Further research is required to determine the psychometric properties of outcome measures used for children and adolescents with BPBP. Caution is required when interpreting the results of commonly used outcome measures in this population owing to their relatively unknown psychometric properties.

The nature of arm movement in children with cerebral palsy when using computer-generated exercise games

Purpose: To compare upper limb kinematics of children with spastic cerebral palsy (CP) using a passive rehabilitation joystick with those of adults and able-bodied children, to better understand the design requirements of computer-based rehabilitation devices. Method: A blocked comparative study involving seven children with spastic CP, nine able-bodied adults and nine able-bodied children, using a joystick system to play a computer game whilst the kinematics of their upper limb were recorded. The translational kinematics of the joystick’s end point and the participant’s shoulder movement (protraction/retraction) and elbow rotational kinematics (flexion/extension) were analysed for each group. Results: Children with spastic CP matched their able-bodied peers in the time taken to complete the computer task, but this was due to a failure to adhere to the task instructions of travelling along a prescribed straight line when moving between targets. The spastic CP group took longer to initiate the first movement, which showed jerkier trajectories and demonstrated qualitatively different movement patterns when using the joystick, with shoulder movements that were significantly of greater magnitude than the able-bodied participants. Conclusions: Children with spastic CP generate large shoulder and hence trunk movements when using a joystick to undertake computer-generated arm exercises. This finding has implications for the development and use of assistive technologies to encourage exercise and the instructions given to users of such systems.Implications for RehabilitationA kinematic analysis of upper limb function of children with CP when using joystick devices is presented.Children with CP may use upper body movements to compensate for limitations in voluntary shoulder and elbow movements when undertaking computer games designed to encourage the practice of arm movement.The design of rehabilitative computer exercise systems should consider movement of the torso/shoulder as it may have implications for the quality of therapy in the rehabilitation of the upper limb in children with CP.

Brain SPECT Analysis After Constraint-Induced Movement Therapy in Young Children with Hemiplegic Cerebral Palsy: Case Report.

Constraint-induced movement therapy (CIMT) was shown recently to be promising for improving upper-limb function in children with cerebral palsy (CP). This study investigated the changes in cerebral perfusion with single-photon emission computerized tomography (SPECT) after modified CIMT (child-friendly CIMT) in young hemiplegic girls. Two young children with left hemiplegic CP were studied with SPECT at rest before and after the CIMT period, and they also performed standardized upper motor function tests [Jebsen hand function test, quality of upper extremity skills test (QUEST), and dynamic electromyography (EMG)]. The cerebral perfusion SPECT revealed regional perfusion increase in the motor cortex area in the affected hemisphere, and the changes associated with functional gain. Our cases showed that intensive movement therapy appears to change local cerebral perfusion and SPECT could show these changes in children with hemiplegic CP.

Improvement in upper limb function in children with dystonia following deep brain stimulation

BackgroundChildhood dystonia can severely impact upper limb function. Deep Brain Stimulation (DBS) has been shown to be effective in reducing dystonic symptoms in childhood. Functional recovery following DBS is however not well understood. AimsTo explore changes in upper limb function following DBS in paediatric dystonia. MethodsUpper limb outcomes, using the Melbourne Assessment of Unilateral Upper Limb Function, are reported in 20 cases of childhood dystonia (unilateral n = 1, four limb n = 19) at 6 and 12 months following DBS. ResultsImprovement in at least in one upper limb was seen in the majority of cases (n = 17, 85%) at 12 months following DBS. Deterioration of scores in both upper limbs was seen in 3 children with progressive disorders. Grouping the children aetiologically, a significant improvement in the dominant hand was obtained for the primary dystonia/dystonia-plus group at both six (p = 0.018) and twelve months (p = 0.012). In secondary dystonia due to a static disorder, improvement was also seen at 6 (p = 0.043) and 12 months (p = 0.046) in the non-dominant hand. No significant change was found in the group of children with progressive disorders. ConclusionsDBS has the potential to alter upper limb function in children with primary and secondary dystonia. The dominant hand improved most in children with primary dystonias, with greater improvement in the non-dominant hand in secondary-static cases.