Title:
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Management of the upper limb in children with cerebral palsy
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Background
Impairment of the upper limb (UL) is a common consequence of cerebral palsy (CP), and results
in difficulties completing daily activities.
Methods
Literature reviews evaluated UL classification systems and measures of impairment for children
with CP. Cross-sectional surveys were mailed to paediatric therapists and families of children
with CP to describe the perceived severity of UL problems and current therapy management of
such problems. Seven children aged 8-15 years with hemiplegic CP were recruited to a mixed
methods study (single subject research design and semi-structured interviews) evaluating the
efficacy and feasibility of constraint induced movement therapy (CIMT).
Results
Five classification systems were recommended for clinical use; two classified function, and
three, deformities. Continued use of the Modified Ashworth Scale, manual muscle testing and
goniometry when measuring UL impairments in clinical practice was supported. Families and
therapists perceived muscle weakness, decreased grip strength, reduced coordination and
impaired fine motor function as having a moderate or great impact on the UL in children with the
condition. Therapists commonly assessed joint range of motion and muscle strength, however
standardised measurement of activity was rare. Current therapy management reflected training
received by therapists with neurodevelopmental therapy and positioning being most often
reported in managing the UL of children with CP. CIMT resulted in significant improvements in
unimanual capacity in four participants, two of whom also significantly improved on UL active
range of motion, although UL strength, tone and participation remained largely unchanged.
Conclusions
This programme of work identified issues regarding assessment and treatment of UL
dysfunction in the paediatric CP population. Recommendations regarding UL assessment
methods and CIMT, pertinent to clinical practice and research, have stemmed from the
completed studies. This thesis has increased understanding of the complexity of UL problems
and provides a basis for further research in the area.
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