Physical Examination and Kinematic Assessment of the Upper Extremity in Cerebral Palsy

The assessment of upper extremity function in children with cerebral palsy (CP) requires an understanding of the age-appropriate activities which should be present. An excellent framework for understanding upper extremity function is the International Classification of Functioning, Disability, and Health (ICF). The central tenant of the ICF framework is to identify activities that a child should perform. These activities may improve participation in age-appropriate function. Limitations in these activities may be due to physical impairments at the body function and structure level such as muscle contractures, joint deformities, or poor motor control. Activity limitations may also be due to personal factors such as poor motor or a non-supportive family structure. Other limitations may have environmental factors such as the lack of available accommodations or appropriate educational environment. Therefore, based on this ICF framework, the first goal in evaluating upper extremity function should be to evaluate age-appropriate activities. The limb needs to be further assessed by developing some classification system of severity of impairment. The patient also needs a very detailed physical examination including joint range of motion, sensory ability testing, selective motor control assessment, and kinematic evaluation. By combining all of these testing results with a clearly defined treatment goal, a comprehensive treatment program can be developed.