Quantification of upper extremity function and range of motion in children with cerebral palsy

Abstract

This study evaluated the hypothesis that upper extremity function and range of motion can be quantified reliably in children with cerebral palsy (CP) in a busy clinical setting. The specific aim was to determine the inter-and intrarater reliability of a modified House Functional Classification (MHC) system to evaluate upper extremity function and a standardized instrument to document upper extremity range of motion (Upper Extremity Rating Scale [UERS]). Sixty-five children with CP (43 males, 22 females, mean age 9y 2mo, SD 4y 1mo) with spasticity involving the upper extremity (quadriplegia n=22; hemiplegia n=36; diplegia n=7; Gross Motor Functional Classification System Levels I n=41, II n=6, III n=3, IV n=5, V n=10) were evaluated independently by occupational therapists and orthopedic surgeons using both instruments at several visits. Inter-and intrarater reliability were determined for both instruments by calculating measures of agreement (weighted kappa values and intraclass correlation coefficients [ICCs]). Interrater agreement (ICC=0.94) and intrarater agreement (ICC=0.96) on the MHC were good to excellent. Similarly, inter-rater agreement (kappa 0.66-0.81) and intrarater agreement (kappa 0.64-0.88) on the UERS was either good or excellent. The MHC and the UERS provide standardized, reliable, reproducible, and efficient instruments that can be used by occupational therapists and orthopedic surgeons to evaluate the upper extremities of children with CP.Cerebral palsy (CP), the most common cause of severe physical disability in children, affects the upper extremities in approximately 80% of the children who are treated in our spasticity clinic. The extent of upper extremity involvement varies between individuals, with the most common deformities being internal rotation at the shoulder, elbow flexion, forearm pronation, wrist and finger flexion, and thumbin-palm. Clinical evaluations repeated throughout childhood allow clinicians to monitor the deformities and select intervention strategies that optimize health and function in children with CP.

Higher Expression of Myosin Heavy Chain IIx in Wrist Flexors in Cerebral Palsy

“…Hand function in the patients with CP was classified according to House, where 0 is no use of the hand, 1 to 3 different levels of passive helper hand, 4 to 6 different levels of active helper hand, and 7 to 8 a hand that can manipulate [9,11,28]. Gross motor function (ambulation ability) was assessed according to the Gross Motor Function Classification System (GMFCS), where GMFCS I refers to independent ambulation without limitations and GMFCS V refers to when a child cannot drive an electric wheelchair by him/herself but has to be driven by someone else [17].…”

Assessment Tools and Classification Systems Used For the Upper Extremity in Children With Cerebral Palsy

“…However, validity for two of the tools (Jebson Taylor Hand Function Test and House Scale) had been challenged by subsequent investigators [7,8,22,23,31,61].…”

“…There is no manual. A Modified House Classification (MHC) that incorporates 32 additional descriptors to the nine-point rating scale has been developed [31].…”

“…The original House Scale and the proposed MHC are reliable and valid classification tools [31,67]. Publications include evidence of criterion validity and interrater and intrarater reliability.…”

A more definitive measure of upper limb capacity for children with unilateral cerebral palsy

“…2 In a brief review in this paper of existing valid measures of upper limb function, the limitations of the more frequently used assessments all suggested that none captured the functional capacity of the affected hand, especially while performing bimanual activities. Interestingly, the authors refined a reliable and valid evaluation of upper extremity function, the Modified House Classification (MHC) 3 in order to develop a valid tool that measures the manual capacity of children with unilateral CP. The refined measure defined a new uni-dimensional 14-item set from the MHC indicating that the 14 items worked well together to measure an upper extremity construct.…”