Review of Therapeutic Interventions for the Upper Limb Classified by Manual Ability in Children with Cerebral Palsy

Abstract

Cerebral palsy (CP) describes "a group of permanent disorders of the development of movement and posture, causing activity limitation, that are attributed to non-progressive disturbances that occurred in the developing fetal and infant brain. The motor disorders of cerebral palsy are often accompanied by disturbances of sensation, perception, cognition, communication and behavior, by epilepsy, and by secondary musculoskeletal problems." 1 Cerebral palsy has been historically categorized topographically and physiologically. Topographically, CP is classified by limb involvement ranging from one limb (monoplegia) to all four limbs (quadriplegia). Physiologically, patients present with tone that can be categorized as spastic, flaccid, rigid, dystonic, or athetoid.With the development of the Gross Motor Classification System (GMFCS) and the Manual Ability Classification System (MACS), CP is also classified by functional performance. The MACS classifies how children with CP use his or her hands when handling objects in daily activities (►Table 1). 2 The classification reflects the child's typical manual performance, not the child's maximal capacity. The MACS reports on the collaboration of both hands together. The expectation is that most children will remain at the same MACS level over time despite intervention or growth/maturity. 3 However, children with CP can make improvements in upper limb function and increase independence with activities of daily living within their MACS level. Keywords► cerebral palsy ► Manual Ability Classification System ► therapy intervention ► surgical intervention ► upper limb AbstractThe aim of this literature review was to assemble an inventory of intervention strategies utilized for children diagnosed with cerebral palsy (CP) based on the Manual Ability Classification System (MACS). The purpose of the inventory is to guide physicians and therapists in intervention selection aimed at improving upper limb function in children with CP. The following databases were searched: CINAHL (Cumulative Index to Nursing and Allied Health Literature), Cochrane Database of Systematic Reviews, ERIC (Educational Research Information Center), Google Scholar, OTSeeker (Occupational Therapy Systematic Evaluation of Evidence), OVID (Ovid Technologies, Inc.), and PubMed. Inclusion criteria were whether the study (1) identified MACS levels of participants, and (2) addressed the effectiveness of intervention on upper limb function. Overall, 74 articles met the inclusion criteria. The summarized data identified 10 categories of intervention. The majority of participants across studies were MACS level II. The most frequently cited interventions were constraint-induced movement therapy (CIMT), bimanual training, and virtual reality and computer-based training. Multiple interventions demonstrated effectiveness for upper limb improvement at each MACS level. However, there is a need for additional research for interventions appropriate for MACS levels IV and V. To fully develop an intervention inventory based on man...

Effectiveness of virtual reality on activities of daily living in children with cerebral palsy: a systematic review and meta-analysis

“…Furthermore, for the NR group, although it was difficult to define participant’s characteristics, the difference between the high and low groups according to the child’s functional level was < 0.1, and there was no significant difference; this may be because VR intervention can select and change the difficulty level according to participant characteristics ( Kuttuva et al, 2006 ; Popescu et al, 2000 ). According to previous studies conducted on CP children, studies confirming the effect of virtual reality according to GMFCS and MACS reported that it was effective at all functional levels or there was no difference according to level, and these results are consistent with this review ( Shierk, Lake & Haas, 2016 ; Cherni et al, 2020 ). For the reason that these results were derived, most of the subjects included in this review were in stages 1-3, and it is thought that a ceiling effect occurred ( Johnson et al, 2014 ).…”

Neuromuscular Electrical Stimulation of Upper Extremities in Patients with Cerebral Palsy: A systematic review and Meta-Analysis of Randomized Controlled Trials

“…The first 30 mins of specific sensory-motor training focus on tactile discrimination function, for improving somatosensory processing. 42,43 In the remaining 30 mins, the participants received task-oriented training to improve unilateral and bilateral upper limb function. When combined with other intervention strategies, including constraint-induced movement therapy and bimanual training, SM-TOT was effective in improving hand function and self-care skills.…”

“…The SM-TOT consisted of two sections. The first 30 mins of specific sensory-motor training focus on tactile discrimination function, for improving somatosensory processing 42,43 . In the remaining 30 mins, the participants received task-oriented training to improve unilateral and bilateral upper limb function.…”

Assessment Scales in Cerebral Palsy: A Comprehensive Review of Tools and Applications

“…This information informs the selection of appropriate therapeutic interventions and strategies to improve hand function and manual dexterity. By tailoring treatment plans to an individual's specific MACS level, therapists can design realistic, effective, and targeted interventions to address their unique needs [ 37 ].…”