Dynamic electromyography and decision-making for surgery in the upper extremity of patients with cerebral palsy

Hoffer, M. Mark; Perry, Jacquelin; Melkonian, Gregory J.

doi:10.1016/s0363-5023(79)80036-2

Cited by 49 publications

(12 citation statements)

References 2 publications

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“…• Sensitivity was classified into three types according to Koman et al and Hoffer et al [10,11] • The children's functional hand use according to House's classification [12] • Muscle tone was measured on Ashworth's scale [13] • Zancolli's classification [14] • The active and passive ROM at the shoulder, elbow and wrist • Thumb position according to the Matev classification [15] Experimental procedure Subjects were asked to perform two daily tasks, named ''to drink'' and ''to move an object'', respectively. With the subject being sat on a chair with the hips and the knees flexed at 90°, the two upper limbs were studied successively, as follows:…”

Section: Clinical Evaluationmentioning

confidence: 99%

Upper limb motion analysis in children with hemiplegic cerebral palsy: Proximal kinematic changes after distal botulinum toxin or surgical treatments

Fitoussi

Diop

Maurel

et al. 2011

Journal of Children's Orthopaedics

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Purpose The purpose of this study is to describe the kinematic changes in children with cerebral palsy (CP) after treatments performed on the forearm, wrist or thumb, with specific attention to the changes around the trunk, shoulder and elbow kinematics. Methods With the use of a specific kinematic protocol, we first described the upper limb kinematics in a group of 27 hemiplegic patients during two simple daily tasks. Eight of these children were treated with botulinum toxin (Botox Ò , Allergan) injection or surgery and were, thereafter, evaluated with another kinematic analysis in order to compare the pre-and post-therapeutic condition. The target muscles were the pronator teres, flexor carpi radialis, flexor carpi ulnaris, flexor digitorum superficialis, flexor pollicis longus and the adductor pollicis. Results Significant kinematic changes were found after treatment. Patients increased forearm supination (P \ 0.05) and wrist extension (P \ 0.05) during both tasks. Patients also decreased trunk flexion/extension range of motion (ROM) (P \ 0.05), improved elbow ROM (P \ 0.05) and improved internal shoulder rotation (P \ 0.05).Conclusions Dynamic shoulder or elbow limitations in children with mild hemiplegia involvement could be related to a compensatory movement strategy and/or co-contractions. As these proximal kinematics anomalies are improved after treatments performed at the forearm, wrist and thumb, they should not be treated first but should be reconsidered after the treatment of more distal problems.

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Section: Clinical Evaluationmentioning

confidence: 99%

Upper limb motion analysis in children with hemiplegic cerebral palsy: Proximal kinematic changes after distal botulinum toxin or surgical treatments

Fitoussi

Diop

Maurel

et al. 2011

Journal of Children's Orthopaedics

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“…The results are contradictory. Hoffer et al 13,14 were unable to find consistent EMG changes after surgery during various specified hand tasks, such as grasping and release of grasp. On the contrary, Mowery et al, 15 who did not specify the tasks which the participants had to perform during EMG recording, reported similar findings as Samilson and Morris.…”

Section: Resultsmentioning

confidence: 96%

Does surgical management of the hand in children with spastic unilateral cerebral palsy affect functional outcome?

Munster

Maathuis

Haga

et al. 2007

Develop Med Child Neuro

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The aim of this review was to examine the literature on the effects of surgery of the spastic hand in children with cerebral palsy on functional outcome and muscle coordination. We performed a search of the relevant literature in Medline, Embase, and Biological Abstracts from 1966 to June 2006. The search resulted in eight studies on the effect of surgery on functional outcome and three studies on the effect of surgery on muscle coordination. Heterogeneity in outcome measures precluded meta-analysis. The studies revealed that -at the level of impairment -surgery has a positive effect on supination and dorsiflexion of the wrist. At the level of function, surgery might improve grip strategy and induce an increase of the repertoire of grips and spontaneous use of the hand. The evidence for the functional effects is, however, limited. Whether the possibly improved function is mediated by alterations in muscle coordination patterns remains unclear. The muscle coordination studies provided inconclusive results. We concluded that surgery improves the position of the hand and there are indications that it might improve hand function. Future research should address the question: does surgery improve hand function and, if so, is this due solely to a better hand position or does change in muscle coordination play an additional role?Cerebral palsy (CP) describes a group of disorders of the development of movement and posture, causing activity limitation that is attributed to non-progressive disturbances which occurred in the developing fetal or infant brain. The motor disorders of CP are often accompanied by disturbances of sensation, cognition, communication, perception, and/or behaviour, and/or by a seizure disorder. 1 Impaired arm and hand function are major problems of children with CP, which contribute to disability in daily functioning. Pathophysiological mechanisms which play a role in these problems are paresis of specific muscles and spasticity and/or reduced muscle length associated with spasticity and disuse. Imbalance between agonistic and antagonistic muscles influences the position of the arm and hand. Secondary contractures and joint deformities often result in adduction and inward rotation of the upper arm, flexion of the elbow, pronation of the forearm, flexion of wrist and fingers, and thumb-in-palm deformity. These impairments contribute to the difficulties experienced in reaching, pointing, grasping, releasing, and manipulating objects. The abnormal hand posture influences the ability for refined grasping of objects of different orientation or shape. 2 One of the treatment options in children with CP is surgery. Surgical treatment, which may include release of spastic muscles and tendon transfers, focuses on improving muscle

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“…Dynamic wrist flexion deformities can be managed with tendon transfers [5, 6, 33, 34]. Assessments of tendon function are used to determine the appropriate tendon transfers; assessments include both clinical and electromyographic muscle testings of the wrist during motion [4, 7, 35, 36]. Muscles are noted as having phasic, nonphasic, or continuous activity.…”

Section: Tendon Transfers and Evaluation Of Dynamic Motor Activationmentioning

confidence: 99%

Surgical Management of the Wrist in Children with Cerebral Palsy and Traumatic Brain Injury

Koman

Smith

2014

Hand (New York, N,Y.)

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Dynamic electromyography and decision-making for surgery in the upper extremity of patients with cerebral palsy

Cited by 49 publications

References 2 publications

Upper limb motion analysis in children with hemiplegic cerebral palsy: Proximal kinematic changes after distal botulinum toxin or surgical treatments

Upper limb motion analysis in children with hemiplegic cerebral palsy: Proximal kinematic changes after distal botulinum toxin or surgical treatments

Does surgical management of the hand in children with spastic unilateral cerebral palsy affect functional outcome?

Surgical Management of the Wrist in Children with Cerebral Palsy and Traumatic Brain Injury

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