Upper Limb In Children Research Articles

Intraobserver reliability of the modified Tardieu scale in the upper limb of children with hemiplegia

This study investigated the reliability of the modified Tardieu scale in the assessment of biceps spasticity in the upper limbs of children with hemiplegic cerebral palsy (CP). Ten children, with hemiplegic CP participated in the study: six males (mean age 9 years, SD 4 years) and four females (mean age 12 years, SD 3 years). Blinded, duplicate measures of dynamic elbow extension were performed on the hemiplegic arm at time 0 and 7 days later, using the three angular velocities described in the Tardieu scale (V1, slow; V2, speed of gravity; V3, as fast as possible). The resulting elbow joint angles were defined as R1, the angle of catch following a fast velocity stretch at either V2 or V3; and R2, the passive range of movement achieved following a slow velocity stretch at V1. Both elbow joint angle and movement angular velocity were measured by three‐dimensional kinematics. Median error in measured elbow joint angle within one session ranged from 3 to 5°. Between sessions median absolute differences in measured elbow joint angle ranged from 4 to 13°, with measurement errors of up to 25 to 30° in some participants at the fastest velocity (V3). The therapist was able to apply three significantly different angular velocities as required for the Tardieu scale (p < 0.001). However, the ranges of the three angular velocities overlapped, with fast velocities for some participants being equivalent to slow velocities for other participants. Three out of 10 participants had an intersessional difference in their R2‐R1 score of more than 20°. From this study, we concluded that the R2‐R1 value determined from the modified Tardieu scale may be of limited value in assessing biceps spasticity the upper limbs in children with hemiplegic CP.

Stochastic-rheological Simulation of Free-fall Arm Impact in Children: Application to Playground Injuries

The aim of this study was to develop and pilot a stochastic-rheological biomechanical model to investigate the mechanics of impact fractures in the upper limbs of children who fall in everyday situations, such as when playing on playground equipment. The rheological aspect of the model characterises musculo-skeletal tissues in terms of inertial, elastic and viscous parameters. The stochastic aspect of the model allows natural variation of children's musculo-skeletal mechanical properties to be accounted for in the analysis. The relationship of risk factors, such as fall height, impact surface, child mass and bone density, to the probability of sustaining an injury in playground equipment falls were examined and found to closely match findings in epidemiological, clinical and biomechanical literature. These results suggest that the stochastic-rheological model is a useful tool for the evaluation of arm fracture risk in children. Once fully developed, information from this model will provide the basis for recommendations for modifications to playground equipment and surface standards.

Functional outcomes of intramuscular botulinum toxin type a in the upper limbs of children with cerebral palsy: a phase II trial

Wallen MA, O’Flaherty SJ, Waugh M-CA. Functional outcomes of intramuscular botulinum toxin type A in the upper limbs of children with cerebral palsy: a phase II trial. Arch Phys Med Rehabil 2004;85:192–200. Objective To describe the functional and family-centered assessment protocol and outcomes of a phase II trial evaluating upper-limb function after botulinum toxin injections in children with cerebral palsy (CP). Design Intervention study, case series, phase II trial, follow-up at 2 weeks and 3 and 6 months. Setting Specialist outpatient physical disabilities clinic within a public pediatric teaching hospital. Participants Convenience sample of 16 children with CP (age range, 2–12y). Interventions Botulinum toxin type A (Botox) injections after electrical stimulation localization of appropriate muscle. Main outcome measures The Canadian Occupational Performance Measure (COPM), Goal Attainment Scale (GAS), Melbourne Assessment of Unilateral Upper Limb Function, Child Health Questionnaire (CHQ), parent questionnaire, Modified Ashworth Scale (MAS), Tardieu scale, and active (AROM) and passive (PROM) range of motion. Results On the COPM, there was significant improvement at 3 months and 6 months. On the GAS, the T-scores were 42 and 47 at 3 and 6 months, respectively. On the Melbourne Assessment and CHQ, there was no significant change. The parent questionnaire indicated acceptability of injections and positive outcomes. On the MAS, there was a significant reduction in tone at 2 weeks, with a return to baseline by 6 months. On the Tardieu scale, there was a significant increase in angle of first catch at 2 weeks, but only the elbow maintained a significant difference at 3 and 6 months. No significant change was found for AROM or PROM. Conclusions Sustained functional outcomes occurred after botulinum toxin injections despite increasing muscle tone after an initial reduction in tone. Randomized controlled trials are required.

Botulinum toxin A as an adjunct to treatment in the management of the upper limb in children with spastic cerebral palsy.

