Upper Extremity Movement Pathology in Functional Tasks

  • Lisa Mailleux
  • Cristina Simon-Martinez
  • Hilde Feys
  • Ellen Jaspers
Reference work entry


Children with unilateral cerebral palsy (uCP) typically present with largely divergent upper extremity sensorimotor impairments that impact on their independence and quality of life. While clinical assessment tools have vastly contributed to our understanding of arm and hand problems in children with uCP, the availability of three-dimensional movement analysis has allowed a more detailed and objective assessment of upper extremity movement pathology in these children. This chapter firstly discusses the typical and atypical development of arm and hand function. The second part provides an overview of measurement protocols and outcome parameters and summarizes upper extremity movement pathology in children with uCP.


Upper extremity Assessment Three-dimensional analysis Movement pathology Unilateral Cerebral palsy Kinematics Reaching Grasping Functional tasks 


  1. Aarts PB, Jongerius PH, Aarts MA, Van Hartingsveldt MJ, Anderson PG, Beumer A (2007) A pilot study of the video observations Aarts and Aarts (VOAA): a new software program to measure motor behaviour in children with cerebral palsy. Occup Ther Int 14:113–122CrossRefGoogle Scholar
  2. Baker R, McGinley JL, Schwartz MH, Beynon S, Rozumalski A, Graham HK et al (2009) The gait profile score and movement analysis profile. Gait Posture 30:265–269CrossRefGoogle Scholar
  3. Berthier NE, Keen R (2006) Development of reaching in infancy. Exp Brain Res 169:507–518CrossRefGoogle Scholar
  4. Berthier NE, Clifton RK, McCall DD, Robin DJ (1999) Proximodistal structure of early reaching in human infants. Exp Brain Res 127:259–269CrossRefGoogle Scholar
  5. Brochard S, Lempereur M, Mao L, Remy-Neris O (2012) The role of the scapulo-thoracic and gleno-humeral joints in upper-limb motion in children with hemiplegic cerebral palsy. Clin Biomech (Bristol, Avon) 27:652–660CrossRefGoogle Scholar
  6. Butler EE, Rose J (2012) The pediatric upper limb motion index and a temporal-spatial logistic regression: quantitative analysis of upper limb movement disorders during the Reach & Grasp Cycle. J Biomech 45:945–951CrossRefGoogle Scholar
  7. Butler EE, Ladd AL, Lamont LE, Rose J (2010a) Temporal-spatial parameters of the upper limb during a Reach & Grasp Cycle for children. Gait Posture 32:301–306CrossRefGoogle Scholar
  8. Butler EE, Ladd AL, Louie SA, Lamont LE, Wong W, Rose J (2010b) Three-dimensional kinematics of the upper limb during a reach and grasp cycle for children. Gait Posture 32:72–77CrossRefGoogle Scholar
  9. Coluccini M, Maini ES, Martelloni C, Sgandurra G, Cioni G (2007) Kinematic characterization of functional reach to grasp in normal and in motor disabled children. Gait Posture 25:493–501CrossRefGoogle Scholar
  10. Davids JR, Peace LC, Wagner LV, Gidewall MA, Blackhurst DW, Roberson WM (2006) Validation of the Shriners Hospital for Children Upper Extremity Evaluation (SHUEE) for children with hemiplegic cerebral palsy. J Bone Joint Surg Am 88:326–333CrossRefGoogle Scholar
  11. Eliasson AC, Krumlinde-Sundholm L, Rosblad B, Beckung E, Arner M, Ohrvall AM et al (2006) The manual ability classification system (MACS) for children with cerebral palsy: scale development and evidence of validity and reliability. Dev Med Child Neurol 48:549–554CrossRefGoogle Scholar
  12. Flash T, Mussa-Ivaldi F (1990) Human arm stiffness characteristics during the maintenance of posture. Exp Brain Res 82:315–326CrossRefGoogle Scholar
