Background

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.

Methods

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.

Findings

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).

Interpretation

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.

中文翻译：

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偏瘫性脑瘫患儿动态肘屈曲畸形的分析。

背景

每1 000名儿童中有1名患有脑瘫，在83％的病例中涉及上肢。动态肘关节屈曲畸形是继发于脑瘫的偏瘫患者的运动障碍。我们试图确定偏瘫性脑瘫患儿在日常活动中是否表现出动态的肘部弯曲畸形及其对功能达到的影响。

方法

该观察性描述性研究包括16例上肢偏瘫和脑瘫患儿（年龄11y 7mo（SD 3y 2mo）； 11个男孩，5个女孩；总体运动功能分类系统I或II级）。使用手动能力分类系统，儿童手使用经验调查表和Shriners儿童儿童上肢评估医院来评估受影响的上肢功能。用改良的Ashworth量表评估痉挛。在八次日常活动中记录了非自愿的屈肘。测量伸手功能期间的肘部运动。

发现

16名患者中有15名表现出动态的肘部屈曲畸形。除“高速爬楼梯”评估外，在所有研究的活动中，涉及的中肘屈伸均显着增加。儿童手使用经验调查表显示，儿童在大多数日常活动中都是独立的（29个中的21个）。仅在坐着活动中观察到动态肘关节弯曲畸形与Shriners儿童儿童上肢评估之间的相关性（Spearmanρ0.549，P  = 0.028）。

解释

动态肘屈曲畸形在偏瘫性脑瘫中非常常见，并且与活动所需的努力程度成正比。尽管存在这种运动障碍，但它不会影响儿童参与日常活动。