Evaluation of hand function in patients with unilateral cerebral palsy who underwent multilevel functional surgery: a retrospective observational study

Abstract

This provisional PDF corresponds to the article as it appeared upon acceptance.A copyedited and fully formatted version will be made available soon. The final version may contain major or minor changes.Subscription: Information about subscribing to Minerva Medica journals is online at: http://www.minervamedica.it/en/how-to-order-journals.php Reprints and permissions: For information about reprints and permissionssend an email to: journals.dept@minervamedica.it -journals2.dept@minervamedica.it -2 1. ABSTRACT Background. Hemiplegia is the most common form of Cerebral Palsy. Upper Limb is generally more affected than lower one. In fact, hemiplegic children can spontaneously acquire standing and walking ability, while manipulation remains uncertain, with severe limitations in activity and participation, which define child's functional status (International Classification of Functioning -ICF). Several non-surgical tools are currently available to approach upper limb impairments. Studies regarding upper limb multilevel surgery in Hemiplegic Cerebral Palsy are relatively few and inhomogeneous.Aim. The aim of this study is to propose a surgical approach based on upper limb functional level and manipulation strategy and establish whether multilevel surgery can improve segmental alignment, performance and capacity, that ICF defines as activities and participation qualifiers.Design. This study is an observational retrospective study.Setting. This study involves patients who referred to Children Rehabilitation Unit of IRCCS S. Maria Nuova in Reggio Emilia (Italy), along a period of four years. Population. It involves children affected by hemiplegic cerebral palsy who underwent upper limb multilevel surgery. Method. For each patient, we previously defined functional use of affected upper limb applying the House classification and the Ferrari one of manipulation pattern. Patients are divided into three groups: synergic hand (House 4, 5), imprisoned hand (House 3), excluded hand (House 0). We recorded goals achievement through Goal Attainment Scale and unimanual and bimanual abilities through Melbourne Assessment of Unilateral Upper Limb Function and through Assisting Hand Assessment respectively. Results. We record 16 upper limb multilevel surgical interventions in 13 children and report their results.Conclusion. This study suggests that surgery can induce a segmental and/or aesthetic and/or a functional change depending on manipulation pattern. It also underlines the importance to analyse results in term of spontaneous manipulation abilities and daily use.Clinical rehabilitation impact. This study provides a preliminary guide to plan surgery in relation to segmental deformities and overall manipulation pattern and describes their feasible improvement measures. It also suggests the most useful tools to record goal achievements in modifying manipulation function. COPYRIGHT© EDIZIONI MINERVA MEDICAThis document is

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