The Upper Extremity in Cerebral Palsy: An Overview

Abstract

Upper extremity functional impairment is a common problem in individuals with cerebral palsy. The level of the disability is very variable, with many individuals having functional use of the limb but with decreased dexterity. The Gross Motor Function Classification System (GMFCS) defines gross motor function as it primarily relates to the trunk and lower extremities. This does also relate to the upper extremity since the ability to do functional ambulation with an assistive device is also impacted by upper extremity function. Manual Ability Classification System (MACS) is a functional assessment similar to the GMFCS for mobility but focused on upper extremity manual use. The MACS evaluates how the upper extremity hand functions for activities of daily living as well as for more sophisticated activities. It considers both hands as a unit; therefore, if one hand is very highly functional, the score may be very high even though one limb has virtually no function. The International Classification of Functioning, Disability and Health (ICF) defines the causes of a disability that would prevent a specific activity from being accomplished. Therefore, based on the ICF guidelines, a child may be able to feed themselves because of the physical impairment caused at the level of body function and structure by not having an upper extremity or hand that is functioning at the level required for this activity. Furthermore, there may be individual personal factors such as lack of motivation as the cause of not self-feeding. The upper extremity disability in children with CP may have a significant impact on the individual's participation and ability to complete activities. The goal of this chapter will be to provide an overview of the disability including expected natural history and a review of treatment options.