Selective Motor Control and Upper Extremity Functions in Children With Hemiparetic Cerebral Palsy

Study Overview
=================
Brief Summary
-----------------
Identification of musculoskeletal and neuromuscular factors that affect the integrity and functional performance in children with cerebral palsy is very essential as it enables multidisciplinary rehabilitation team to design the proper intervention to improve functional performance and independence for those children.

Detailed Description
-----------------
Limited literature is available regarding the relation between selective voluntary motor control and motor functions in children with cerebral palsy. Up to our knowledge this is the first study intending to investigate the influence of selective voluntary motor control on upper extremity function in children with spastic cerebral palsy. Therefore, the current study will be conducted to investigate the correlation between selective voluntary motor control and upper extremity functions in children with spastic hemiparetic cerebral palsy. It is hypothesized that:- There is no relation between SVMC and upper limb function in children with spastic hemiparetic CP. There is no relation between upper extremity SVMC and hand grip strength in children with spastic hemiparetic CP.

Official Title
-----------------
Correlation Between Selective Motor Control and Upper Extremity Functions in Children With Hemiparetic Cerebral Palsy

Conditions
-----------------
Cerebral Palsy

Intervention / Treatment
-----------------
* Other: Test of Arm Selective Control
* Other: Hand Held Dynamometer
* Other: Quality of Upper Extremity Skill Test


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Age ranges from 4 to 8 years. Both genders. Diagnosis of spastic hemiparetic cerebral palsy. Level I-IV on Manual Ability Classification System. Spasticity grade 1 to 2 on Modified Ashworth Scale. Level I-III on Gross Motor Classification System . Exclusion Criteria: Significant mental or psychological problems. Significant visual/auditory problem. Botox injection and/or surgery of the upper limb in the past 12 months. Fixed deformities in the affected upper extremity.

Ages Eligible for Study
-----------------
Minimum Age: 4 Years
Maximum Age: 8 Years

Sexes Eligible for Study
-----------------
All

Study Plan
=================
How is the study designed?
-----------------

Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| cohort group<br>A convenient sample of children with spastic hemiparetic CP of both genders will participate in this study. To avoid type II error, sample size calculation was performed prior to the study, based on data of pilot study, using G*POWER statistical software (version 3.1.9.2; Franz Faul, Universitat Kiel, Germany) [Exact tests- correlational study, α=0.05, β=0.2, and effect size = 0.4] and revealed that the appropriate sample size for this study is N=46. | Other: Test of Arm Selective Control<br>* It will be used to assess selective voluntary motor control. It is a reliable and valid evaluation tool used to quantify and describe selective voluntary motor control in children with spastic cerebral palsy. The goal of the assessment is to systematically evaluate a person's ability to move the upper extremity with selective voluntary motor control by observing movement control, coordination, fluency, mirroring, and speed at each joint, and then assigning a grade, all in 'real time. Clinically this measure may guide the selection of medical, surgical, or therapy interventions and may improve outcome prognosis after brief training. Raters demonstrated excellent reliability in assessing upper extremity SVMC in a group of children with hemiplegic, diplegic, and quadriplegic CP using the Ttest of arm selective control<br>Other: Hand Held Dynamometer<br>* Hand held dynamometer (Camry Digital Hand Dynamometer Grip Strength, Model EH101-37, China) will be used to assess hand grip strength of the affected upper extremity. It is generally small, portable and relatively cheap reliable measurement instruments to measure muscle strength of the arm and hand in children with spastic cerebral pasly. It is used to measure strength; maximal voluntary isometric contraction; objectively in kilograms, pounds or newtons. Such devices have been proven to have good to excellent reliability in different populations. It represents an easily accessible way to assess muscle weakness in children with cerebral palsy and the overall reliability is considered to be good.<br>Other: Quality of Upper Extremity Skill Test<br>* It will be used to assess function of the affected upper extremity. It is a reliable and valid outcome measure designed to evaluate movement patterns and hand function in children with cerebral palsy. It is designed to be used with children who have neuromotor dysfunction with spasticity and has been validated with children from 18 months to 8 years of age.<br>|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Test of Arm Selective Control | The goal of the assessment is to systematically evaluate a person's ability to move the upper extremity with selective voluntary motor control by observing movement control, coordination, fluency, mirroring, and speed at each joint, and then assigning a grade. Each joint is scored as a 0, 1, or 2. The joints of the affected limb are summed for a limb score for a total score. The maximum score is 16 per side, or 32 points in total (in hemiplegia assess the affected side only) with higher score indicates better performance. Admiration of the teat items and scoring will be conducted according to the scale user instructions. | 1/2/2021 to 30/4/2021 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Hand Held Dynamometer | to evaluate hand grip strength | 1/2/2021 to 30/4/2021 | 
| Quality of Upper Extremity Skill Test | to assess upper limb function | 1/2/2021 to 30/4/2021 | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
Cerebral pals, selective voluntary motor control, upper extremity function, hand grip strength