An Assessment of the Applicability of Shriners Hospital Upper Extremity Evaluation as a Decision-making Tool and Outcome Measure in Upper Limb Cerebral Palsy in Indian Children

Abstract

Background: The aim of this study was to assess the applicability and performance of the Shriners Hospital Upper Extremity Evaluation (SHUEE) and to determine its usefulness in clinical decision-making and as an outcome measure with reference to Indian children suffering from cerebral palsy. Materials and Methods: The SHUEE videos of 40 children with cerebral palsy with spastic hemiplegia or asymmetrical diplegia were analyzed and scored. Seven children had undergone upper extremity surgery based on a preoperative evaluation. All seven had a postoperative evaluation. Pre- and postoperative scores were compared. Intra- and interobserver reliability was assessed. The level of familiarity and comfort of the children with the assigned tasks was gauged. Results: Analysis of the scores revealed that patients could be categorized into three discrete groups based on the modified House scores and Spontaneous Functional Analysis (SFA) scores, which helps in identifying the patients who would benefit from surgical intervention. In the seven children who were operated, there was a mean increase in the postoperative SFA (2.97, P = 0.259), Dynamic Positional Analysis (3.15, P = 0.229) and Grasp/Release Analysis (4.96, P = 0.334) scores, though the differences were not statistically significant. There was excellent intraobserver ( r - 0.98) and interobserver reliability ( r - 0.97, 0.96) based on the intraclass correlation coefficient. The children were familiar with the assigned tasks and were not duly uncomfortable while attempting to perform them. Conclusions: SHUEE is a useful modality to assess upper limb function in Indian children with cerebral palsy, and can be used as a decision-making tool and mode of documentation.

Can the Shriners Hospital Upper Extremity Evaluation (SHUEE) Detect Change in Dynamic Position and Spontaneous Function of the Upper Limb in People With Hemiplegic Cerebral Palsy?

“…The non-surgical group consisted of GMFCS levels I (5), II (4), and IV (1) and MACS levels I (1), II (7), III (1), and IV (1). Children in the surgical group consisted of GMFCS levels I (7), II (6), and IV (1) and MACS levels I (2), II (5), and III (7). A χ 2 test showed no significant differences in GMFCS distribution (P = 0.5) between groups, but significantly more limited upper extremity function according to MACS classification in the surgical group (P < 0.00001).…”

“…The SHUEE takes ~15 minutes to administer, after which DPA and SFA are scored from video by a physical or occupational therapist (training is required). The SHUEE has been used as a preoperative measure in treatment planning for people with CP and found to be useful in evaluating UE function 5,13. Moreover, some authors report findings of the capabilities of SHUEE to measure changes in DPA after surgical intervention 9,10…”

“…[1][2][3][4] The neuroorthopaedic consequences include reduced upper limb function in performing daily living tasks that involve reaching, grasping, and releasing objects. 5 Children with CP and hemiplegic upper limb involvement struggle to use the affected limb as frequently and as effectively as the noninvolved upper limb. [6][7][8] Surgical interventions such as tendon transfers can be effective treatment options to address positional alignment of the affected limb.…”

“…The SHUEE has been used as a preoperative measure in treatment planning for people with CP and found to be useful in evaluating UE function. 5,13 Moreover, some authors report findings of the capabilities of SHUEE to measure changes in DPA after surgical intervention. 9,10 There is limited research available on the utility of the SHUEE as an outcome of UE surgery effectiveness.…”

Validity and reliability of the Turkish versions of Assessment of Children's Hand Skills and Children's Hand‐Skills Ability Questionnaire in children with hemiplegic cerebral palsy

“…Finally, the GRF parameter contains assessing the grip and release functions in three wrist positions with a dichotomous scale (0 = cannot grip and release , 1 = can grip and release ). All parameters' final scores are calculated as percentage scores (Davids et al, 2006; Jose, Radhakrishna, Sahoo, & Madhuri, 2019). Turkish version of SHUEE was shown to be valid and reliable in children with HCP.…”