Upper Limb In Cerebral Palsy Research Articles

The “Exo hand-2” complex in the rehabilitation of the upper limb in cerebral palsy using the non-invasive interface “brain-computer”

Improving the function of the upper limb in cerebral palsy is one of the main tasks of rehabilitation treatment and socialization of the patient.The purpose of the study was to evaluate the effectiveness of the “Exo hand-2” complex with the non-invasive interface “brain-computer” for correcting the motor function of the upper limb in cerebral palsy.The study involved 50 male and female with cerebral palsy (main group n = 30, control group n = 20) aged 12–18 years old. The level of motor activity according to the criteria of classification of large motor functions (GMFCS) was not more than III. All patients received a standard course of spa rehabilitation for 21 days. Patients of the main group were additionally rehabilitated using the “Exo hand-2” complex with the non-invasive interface “brain-computer”. As a result of treatment in the main group, spasticity in the paretic hand on the Modified Ashworth Scale decreased from 3 (2; 3) to 2 (1; 2) points (p <0.002); according to Tardieu, spasticity decreased from the level of 3 (2; 3) to 2 (1; 2) (p <0.002). Half of the patients had paretic arm muscle strength in the Medical Research Counsil Weakness Scale sums core from 2.3 (2; 3) to 3 (2; 3) points after treatment (p = 0.002); assessment of household skills on the Modified Franchay Scale showed an improvement from 37 (22.75; 63.75) to 45 (30; 72.75) points after therapy.

Does fascial manipulation and myofascial surgery reduce spasticity and improve function of upper limb in cerebral palsy?

Does fascial manipulation and myofascial surgery reduce spasticity and improve function of upper limb in cerebral palsy?

Contracture formation in the upper limb in cerebral palsy starts early.

This commentary is on the original article by Hedberg‐Graff et al. on pages 204–211 of this issue.

One stage correction of forearm pronation, wrist flexion and thumb in palm deformity in spastic cerebral palsy

Thirty eight patients, with spastic cerebral palsy hemiplegic aged from 4to16 years with mean of 10 years had surgical procedures for the upper limb to increase functional status of hand. All the patients underwent various surgical procedures depending upon the necessity. IQ of all the patients were more than seventy. 36 patients felt an improvement in function, range of movement in the fore arm and wrist were also increased 74.7% the patients, thumb in palm deformity was completely corrected and resting position towards neutral and stability of hand were also some of the achievements of surgery. There was improvement in different functional grasps. The management of upper limb in cerebral palsy is a challenge, but in properly selected patients there is some improvement in functional status.

SHUEE on the evaluation of upper limb in cerebral palsy.

OBJECTIVE: To demonstrate the use of the tool for evaluation of spastic upper limb SHUEE (Shriners Hospital Upper Extremity Evaluation) in the evaluation of upper limb in cerebral palsy (CP) and its ability to detect changes after surgical treatment of identified deformities. METHODS: 19 patients with spastic hemiplegic CP had their upper limb evaluated by SHUEE. Five patients underwent surgical treatment of deformities detected and performed the test at one year postoperatively. RESULTS: The mean age was 9.02 years old; 18 patients were classified as level I GMFCS and one patient as level II. At baseline, the mean spontaneous functional analysis was 59.01; dynamic positional analysis was 58.05 and grasp-and-release function, was 91.21. In the postoperative period the scores were, respectively, 65.73, 69.62 and 100, showing an improvement of 3.5% in the spontaneous functional analysis and of 44.8% in dynamic positional analysis. CONCLUSIONS: SHUEE is a tool for evaluation of spastic upper limb in cerebral palsy that helps in the specific diagnosis of deformities, indication of treatment and objective detection of results after surgical treatment. Level of Evidence IV, Case Series.

Neuromuscular taping for the upper limb in Cerebral Palsy: A case study in a patient with hemiplegia

Objective: To assess quantitatively the effects of Neuromuscular Taping (NMT) on the upper limb in a female child with left hemiplegia, due to Cerebral Palsy (CP).Methods: The patient underwent NMT on cervical level, shoulder and hand only of the plegic upper limb, followed by physical therapy. Kinematic data of upper limbs during reaching task were collected before (PRE) and after 2 weeks of treatment (POST).Results: After the intervention, the affected limb improved in terms of movement duration, Average Jerk and Number of Unit Movements indices, indicating a faster, smoother and less segmented movement. Improvements appeared at the ranges of motion of the upper limb joints, both at shoulder and elbow joints. No significant changes were globally displayed for the unaffected arm.Conclusion: NMT seems to be a promising intervention for improving upper limb movement in patients with CP. Further investigations are certainly needed to assess effectively the effects of the intervention in this pathological state.

Upper Extremity Surgery in Spastic Cerebral Palsy

Involvement of the upper extremity in cerebral palsy often results in a typical pattern of spasticity, with elbow flexion, forearm pronation, ulnar deviation and flexion of the wrist, and adduction-flexion posture of the thumb. Although only a relatively small subset of cerebral palsy patients are candidates for surgery, properly selected patients and procedures yield a reasonable improvement. Nonsurgical treatment modalities include physical therapy, orthoses, and medications aimed at decreasing spasticity. Surgical options for the management of the spastic upper extremity vary with the specific parts, however they are focused around three basic principles: weakening the overactive muscle/tendons, strengthening the underactive muscle/tendons, and stabilizing non-stable joints. Surgical management of the spastic upper limb in cerebral palsy requires meticulous evaluation and planning. It is important to know that upper extremity deformities are secondary manifestations of the cerebral injury. Therefore, in addition to evaluation of upper extremity function, consideration should be given to the intelligence and motivation of the patient, and voluntary use of the upper extremity. Prior to surgery, the overall level of function needs to be considered. These are also important details for the patients and their families, who should know that surgery is aimed at improving the upper extremity deformity, and not the primary disorder. Appropriately indicated surgery can significantly contribute to upper extremity function. (JAREM 2012; 2: 43-54)

Assessment of the upper limb in cerebral palsy: validity and reliability of the revised VOAA‐DDD

This paper is on the original article by Houwink et al. on pages 76–82 of this issue

Management of the upper limb in cerebral palsy

The management of the upper limb in cerebral palsy is often complex and challenging. Effective treatment requires a multidisciplinary approach involving paediatricians, occupational therapists, physiotherapists, orthotists and upper extremity surgeons. Interventions are generally aimed at improving function and cosmesis by spasticity management, preventing contractures and correcting established deformities. Treatment objectives vary according to each child and range from static correction of deformities to ease nursing care, to improvements in dynamic muscle balance to augment hand function. Botulinum toxin A therapy has been shown to relieve spasticity and improve function in the short term. Surgery is also effective but requires careful patient selection, as many children with cerebral palsy are not candidates for surgery. Occupational therapy and physiotherapy have small treatment effects alone but are essential adjuncts to medical and surgical management.

Deformities of the upper limb in cerebral palsy: their surgical management.

Deformities of the upper limb in cerebral palsy: their surgical management.

Principles of Assessment of the Upper Limb in Cerebral Palsy

* Assistant Clinical Professor, Orthopaedic Surgery, University of California School of Medicine, Chief, Orthopaedic Surgery, Sonoma State Hospital.