Occupational Therapy Department, Rehabilitation and Physical Medicine, Sant Joan de Dèu Barcelona Children's Hospital, Passeig de Sant Joan de Déu, 2, 08950 Barcelona, Spain.
Hand Surgery Unit, Orthopaedic Surgery, Hospital Universitari Vall d'Hebron, Passeig Vall Hebron 119-129, 08035, Barcelona 08035, Spain.
Clin Biomech (Bristol). 2021 Jan;81:105245. doi: 10.1016/j.clinbiomech.2020.105245. Epub 2020 Dec 5.
Cerebral palsy affects 1 per 1.000 children, and in 83% of the cases upper extremity is involved. Dynamic elbow flexion deformity is a movement disorder observed in individuals with hemiparesis secondary to cerebral palsy. We sought to determine whether children with hemiplegic cerebral palsy exhibit dynamic elbow flexion deformity during daily activities and its influence to reaching function.
Sixteen children with upper limb hemiparesis and cerebral palsy (age 11y 7mo (SD 3y 2mo); 11 boys, 5 girls; Gross Motor Function Classification System level I or II) were included in this observational descriptive study. Manual Ability Classification System, Children's Hand-use Experience Questionnaire and Shriners Hospital for Children Upper Extremity Evaluation were used to evaluate affected upper extremity function. Spasticity was assessed with Modified Ashworth scale. Involuntary elbow flexion was recorded in eight daily activities. Elbow motion during reach function was measured.
Fifteen out of 16 individuals showed dynamic elbow flexion deformity. There was a significative increase of involved median elbow flexion in all the activities studied, except for "high speed stairs climbing" evaluation. Children's Hand-use Experience Questionnaire showed that children were independent in most of the daily activities (21 out of 29). Correlation between dynamic elbow flexion deformity and Shriners Hospital for Children Upper Extremity Evaluation was observed only in sitting-standing activity (Spearman's ρ 0.549, P = 0.028).
Dynamic elbow flexion deformity is very common in hemiplegic cerebral palsy and occurs proportionally to the degree of the effort demanded by the activities. Despite of presenting this movement disorder, it does not affect in children participation in daily activities.
脑瘫影响每 1000 名儿童中的 1 名，83%的病例涉及上肢。动态肘屈曲畸形是一种运动障碍，见于脑瘫引起的偏瘫患者。我们旨在确定偏瘫脑瘫患儿在日常活动中是否存在动态肘屈曲畸形及其对伸手功能的影响。
本观察性描述性研究纳入了 16 名上肢偏瘫脑瘫患儿（年龄 11y 7mo（SD 3y 2mo）；11 名男孩，5 名女孩；粗大运动功能分类系统 1 级或 2 级）。使用手功能分类系统、儿童手使用经验问卷和 Shriners 儿童医院上肢评估来评估受累上肢功能。痉挛程度采用改良 Ashworth 量表评估。在 8 项日常活动中记录不自主的肘屈曲。测量伸手功能时的肘部运动。
16 名患儿中有 15 名出现动态肘屈曲畸形。除“高速爬楼梯”评估外，所有研究活动的患侧肘屈曲中位值均显著增加。儿童手使用经验问卷显示，患儿在大多数日常活动中都能独立完成（29 项中的 21 项）。仅在坐站活动中观察到动态肘屈曲畸形与 Shriners 儿童医院上肢评估之间存在相关性（Spearman's ρ 0.549，P = 0.028）。
动态肘屈曲畸形在偏瘫脑瘫中非常常见，且与活动所需的努力程度成比例。尽管存在这种运动障碍，但它并不影响患儿参与日常活动。
