The relationship between different upper extremity patterns and independence level in individuals with spastic cerebral palsy from the ICF perspective

Authors

Keywords:

Cerebral Palsy, upper limb, pattern, ICF, ADL, Independency

Abstract

Aim: Although various upper limb and hand involvement patterns in individuals with cerebral palsy (CP) have been defined, our knowledge about their functionality in daily life is still insufficient. The purpose of this study was to investigate upper extremity involvement patterns concerning the level of functionality in individuals with spastic CP. Methods: A total of 101 individuals, aged 7 to 21 years, with spastic cerebral palsy (30% unilateral CP, 70% bilateral CP), and a total of 172 hand and upper limb patterns were evaluated in this study. To identify different spastic upper extremity patterns, two classification systems, one for the upper limb and one for the hand (Classification of Upper Limbs and Hand Patterns), were used separately. Then, the Manual Ability Classification System [MACS] and Functional Independency Measure [Wee-FIM] were utilized to quantify hand functions and functional independency level, respectively, in the activities of daily living. Results: A strong correlation was found between MACSI and Simple Flex of Hand Pattern (r=0.72) while a moderate correlation was detected between MACSII and Simple Flex of Hand Pattern (r2=0.57). Besides, the level of independence in daily living activities was consistent with Type Ia and Type Ic patterns of the upper limb (r1=0.56 and r2=0.44) Conclusion: It was concluded in the light of the obtained data that Type Ia and Type Ic patterns of the upper limb, as well as Simple Flex of the hand pattern, are very efficient for functionality. Additionally, the pattern of Simple Flex Plus and Intrinsic Punching Hand were significantly related to bad capacity in hand functioning. The various upper limb and hand patterns affect the functionality or functional independence in daily living. Consequently, abnormal upper limb and hand patterns, which commonly occur in the upper extremities of children with CP, are quite different from each other in terms of functionality. Hence, it is recommended that before the application of BoNT-A or orthopedic surgery in managing spasticity, the client should be comprehensively evaluated in both terms of rigidity and functionality.

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References

Rosenbaum P, Paneth N, Leviton A, Goldstein M, Bax M, Damiano D, et al. A report: the definition and classification of cerebral palsy April 2006. Developmental medicine and child neurology Supplement. 2007;109:8-14.

Bar-On L, Molenaers G, Aertbeliën E, Van Campenhout A, Feys H, Nuttin B, et al. Spasticity and its contribution to hypertonia in cerebral palsy. BioMed Research International. 2015;2015.

Gage JR, Schwartz MH, Koop SE, Novacheck TF. The identification and treatment of gait problems in cerebral palsy. John Wiley & Sons; 2009.

Pontén E. Contracture formation in the upper limb in cerebral palsy starts early. Developmental Medicine & Child Neurology. 2019;61:117-8.

Sugiyama T, Taguchi T, Kawai S. Spontaneous fractures and quality of life in cerebral palsy. The Lancet. 2004;364:28.

Klingels K, Demeyere I, Jaspers E, De Cock P, Molenaers G, Boyd R, et al. Upper limb impairments and their impact on activity measures in children with unilateral cerebral palsy. European Journal of Paediatric Neurology. 2012;16:475-84.

Park ES, Sim EG, Rha D-w. Effect of upper limb deformities on gross motor and upper limb functions in children with spastic cerebral palsy. Research in Developmental Disabilities. 2011; 32: 2389-97.

Chaleat-Valayer E, Bard-Pondarre R, Bernard J, Roumenoff F, Lucet A, Denis A, et al. Upper limb and hand patterns in cerebral palsy: Reliability of two new classifications. European Journal of Paediatric Neurology 2017;21:754-62.

McConnell K, Johnston L, Kerr C. Upper limb function and deformity in cerebral palsy: a review of classification systems. Developmental Medicine & Child Neurology. 2011;53:799-805.

Rosenbaum P, Stewart D. The World Health Organization International Classification of Functioning, Disability, and Health: a model to guide clinical thinking, practice and research in the field of cerebral palsy. In: Seminars in Pediatric Neurology. 2004; Elsevier; p.5-10.

Hermann KM, Reese CS. Relationships among selected measures of impairment, functional limitation, and disability in patients with cervical spine disorders. Physical Therapy 2001;81:903-12.

