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Methods Upper extremity data were collected for children who were born between and and were registered in a population-based health care program for children with CP.
The type of spastic thumb-in-palm deformity was evaluated according to House. Conclusions Limitations in hand function are common in all types of CP, but characteristics of the disability vary considerably between different CP subtypes.
The MACS classification is useful to evaluate how well children can handle objects in daily activities. The House functional classifi- cation describes grip function in each hand separately; the Zancolli classification of finger and wrist extension and the classification of thumb-in-palm deformity according to House give an estimate of dynamic spasticity.
All these classifications were shown to be useful in a population- based health care program, but further studies of the psychometric properties are required. J Hand Surg ;33A: Key words Hand function, cerebral palsy, children, total population.
Hand surgery, mainly muscle or movement disorders in children with cerebral tendon lengthening and tendon transfer, in selected palsy CP. Hand disability varies according to cases has been shown to improve hand function in the underlying pathology Zancolli classification hand function scale the timing of the injury to CP.
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article. Much less is known about hand 25 function in children with spastic bilateral, dyskinetic, or 20 ataxic types of CP.
Focus in these children is often on 15 gross motor function, such as walking ability. Some of 10 5 these children may, however, also benefit from upper 0 extremity surgery or botulinum toxin treatment.
The 4 5 6 7 8 9 10 11 12 13 14 selection of suitable candidates and timing of surgery Age Years are considered the most crucial prerequisites to obtain FIGURE 1: Age distribution of the children with CP at good results.
CPUP who were born from to and living in A population-based health care program for children the study area on January 1,were included. There with CP was started in Sweden in with the main were in total children, boys and girls, aged aim of preventing hip dislocation and severe contrac- 4 —14 median 9 years.
The number of children in each tures by early detection and intervention. There were 18 children with CP born in or later and living in the area are whose families declined participation in CPUP.
The age according to the internationally accepted Swedish program includes a standardized and regular follow-up classification SC.
Hip joints are monitored by regular radiographic diplegia, where spasticity dominates in the lower ex- examinations. SinceCPUP has been a national tremities; and tetraplegia, where all 4 extremities are health care quality register in Sweden approved by the involved.
In spastic tetraplegia, the upper extremities National Board of Health and Welfare. CPUP has been are usually more involved than the lower, and all these a successful prevention program, with statistically sig- children have a severe functional disability.
To clarify, the authors. The study area has a Assessments total population of 1. The preva- The children were evaluated by their occupational ther- lence of CP in the region is approximately 2. There is a regular educational program for the dren with CP each year.
Regular inventories of medical assessments in order to ensure the high quality of data records are performed to identify all children with CP.
The following assessments were used: If no spontaneous finger or wrist I Handles objects easily and successfully. Each hand was scored separately. Children III Handles objects with difficulty; needs help to with normal ability for finger and wrist extension were prepare or modify activities.
IV Handles a limited selection of easily managed Evaluation of thumb-in-palm deformity: To evaluate thumb- objects in adapted situations. The position of the thumb was scored in tween levels, please see Eliasson et al. Children without active hand function were MACS:The House functional classification describes grip function in each hand separately; the Zancolli classification of finger and wrist extension and the classification of thumb-in-palm deformity according to House give an estimate of dynamic spasticity.
Zancolli classification hand function scale was formed by Eduardo Zancolli in He first used this scale in assessing the children with cerebral palsy who underwent reconstructive surgery.
In this scale he explained about the grasping and release patterns between the wrist and fingers and hand appearance of the spastic children. Until recently, most classification systems related to the use of upper limbs in children with cerebral palsy focused on manual function (e.g.
House Classification 3, Modified House Classification 4, and Zancolli Classification 5 systems) or on manual functional capacity (e.g. Bimanual Fine Motor Function classification system 6).
Children were included if they were aged between 4 and 12 years, diagnosed with spastic hemiplegic CP, and had a hand function with a classification of Zancolli I, IIA, or IIB. 8 Children who were classified as Zancolli III (severe impairment of hand function, with no voluntary extension of the fingers and wrist and no active extension of the fingers even .
Eight systems were identified that classified hand or upper limb function: the MACS 10, Green and Banks Functional Capacity and Functional Rating scales, 15 the House functional, 16 and modified House functional 17 classification systems, the Bimanual Fine Motor Function, 18 Mowery’s system, 19 and the upper limb movement classification.
Hand function was classified according to the Manual Ability Classification System (MACS), the House functional classification, and the Zancolli classification. The type of spastic thumb-in-palm deformity was evaluated according to House.