Evaluation of Hemiplegia Pre and Post-Surgical Intervention

Abstract

Research Question: In children with hemiplegia following upper extremity surgical intervention do SHUEE scores improve significantly postoperatively?

Background, Significance, and Rationale for the Question: The purpose of this retrospective review was to evaluate the results of surgical intervention for the upper extremity in children with hemiplegia. The Shriners Hospital upper extremity evaluation (SHUEE) was performed both preoperatively and postoperatively in each individual. The objective was to analyze the evaluation and compare surgical results based on SHUEE scores of these patients with hemiplegia.

Materials and Methods: A respective review of eleven patients (age 6 to 20) with hemiplegia that underwent surgical intervention during the time period of 2018 to 2022 who had completed SHUEE evaluations both pre and postoperatively was performed. The age, intervention, surgery performed, gender, date of SHUEE pre-and post, as well as results of SHUEE were collected. Pre and postoperative means for total and subgroup scores were analyzed for statistical significance. A minimum of 6 months from surgery elapsed before the second SHUEE was performed. Wrist specific surgical intervention included 6 patients with bony fusion surgery (proximal row carpectomy-fusion) of the wrist and 5 with tendon transfers about the wrist along with other procedures in and around the fingers, thumb. One patient had a biceps lengthening in addition to the forearm procedures. All but one had first webspace releases with rotation of dorsal skin into the webspace along with hand muscle lengthening.

Results: 11 patients with hemiplegia had a SHUEE pre and postoperatively. The average length of follow up after surgery was 366.8 days. There were 3 males and 8 females. The right side was affected in 7 patients. The mean age was 11.9 years. Overall, the postoperative SHUEE scores were higher than preoperative scores for spontaneous functional analysis (SFA), dynamic positional analysis (DPA), and grasp and release analysis. There was a clinically significant difference in pre and post operation scores for DPA and the DPA wrist sub score. There was no significant difference between the fusion group and the tendon group post operatively, both group scores changed similarly.

Conclusions: For children with upper extremity cerebral palsy surgical intervention has demonstrated improvement in functional outcome in comparison to preoperative function. The most significant scores were noted in wrist realignment and positioning. However, there are limitations to a functional assessment given that they do not account for a patient/parent perspective in assessing surgical outcome.