The relative contribution of motor impairments to limitation in physical activity

Objective: Cerebral palsy is a non-progressive neurologicalcondition resulting in motor impairments, yet the conditionis not unchanging, and permanent physical impairments canrange from mild weakness in one hand to almost completelack of movement1. People with hemiplegic cerebral palsy,which affects the leg and arm on one side of the body, mayhave difficulties in reaching and manipulation, which in turnaffect their participation, because of muscle weakness, spas-ticity, contracture, associated reactions, and loss of dexterityof the upper limb2. This study aims to determine whichmotor impairments have the most significant influence onhand activity, and which in turn will affect participation. Theimpairments that will be studied include muscle weakness,spasticity, contracture, associated reactions, and loss of dex-terity of the upper limb. Design: Exploratory, predictive research. Method: Thirty people with hemiplegic cerebral palsy over 18years of age will be recruited from the Spastic Centre andthrough placing advertisements in the local newspapers. Fivemotor impairments, weakness, spasticity, contracture, associ-ated reactions and dexterity, will be evaluated in randomorder. Three tests, Nine Hole Peg Test, Spiral Test, and Item 6,7 and 8 of the Motor Assessment Scale will be used to quantifyupper limb function. A questionnaire will be used to gaugeparticipation of people with cerebral palsy. Multiple linearregression will be used to determine the relative contributionof motor impairments (weakness, spasticity, associated reac-tions, loss of dexterity, and contracture) to hand activity (NineHole Peg Test, Spiral Test, and Item 6,7 and 8 of The MotorAssessment Scale), and to participation (questionnaire). Results: This research will indicate which motor impair-ment(s) of upper limb most significantly limit hand activityand participation in adults with hemiplegic cerebral palsy.This will also have implications for children with cerebralpalsy by identifying the impairments in the upper limb whichmost need attention in childhood. Conclusion: By investigating the upper limbs of adults withhemiplegic cerebral palsy, which motor impairment(s)should be focus of treatment in children with hemiplegiccerebral palsy will be proposed.