Musculoskeletal growth and hand deformity in children with cerebral palsy : a systematic review of the evidence ; and, Description of the progression of hand deformity in children with cerebral palsy
Date of Award
Bachelor of Science (Occupational Therapy) Honours
School of Exercise and Health Science
Computing, Health and Science
Associate Professor Catherine Elliott
Mr Simon Garbellini
Musculoskeletal Growth and Hand Deformity in Children with Cerebral Palsy: A Systematic Review of the Evidence
Aim The objective of this review was to describe the relationship between musculoskeletal growth and hand deformity in children with cerebral palsy. Understanding the effects of growth on hand deformity will enable therapists to confidently communicate with children with cerebral palsy, families, health professionals and others regarding appropriate management and intervention strategies.
Methods A systematic review of the literature describing the relationship between bone or muscle growth and hand deformity in children with cerebral palsy was conducted between January and April 2012 by two reviewers using electronic searching in Medline, CINAHL, PeDRO, Cochrane, Web of Science and Scopus. Reference lists of all potentially relevant articles and books were manually searched. Studies of animals, the lower limb, upper limb interventions and upper limb function and grey literature were excluded.
Results Following exhaustive searching, one book chapter of Level V evidence was located that matched the inclusion criteria. No systematic reviews or journal articles were located that discussed the relationship between musculoskeletal growth and hand deformity in children with cerebral palsy.
Conclusions No research was found to describe the relationship between musculoskeletal growth and hand deformity for this population. This highlights the need for future research to describe this relationship in order to identify whether critical time points for intervention exist that may guide clinical practice.
Description of the progression of hand deformity in children with cerebral palsy
Aim To describe the progression of hand deformity in children with cerebral palsy, with the aim of identifying critical time periods for intervention and evaluate the reliability of the Modified Wilton Classification.
Method Audiovisual data was collected of 26 children (11 males, 15 females) with spastic cerebral palsy, aged one to 18 years, performing upper limb tasks at multiple time points (n=3-8) at least six months apart. Three observers used the Modified Wilton classification to determine the level of hand deformity at each video time point. Single case series data analysis was employed to investigate the change in hand deformity over time. Inter and intra-rater reliability was analysed using Fleiss and Cohen’s kappa. Treatment history was also collected.
Results The Wilton classification demonstrated near perfect intra-rater (κ=0.91) and inter-rater (κ=0.87) reliability. Observed trends of the case series included a progression of hand deformity with age, increases in deformity before 3 years and increased BoNT-A and surgical intervention during adolescence.
Interpretation The Modified Wilton is a reliable system to classify hand deformity in children with spastic cerebral palsy. Hand deformity was demonstrated to progress with age with critical time periods for upper limb intervention prior to three years and at pre-adolescence.
What this paper adds
First study to document the progression of hand deformity with age in children with cerebral palsy.
Critical time periods for intervention are pre-adolescence.
The Modified Wilton classification has almost perfect inter and intra-rater reliability.
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Georgiades, M. (2012). Musculoskeletal growth and hand deformity in children with cerebral palsy : a systematic review of the evidence ; and, Description of the progression of hand deformity in children with cerebral palsy. Retrieved from http://ro.ecu.edu.au/theses_hons/48
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