Cerebral palsy (CP) is a central nervous system deficit resulting from a non-progressive lesion in the developing brain. Although the brain lesions are static, the movement disorders that arise are not unchanging and are characterised by atypical muscle tone, posture and movement (Rang 1990). The spastic motor type is the most common form of CP and its conventional therapeutic management may include splinting/casting, passive stretching, facilitation of posture and movement, spasticity-reducing medication and surgery. More recently, health care professionals have begun to use botulinum toxin A (BtA) as an adjunct to interventions in an attempt to reduce muscle tone and spasticity to improve function To assess the effectiveness of intramuscular BtA injections as an adjunct to managing the upper limb in children with spastic CP. We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 4, 2003), MEDLINE (1966 to March Week 3 2004), EMBASE (1980 to 2003 Week 16) and CINAHL (1982 to Week 3 March 2004). All randomised controlled trials (RCTs) comparing intramuscular BtA injections into any muscle group of the upper limb with placebo, no treatment or other interventions. Two authors using standardised forms extracted the data independently. Each trial was assessed for internal validity with differences resolved by discussion. Data was extracted and entered into RevMan 4.2.3. Two trials met the inclusion criteria, each having short-term follow up, a small number of subjects and using a single set of injections. The study by Corry 1997 compared BtA with an injection of normal saline and found promising results in elbow extension, elbow and wrist muscle tone. At three months, encouraging results for wrist muscle tone and grasp and release were noted. The trial reported median change, range of changes and the difference in these measures between groups. The study by Fehlings 2000 compared BtA with no intervention. When data were analysed no treatment effect was found for quality of upper limb function, passive range of motion, muscle tone, grip strength or self-care ability. This systematic review has not found sufficient evidence to support or refute the use of intramuscular injections of BtA as an adjunct to managing the upper limb in children with spastic cerebral palsy. Only one of the two identified RCTs reported some promising results in support of reduced muscle tone following BtA injections. Further research incorporating larger sample sizes, rigorous methodology, measurement of upper limb function and functional outcomes is essential.

Therapeutic effects of functional electrical stimulation of the upper limb of eight children with cerebral palsy

Functional electrical stimulation (FES) of the upper limb has been used for patients with a variety of neurological conditions, although few studies have been conducted on its use on the upper limb of children with cerebral palsy (CP). The aim of this study was to investigate the effect of cyclic FES on the wrist extensor muscles of a group of eight children (five boys, three girls) with hemiplegic CP (mean age 10 years). The study design involved a baseline (3 weeks), treatment (6 weeks), and follow‐up (6 weeks). FES was applied for 30 minutes daily during the treatment period of the study. Improvements in hand function (p≤0.039) and active wrist extension (p=0.031) were observed at the end of the treatment period. These improvements were largely maintained until the end of the follow‐up period. No significant change was observed in the measurements of wrist extension moment during the treatment period (p=0.274). Hand function in this group of children improved after they were exposed to FES of wrist extensor muscles. This suggests that FES could become a useful adjunct therapy to complement existing management strategies available for this patient population.

Therapeutic effects of functional electrical stimulation of the upper limb of eight children with cerebral palsy

Functional electrical stimulation (FES) of the upper limb has been used for patients with a variety of neurological conditions, although few studies have been conducted on its use on the upper limb of children with cerebral palsy (CP). The aim of this study was to investigate the effect of cyclic FES on the wrist extensor muscles of a group of eight children (five boys, three girls) with hemiplegic CP (mean age 10 years). The study design involved a baseline (3 weeks), treatment (6 weeks), and follow-up (6 weeks). FES was applied for 30 minutes daily during the treatment period of the study. Improvements in hand function (p < or = 0.039) and active wrist extension (p = 0.031) were observed at the end of the treatment period. These improvements were largely maintained until the end of the follow-up period. No significant change was observed in the measurements of wrist extension moment during the treatment period (p = 0.274). Hand function in this group of children improved after they were exposed to FES of wrist extensor muscles. This suggests that FES could become a useful adjunct therapy to complement existing management strategies available for this patient population.

VASCULAR CELL TUMORS OF THE HAND IN CHILDREN

The diagnosis of vascular cell tumors of the upper limb in children can be extremely difficult. There is considerable variation in their presentation and natural history. In most instances, the correct diagnosis can be achieved after a careful history and examination. Almost invariably, they are benign lesions and, of these, hemangiomas and vascular malformations account for more than 90%. Worrying tumors of the intermediate and malignant grade are rare. Any atypical, rapidly growing tumor with superficial ulceration and bony destruction on radiology should be regarded as malignant. Histologic differentiation of all problematic vascular swellings requires the services of an experienced pediatric vascular pathologist. In the future, specific cellular marker profiles of individual lesions may simplify the diagnosis. Conservative, symptomatic management is the first line of treatment for almost every vascular swelling. Intervention is reserved for swellings complicated by ulceration, uncontrollable rapid growth, coagulopathies, cardiovascular compromise, or the possibility of malignancy. Small lesions may generally be simply excised, whereas larger lesions often remain a problem.

