Effects of different sitting positions on upper limb function of children with bilateral spastic cerebral palsy

Abstract

Purpose: The purpose of this study was to investigate the effects of different sitting positions on upper limb functions of children with bilateral spastic cerebral palsy (CP). Methods: Twenty-one children with bilateral CP who were between 18 and 60 months (mean age 42±11 months), in level IV according to Gross Motor Function Classification System (GMFCS) were included in the study. Motor function was evaluated using “Gross Motor Function Measurement (GMFM)”, postural stability was assessed using “Early Clinical Assessment of Balance (ECAB)”. Quality of Upper Extremity Skills Test (QUEST) was used to assess upper extremity function in child-adapted chair-sitting position and unsupported floor sitting position. Results: The mean percentage GMFMtotal score was 29.69±3.87 (23.19-38.99) and ECABtotal sore was 21.15±4.0 . QUEST “disassociated movement” (32.44±18.86) and “grasp” (8.07±27.0) subdivision scores and total (26.72±26.08) scores with adapted-chair sitting were significantly higher than those of floor sitting (p<0.05). Conclusion: Child-adapted chair-sitting position is the most functional position for upper limb activities of bilateral spastic CP with GMFCS level IV. Family should be informed that different types of floor sitting positions were not functional, and child should not be placed on the floor sitting positions while eating or playing

Keywords

• Upper limb, Motor skills, Cerebral palsy

Bilateral spastik serebral palsili çocuklarda farklı oturma pozisyonlarının üst ekstremite fonksiyonuna etkisi

Abstract

Amaç: Bu çalışmanın amacı; farklı oturma pozisyonlarının bilateral spastik serebral palsili (SP) çocukların üst ekstremite fonksiyonları üzerine olan etkilerini araştırmaktı. Yöntem: Çalışmaya 18-60 ay (yaş ortalaması 42±11 ay) arası, Kaba Motor Fonksiyon Sınıflandırma Sistemine (KMFSS) göre seviye IV olan 21 bilateral spastik serebral palsili çocuk dahil edildi. Kaba motor fonksiyon “Kaba Motor Fonksiyon Ölçütü (KMFÖ)” ile postüral stabilite “Erken Dönem Kliniksel Denge Değerlendirmesi (EDKDD)” ile değerlendirildi. Çocuğa göre uyarlanmış sandalyede oturma pozisyonu ile desteksiz yerde oturma pozisyonunda üst ekstremite fonksiyonlarını değerlendirmek için “Üst Ekstremite Becerilerinin Kalitesi Testi (ÜEBKT)” kullanıldı. Bulgular: Ortalama yüzde KMFÖtoplam puanı 29.69±3.87 (23.19-38.99), EDKDDtoplam puanı 21.15±4.0 olarak hesaplandı. Uyarlanmış sandalyede oturma pozisyonunda ÜEBKT “ayrışık hareket” (32.44±18.86) “kavrama” (8.07±27.0) alt bölümleri ve ÜEBKT toplam (26.72±26.08) puanları, yerde oturma pozisyonunda elde edilen ÜEBKT puanlarından anlamlı oranda daha yüksekti (p

Keywords

• Üst ekstremite, Motor beceriler, Serebral palsi

References

1. 1. Eliasson AC. Improving the use of hands in daily activities: aspects of the treatment of children with cerebral palsy. Phys Occup Ther Pediatr. 2005;25:37-60.
2. 2. Rosenbaum P, Paneth N, Leviton A, et al. A report: the definition and classification of cerebral palsy April 2006. Dev Med Child Neurol. 2007;109(suppl 109):8-14.
3. 3. Jones MW, Morgan E, Shelton JE, et al.Cerebral palsy: introduction and diagnosis (part I). J Pediatr Health Care. 2007;21:146- 152.
4. 4. Rosenbaum PL, Palisano RJ, Bartlett DJ, et al. Development of the gross motor function classification system for cerebral palsy. Dev Med Child Neurol. 2008;50:249-253.
5. 5. Palisano R, Galuppi B. Gross motor function classification system for cerebral palsy: CanChild Centre for Childhood Disability Research; 1999.
6. 6. Martin S. Floor sitting with sandbags: an adjunct to physical therapy. Pediatr Phys Ther. 1990;2:228-231.
7. 7. van der Heide JC, Hadders-Algra M. Postural muscle dyscoordination in children with cerebral palsy. Neural Plasticity. 2005;12:197- 203.
8. 8. Palisano RJ, Rosenbaum P, Bartlett D, et al. Content validity of the expanded and revised Gross Motor Function Classification System. Dev Med Child Neurol. 2008;50:744-750.

9. 9. Russell DJ, Rosenbaum PL, Avery LM, et al. Gross motor function measure (GMFM-66 and GMFM-88) user's manual: Cambridge University Press; 2002.
10. 10. McCoy SW, Bartlett DJ, Yocum A, et al. Development and validity of the early clinical assessment of balance for young children with cerebral palsy. Dev Neurorehabil. 2013;17:375- 383.
11. 11. DeMatteo C, Law M, Russell D, et al. The reliability and validity of the Quality of Upper Extremity Skills Test. Phys Occup Ther Pediatr. 1993;13:1-18.
12. 12. Thorley M, Lannin N, Cusick A, et al. Construct validity of the Quality of Upper Extremity Skills Test for children with cerebral palsy. Dev Med Child Neurol. 2012;54:1037-1043.
13. 13. Roxborough L. Review of the efficacy and effectiveness of adaptive seating for children with cerebral palsy. Assist Technol. 1995;7:17- 25.
14. 14. Harris SR, Roxborough L. Efficacy and effectiveness of physical therapy in enhancing postural control in children with cerebral palsy. Neural Plast. 2005;12:229-243.
15. 15. Stavness C. The effect of positioning for children with cerebral palsy on upper-extremity function: a review of the evidence. Phys Occup Ther Pediatr. 2006;26:39-53.
16. 16. Mcnamara L, Casey J. Seat inclinations affect the function of children with cerebral palsy: A review of the effect of different seat inclines. Disabil Rehabil Assist Technol. 2007;2:309-318.
17. 17. Chung J, Evans J, Lee C, et al. Effectiveness of adaptive seating on sitting posture and postural control in children with cerebral palsy. Pediatr Phys Ther. 2008;20:303-317.
18. 18. Ryan SE. An overview of systematic reviews of adaptive seating interventions for children with cerebral palsy: where do we go from here? Disabil Rehabil Assist Technol. 2012;7:104-111.
19. 19. Levitt S. Treatment of cerebral palsy and motor delay: John Wiley & Sons; 2013.
20. 20. Richardson M, Roberts B, Lyons A. A life with cerebral palsy: Neil's story and Jose's case studies. Intellectual Disability in Health and Social Care. 2014:247.
21. 21. Himmelmann K, Beckung E, Hagberg G, et al. Bilateral spastic cerebral palsy-prevalence through four decades, motor function and growth. Eur J Paediatr Neurol. 2007;11:215- 222.
22. 22. McDonald RL, Surtees R. Longitudinal study evaluating a seating system using a sacral pad and kneeblock for children with cerebral palsy. Disabil Rehabil. 2007;29:1041-1047.
23. 23. Reid DT. The effects of the saddle seat on seated postural control and upperextremity movement in children with cerebral palsy. Dev Med Child Neurol. 1996;38:805-815.
24. 24. Nwaobi OM. Seating orientations and upper extremity function in children with cerebral palsy. Phys Ther. 1987;67:1209-1212.