Typical Arm Appearance in CP
Upper limb positioning in individuals with cerebral palsy (CP) can vary widely depending on the individual. However, there are some common upper limb positions and postures that are commonly seen.
If there are fixed contractures of the muscle the arm may be stuck in this position all the time. The abnormal position could also be a result of spasticity. Spasticity means the arm position may sometimes improve when relaxed or can get worse if running or concentrating on a particular activity.
- Flexed Elbow: One of the common upper limb positions in CP is a flexed elbow - this is where the elbow is tucked up and more bent than normal.
- Wrist Flexion: The wrist is most commonly bent downward. This can make it challenging to use the hand and wrist for tasks and can also make it harder to use the fingers and grip strength.
- Clenched Fist: The fingers can be tightly clenched into a fist, making it difficult to open the hand fully.
- Thumb-In Palm : The thumb is pulled inward toward the palm, it may be tucked in between the fingers. There is often difficulty with opening to grasp and the skin may also be tight.
- Shoulder Adduction and Internal Rotation: The shoulder can be pulled inward and rotated internally, affecting their overall arm positioning. This can make it difficult to wash in their armpit or get clothes on. It also affects reaching above their head.
- Scapular Position: The shoulder blade can look higher and asymmetrical to the other side.
- General Asymmetry: CP often results in asymmetrical upper limb positioning, where one side of the body may be more affected than the other.
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Common Assessments
History
Special Tests
Examination
A thorough consultation is generally undertaken to assess the underlying cause of your spasticity. It also aims to understand what the main current issues are that are affecting you in your daily life, aspirations for the future and to establish realistic goals for treatment or prevention of deterioration.
Whilst it is recommended that all children or adults with demonstrable upper limb spasticity have an early assessment undertaken. It is important to note that not everyone with upper limb CP will require or want treatment.
Examination
Special Tests
Examination
An examination by an healthcare professional or MDT with experience in upper limb CP is recommended. To gain an accurate understanding, clinical assessment should be undertaken on more than one occasion as spasticity can be negatively affected by stress and the environment.
Special Tests
Special Tests
Special Tests
Clinical evaluation commonly includes assessment of active range of movement (when you move it yourself) and passive range of movement (when the doctor moves it for you). It also includes an assessment of spasticity - this involves the doctor moving your arm rapidly and looking for a sudden "muscle catch". Testing of muscle strength, joint stiffness and sensation is also checked. Sensation checks are called "Sterogynosis" and involve showing you a series of objects and asking you to tell us which objects are in your hand without looking.
Functional Assessment
Functional Assessment
Functional Assessment
When there is any demonstrable function in the upper limb, formal assessment of function can be helpful. This may involve a test called the AHA or SHUEE where you are asked to undertake a number of common tasks using your hand while a video is taken. This allows your team to closely assess your function and make a well informed recommendation. It often done before and after intervention to assess how successful the treatment has been.
Botox
Functional Assessment
Functional Assessment
Botox injections can be an extension of the clinical assessment. It temporarily reduces the spasticity within targeted muscles and can help enhance therapy or predict the outcome of surgery.
Decision Making
Functional Assessment
Decision Making
After thorough assessment and investigation a consultation for shared decision making should be undertaken. This will give your clinician and you the chance to discuss your goals, how they might be achieved and whether they are realistic and achievable.