Does stable sitting influence upper limb function in children with cerebral palsy?

Abstract

Bilateral spastic cerebral palsy (BSCP) patients frequently need to use various sitting devices for body control and function. The aim of this study was to investigate whether the use of a belt to position the pelvis in an adjustable chair would affect upper limb function in preschool children with BSCP. Fortyone children with BSCP [mean age 44 ±11, range 18-60 months] classified according to the Gross Motor Function Classification System (GMFCS), as level III (n=21) and level IV (n=20) were fitted with a hip-positioning belt. Upper limb functions were assessed by Quality of Upper Extremity Skills Test (QUEST). The median scores of the following upper extremity functions increased significantly by wearing the hip positioning belt: dissociated movements, grasping, weight bearing and protective extension. The total QUEST score increased from 56.7 (±46.3) to 66.1 (±39.2) (p<0.001). The portable and adaptable hip-positioning belt may be used in daily life to improve upper limb activity in preschool children with moderate to severe BSCP.

An investigation into the factors which affect the sitting balance of non-ambulatory children with cerebral palsy

“…Children with better upper extremity functions can perform corrective protective and balance reactions more accurately and have better sitting function. 16 In our study, we found that sitting function and trunk control were significantly worse in patients with hip dislocation than those without, and trunk control was significantly worse in patients with scoliosis than those without. Krebs et al found that 14% of patients with hip dislocation had an improved sitting skill after surgery.…”

Effect of Adaptive Seating Systems on Postural Control and Activity Performance: A Systematic Review

“…Of the remaining 59 studies, a fulltext review resulted in 21 studies that met the inclusion criteria (Figure). 14,[24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43] Six cohort, 5 experimental, 10 crosssectional, and among these 11 were longitudinal studies with no RCT studies identified. Seating posture was investigated in 15 studies, postural control in 13 studies, and activity performance in 10 studies with some studies investigating more than 1 outcome (Table 2).…”

“…The regular use of paper-made chairs promoted child motor skills, interaction with family and friends, and involvement in daily activities 30. Dynamic seating systems reduced vigorous movements, helped decrease pain intensity, enhanced upper limb function, reduced dynamic spinal curvatures, and quality of reaching 24,31,32,34,39. The use of lateral pads on the sitting chair corrected scoliosis, and use of contoured foam promotes child engagement with toys 35,38…”

“…27 Sacral pad and knee blocks did not result in functional changes in posture but may improve the hip position. 37 Tools used to measure activity performance were video recordings, 29,40,43 Family Impact of Adaptive Technology Scale for Adaptive Seating (FIATS-AS), 14,30 Sitting Assessment Scale (SAS), 27,29 the Quality of Upper Extremity Skills Test (QUEST), 26,31 and Paediatric Evaluation of Disability Computer Adapted Test (PEDICAT). 14…”

Effect of different levels of segmental trunk stability training on sitting and upper limbs functions in children with bilateral spastic cerebral palsy

“…Children with BSCP have a low tone in body muscles but a high tone in extremity muscles. The risk of deformities in the lower extremities and spine may be increased due to insufficient postural stabilization, and spinal malalignment (Seyhan and Kerem-Günel, 2019).…”