Effect of upper limb deformities on gross motor and upper limb functions in children with spastic cerebral palsy.
Limited palm-up motion is the biggest arm-function blocker in spastic CP.
01Research in Context
What this study did
Park et al. (2011) looked at how twisted or tight arm muscles change what kids with spastic cerebral palsy can do. They checked each child’s arms for fixed joint positions and then scored how well the same arms moved and gripped.
The team wanted to know which arm problems hurt daily skills the most.
What they found
The tighter the forearm, the lower the arm-use score. Kids who could not turn their palm up had the worst scores.
Gross motor level did not always match arm problems; some kids walked fine but still struggled to feed themselves.
How this fits with other research
Bleyenheuft et al. (2017) built a new 43-item parent scale called ACTIVLIM-CP that mixes arm and leg tasks. Their tool backs up Sook’s point: arm limits drag down total activity.
Kushki et al. (2011) watched typical and dysgraphic kids write for ten minutes. Everyone gripped harder as they tired, showing that even normal arms change strategy when stressed. Sook’s kids start with less range, so fatigue hits faster.
Gilboa et al. (2010) found kids with NF1 had slower, messier handwriting. Together these studies say: measure the arm first, then watch how long the skill lasts.
Why it matters
Before you write a grasp goal, check forearm supination. If the palm will not turn up, switch to a neutral-grip spoon or angled crayon. Track both the angle and the minutes the child can use it. Small arm fixes can save larger session time.
Want CEUs on This Topic?
The ABA Clubhouse has 60+ free CEUs — live every Wednesday. Ethics, supervision & clinical topics.
Join Free →Test palm-up range with a toy hammer; if less than 30°, trial a vertical-handle marker.
02At a glance
03Original abstract
The aims of this study were to investigate the nature and extent of upper limb deformities via the use of various classifications, and to analyze the relationship between upper limb deformities and gross motor or upper limb functionality levels. Upper extremity data were collected from 234 children with spastic cerebral palsy (CP) who were admitted to the university hospital for intensive rehabilitation. Upper limb deformities were classified according to the Zancolli classification for finger and wrist extension ability, the Gshwind and Tonkin classification for supination ability, and the House classification for thumb-in-palm deformity. Digital deformity was also classified. Upper limb function was assessed using the Upper Extremity Rating Scale (UERS) and the Upper Limb Physician's Rating Scale (ULPRS). Gross motor function was assessed using the Gross Motor Functional Classification System (GMFCS). Among the 234 children observed, 70.5% had a limitation in forearm supination, and 62.8% had problems with wrist and finger extension in at least one limb. Thumb-in-palm deformity of at least one hand was found in 47.0% of patients. Swan neck deformity was the most common finger deformity. Upper limb functional measures, the ULPRS and the UERS, significantly correlated with the degree of upper limb deformity, as assessed by the Gschwind and Tonkin, Zancolli, and House classifications. Further, the degree of upper limb deformity was significantly related to the GMFCS level in children with bilateral CP, but not in children with unilateral CP. Limitation of forearm supination was the most common upper limb deformity in children with spastic CP. The degree of upper limb deformity significantly affected upper limb function in these children.
Research in developmental disabilities, 2011 · doi:10.1016/j.ridd.2011.07.021