The Dynamic Thumb-in-Palm Pattern in Children with Spastic Cerebral Palsy and Its Effects on Upper Limb Function

Abstract

The thumb-in-palm (TIP) pattern is one of the most common upper limb deformities in cerebral palsy (CP). This study was designed to investigate the effect of the dynamic TIP pattern on upper limb function in children with spastic CP. This prospective observational study included a total of 106 children with CP with dynamic TIP. The House TIP classification while grasping small or large objects, Melbourne Assessment of Unilateral Upper Limb Function (MUUL), Shriners Hospital Upper Extremity Evaluation (SHUEE), Zancolli classification for wrist–finger flexor deformity, and degree of swan neck deformity were assessed. Type I was the most common and highest functioning House TIP classification type. However, there were no significant differences in upper arm function between types II, III, and IV. The three components of the SHUEE showed stronger association with MUUL than House TIP and Zancolli classifications. After multivariable analysis, functional use of the wrist–finger and the thumb played a more significant role than the dynamic alignment of the thumb. In conclusion, the House TIP classification is useful to describe the TIP pattern. The SHUEE thumb assessment is a useful tool for reflecting upper arm function. The upper arm function was related more with the associated wrist flexor deformity than dynamic TIP.

A Pilot Feasibility Study on the Use of Dual-Joystick-Operated Ride-on Toys in Upper Extremity Rehabilitation for Children with Unilateral Cerebral Palsy

“…We summed the prompt score across all tasks of the SHUEE to calculate a total raw prompt score (maximum possible prompt score of 96). We report on percent total SFA and DPA scores [35][36][37][38], percent unprompted affected UE use, and raw prompt scores. At present, there are no data available on standard error of measurement or minimal clinically important difference for the SHUEE.…”

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 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…”

“…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.…”