Hand Function in Cerebral Palsy. Report of 367 Children in a Population-Based Longitudinal Health Care Program
Hand Function in Cerebral Palsy. Report of 367 Children in a Population-Based Longitudinal Health Care Program
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DOI：
10.1016/j.jhsa.2008.02.032
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发表时间：
2008-10-01
影响因子：
1.9
通讯作者：
Hagglund, G.
中科院分区：
文献类型：
--
作者：
Arner, Marianne;Eliasson, A. -C.;Hagglund, G.
目的描述脑性瘫痪(CP)儿童的手功能状况。方法收集1992~2001年出生的367名脑瘫儿童的上肢数据。手功能按手动能力分类系统(MACS)、House功能分类和Zancolli分类进行分类。结果在4~14岁的脑性瘫痪患儿中，60%的儿童手部功能存在较大的问题。与年龄相关的日常体力活动(MACS I-II)的独立性在痉挛单侧CP儿童中为87%，在痉挛双侧CP儿童中为63%，但在运动障碍儿童中仅为20%。根据众议院功能分类，55%的儿童自发地独立使用双手(7-8号住房)，而5%的儿童不使用任何一只手(0号住房)。69%的儿童屈肌张力轻微增加(Zancolli 1级)。只有2%的人双手处于3级水平。痉挛型拇指掌指畸形1只手占25%，双手占15%。结论手功能障碍在各型脑瘫中普遍存在，但不同亚型的手部功能障碍特征有较大差异。MACS分类对评估儿童在日常活动中处理物体的能力很有用。House功能分类分别描述了每只手的握力功能；Zancolli的手指和手腕伸展分类以及House的拇指手掌畸形分类给出了动态痉挛的估计。所有这些分类在基于人群的医疗保健计划中都被证明是有用的，但还需要对心理测量学特性进行进一步的研究。J Hand Surg 2008；33A：1337-1347.版权所有(C)2008年，由美国手外科学会。保留所有权利。)
Purpose To describe aspects of hand function in a total population of children with cerebral palsy (CP).Methods Upper extremity data were collected for 367 children who were born between 1992 and 2001 and were registered in a population-based health care program for children with CP. 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.Results In the total population of children with CP aged 4 to 14 years, 60% had more than minor problems with hand function (>MACS I). Independence in age-relevant, daily manual activities (MACS I-II) was noted in 87% of children with spastic unilateral CP and in 63% of children with spastic bilateral CP, but in only 20% of children with dyskinetic CP. According to the House functional classification, both hands were spontaneously and independently used in 55% of children (House 7-8), whereas 5% did not use either of their hands (House 0). Minor increase of flexor muscle tone (Zancolli level 1) was found in 69% of all children. Only 2% were in level 3 in both hands. Spastic thumb-in-palm deformity in 1 hand was found in 25% and in both hands in another 15%.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 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. 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 2008;33A:1337-1347. Copyright (C) 2008 by the American Society for Surgery of the Hand. All rights reserved.)