Park E-Y. Path analysis of strength, spasticity, gross motor function, and health-related quality of life in children with spastic cerebral palsy. Health and Quality of Life Outcomes. 2018;16:70.

Abel MF, Damiano DL, Blanco JS, Conaway M, Miller F, Dabney K, et al. Relationships among musculoskeletal impairments and functional health status in ambulatory cerebral palsy. Journal of Pediatric Orthopaedics. 2003;23:535-41.

Wright FV, Rosenbaum PL, Goldsmith CH, Law M, Fehlings DL. How do changes in body functions and structures, activity, and participation relate in children with cerebral palsy? Developmental Medicine & Child Neurology. 2008;50:283-9.

Love S, Valentine J, Blair E, Price C, Cole J, Chauvel P. The effect of botulinum toxin type A on the functional ability of the child with spastic hemiplegia a randomized controlled trial. European Journal of Neurology 2001; 8: 50-8.

Hefter H, Jost WH, Reissig A, Zakine B, Bakheit AM, Wissel J. Classification of posture in poststroke upper limb spasticity: a potential decision tool for botulinum toxin A treatment? International Journal of Rehabilitation Research 2012; 35: 227-33.

Wasiak J, Hoare BJ, Wallen MM. Botulinum toxin A as an adjunct to treatment in the management of the upper limb in children with spastic cerebral palsy. Cochrane Database of Systematic Reviews. 2004;(3):CD003469. doi: 10.1002/14651858.CD003469.pub2..

Fehlings D, Novak I, Berweck S, Hoare B, Stott N, Russo RN. Botulinum toxin assessment, intervention and follow‐up for paediatric upper limb hypertonicity: international consensus statement. European Journal of Neurology. 2010;17:38-56.

Heinen F, Desloovere K, Schroeder AS, Berweck S, Borggraefe I, van Campenhout A, et al. The updated European Consensus 2009 on the use of Botulinum toxin for children with cerebral palsy. European Journal of Paediatric neurology. 2010;14:45-66.

Compagnone E, Maniglio J, Camposeo S, Vespino T, Losito L, De Rinaldis M, et al. Functional classifications for cerebral palsy: correlations between the gross motor function classification system (GMFCS), the manual ability classification system (MACS) and the communication function classification system (CFCS). Research in Developmental Disabilities. 2014;35:2651-7.

Öhrvall A-M, Krumlinde-Sundholm L, Eliasson A-C. Exploration of the relationship between the Manual Ability Classification System and hand-function measures of capacity and performance. Disability and Rehabilitation. 2013;35:913-8.

Organization WH. The World Health Report 2001: Mental health: new understanding, new hope. World Health Organization; 2001.

Cohen J. Statistical power analysis for the behavioral sciences. Routledge; 2013.

Kane PM, Vopat BG, Got C, Mansuripur K, Akelman E. The effect of supination and pronation on wrist range of motion. Journal of Wrist Surgery 2014;3:187-91.

Brumfield RH, Champoux JA. A biomechanical study of normal functional wrist motion. Clinical Orthopaedics and Related Research. 1984:23-5.

Arnould C, Penta M, Thonnard J-L. Hand impairments and their relationship with manual ability in children with cerebral palsy. Journal of Rehabilitation Medicine. 2008;39:708-14.

Hung J-W, Chang Y-J, Chou C-X, Wu W-C, Howell S, Lu W-P. Developing a Suite of Motion-Controlled Games for Upper Extremity Training in Children with Cerebral Palsy: A Proof-of-Concept Study. Games for Health Journal. 2018;7:327-34.

Furuya M, Ohata K, Izumi K, Matsubayashi J, Tominaga W, Mitani A. Effect of the angle of shoulder flexion on the reach trajectory of children with spastic cerebral palsy. Research in Developmental Disabilities. 2015;36:413-8.

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Published

2020-09-01

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Research Article

How to Cite

1.
Bingöl H, Kocaman H, Kerem Günel M. The relationship between different upper extremity patterns and independence level in individuals with spastic cerebral palsy from the ICF perspective. J Surg Med [Internet]. 2020 Sep. 1 [cited 2024 Dec. 6];4(9):798-802. Available from: https://jsurgmed.com/article/view/711490