Upper limb function in children with cerebral palsy: a structured approach to assessment and management

The cerebral palsies (CP) have a UK prevalence of 1–2/1000. 60–80% of children with CP have upper-limb involvement. Physical movement difficulties including tone abnormalities, weakness and secondary musculoskeletal function are associated with sensory, cognitive difficulties and medical co-morbidities. Understanding the underlying pathophysiology of CP and structured multidisciplinary assessment in the context of the International Classification of Functioning, Disability and Health (ICF) can guide management to improve activity and participation for children with CP. A range of therapy, medical and surgical interventions may be offered to a child and their family. The selection of treatment options should be focused on individualized and realistic goals. Clear outcomes should be evaluated. This review aims to summarize a structured approach to assessment and management of upper limb function in CP; and is illustrated by case examples.