Accidental contact burns of the upper limb in children with obstetric brachial plexus injury

The denervated limb of the child with obstetrical brachial plexus injury is theoretically at risk of contact burns. A prospective study was designed to document the incidence and clinical presentation of these burn injuries in a series of 127 birth palsy cases. The study group included 90 Erb's and 37 total plexus palsy cases. Accidental burns occurred in 11% of total palsy cases and 1% of the Erb's palsy group. All injuries were contact burns and confined to the denervated limb. When the circumstances of the burn injury where investigated, it was concluded that injury to the denervated limb was either due to poor motor control, insensibility or a combination of both factors. Finally, treatment and prevention of these injuries are discussed.

Two rapidly growing fatty tumors of the upper limb in children: Lipoblastoma and infiltrating lipoma

One case of lipoblastoma and another case of infiltrating lipoma of the upper limb in infancy are reported. These rare benign fatty tumors may be congenital and may grow rapidly soon after birth. The classification of these fatty tumors and their management are presented to increase awareness of the benign nature of these tumors despite their rapid growth and to demonstrate that complete surgical excision should be done to prevent local recurrence.

Tumeur fibrohistiocytaire plexiforme de la main. Forme tardive

Plexiform fibrohistiocytic tumours are very rare, apparently benign neoplasms of the superficial soft tissue: only two series and one case report have been described in the literature. Macroscopically located within the dermis or superficial subcutis, they seem to predominate in the upper limbs of children and young adults. Moreover their recurrence rate is relatively high. We report the case of a 56 year old male patient presenting such a plexiform fibrohistiocytic tumour of the hand, which was surgically excised after a progressive clinical evolution of approximately 5 years and in which no recurrence has been observed with a follow-up of more than 24 months.

Physical Hand Function of the Child with Spina Bifida Myelomeningocele

Hand dysfunction has been reported to be present in myelomeningocele children, yet the type, extent, and cause of such dysfunction have remained unclear. This study was undertaken to discover whether motor dysfunction was present in the upper limbs of children with the diagnosis spina bifida myelomeningocele with lesions below the spinal level T4. Tests of manual muscle strength and grip strength indicated that spina bifida children have inferior motor function when compared with a control group of individually matched normal children. When the spina bifida group was divided on the basis of presence or absence of hydrocephalus it was apparent that the hydrocephalic children had poorer muscle power. The non-hydrocephalic children, however, did not have normal motor function. Thus the level of the lesion, and the presence of hydrocephalus, could not be identified as the prime cause of hand dysfunction discovered in the sample studied.

Les potentiels cerebraux somesthesiques evoques a partir du membre inferieur chez le nouveau-ne et le nourrisson

In 26 babies, from 1 day to 3 months old, the somatosensory scalp potentials (SEPs) were evoked by electrical stimulation of the tibialis posterior nerve. No reproducible response in any location was obtained in 6 cases. In the other 20 cases, the initial wave was positive in 18 cases, with a peak latency at about 35 msec (P36) but the initial latency differed according to the location of the electrodes on the midline and to the baby. In a systematic topographical study, P36 was found to be variable in its distribution and its latency without correlation, whether with the baby's age, size, physiological state or intensity of stimulation. Our results are compared with SEPs obtained from the lower limb in adults and from the upper limb in children.

Loss and recovery of trabecular bone in the distal radius following fracture ? Immobilization of the upper limb in children

Computed tomography of the human radius is performed using a special purpose scanning device which incorporates a radionuclide (125I) as radiation source. Parameters decribing the trabecular bone and the compact bone are determined at a distal and a diaphyseal measuring site respectively. Using this measurement technique changes in bone mineralization in the radius were studied in a group of 23 children following immobilization of an upper limb for fracture healing. An immobilization period of between three to six weeks resulted in a reduction of the relevant parameter value of up to 44% (mean 16%) in the distal part of the radius, whereas no significant change could be seen in the diaphyseal part of the same bone. Rapid remineralization of trabecular bone is indicated by the increase of the corresponding parameter value at a rate of up to several percent per week. However, in some of the patients studied complete normalization was not attained during the first six months following cast removal.