  13. Forssberg H, Eliasson AC, Kinoshita H, Johansson RS, Westling G (1991) Development of human precision grip. I: basic coordination of force. Exp Brain Res 85:451–457CrossRefGoogle Scholar
  14. Gordon AM, Bleyenheuft Y, Steenbergen B (2013) Pathophysiology of impaired hand function in children with unilateral cerebral palsy. Dev Med Child Neurol 55(Suppl 4):32–37CrossRefGoogle Scholar
  15. Greaves S, Imms C, Dodd K, Krumlinde-Sundholm L (2013) Development of the mini-assisting hand assessment: evidence for content and internal scale validity. Dev Med Child Neurol 55:1030–1037CrossRefGoogle Scholar
  16. Hamer EG, Bos AF, Hadders-Algra M (2011) Assessment of specific characteristics of abnormal general movements: does it enhance the prediction of cerebral palsy? Dev Med Child Neurol 53:751–756CrossRefGoogle Scholar
  17. Himmelmann K, Sundh V (2015) Survival with cerebral palsy over five decades in western Sweden. Dev Med Child Neurol 57:762–767CrossRefGoogle Scholar
  18. Himmelmann K, Hagberg G, Uvebrant P (2010) The changing panorama of cerebral palsy in Sweden. X. Prevalence and origin in the birth-year period 1999–2002. Acta Paediatr 99:1337–1343CrossRefGoogle Scholar
  19. van Hof R, van der Kamp J, Savelsbergh GJ (2002) The relation of unimanual and bimanual reaching to crossing the midline. Child Dev 73:1353–1362CrossRefGoogle Scholar
  20. von Hofsten C (1991) Structuring of early reaching movements: a longitudinal study. J Mot Behav 23:280–292CrossRefGoogle Scholar
  21. von Hofsten C, Ronnqvist L (1988) Preparation for grasping an object: a developmental study. J Exp Psychol Hum Percept Perform 14:610–621CrossRefGoogle Scholar
  22. Holmefur MM, Krumlinde-Sundholm L (2016) Psychometric properties of a revised version of the assisting hand assessment (kids-AHA 5.0). Dev Med Child Neurol 58:618–624CrossRefGoogle Scholar
  23. Hung YC, Charles J, Gordon AM (2004) Bimanual coordination during a goal-directed task in children with hemiplegic cerebral palsy. Dev Med Child Neurol 46:746–753CrossRefGoogle Scholar
  24. Jaspers E, Desloovere K, Bruyninckx H, Molenaers G, Klingels K, Feys H (2009) Review of quantitative measurements of upper limb movements in hemiplegic cerebral palsy. Gait Posture 30:395–404CrossRefGoogle Scholar
  25. Jaspers E, Feys H, Bruyninckx H, Cutti A, Harlaar J, Molenaers G et al (2011a) The reliability of upper limb kinematics in children with hemiplegic cerebral palsy. Gait Posture 33:568–575CrossRefGoogle Scholar
  26. Jaspers E, Desloovere K, Bruyninckx H, Klingels K, Molenaers G, Aertbelien E et al (2011b) Three-dimensional upper limb movement characteristics in children with hemiplegic cerebral palsy and typically developing children. Res Dev Disabil 32:2283–2294CrossRefGoogle Scholar
  27. Jaspers E, Feys H, Bruyninckx H, Klingels K, Molenaers G, Desloovere K (2011c) The arm profile score: a new summary index to assess upper limb movement pathology. Gait Posture 34:227–233CrossRefGoogle Scholar
  28. Kimmerle M, Ferre CL, Kotwica KA, Michel GF (2010) Development of role-differentiated bimanual manipulation during the infant’s first year. Dev Psychobiol 52:168–180Google Scholar
  29. Klingels K, De Cock P, Molenaers G, Desloovere K, Huenaerts C, Jaspers E et al (2010a) Upper limb motor and sensory impairments in children with hemiplegic cerebral palsy. Can they be measured reliably? Disabil Rehabil 32:409–416CrossRefGoogle Scholar
  30. Klingels K, Jaspers E, Van de Winckel A, De Cock P, Molenaers G, Feys H (2010b) A systematic review of arm activity measures for children with hemiplegic cerebral palsy. Clin Rehabil 24:887–900CrossRefGoogle Scholar
  31. Klingels K, Demeyere I, Jaspers E, De Cock P, Molenaers G, Boyd R et al (2012) Upper limb impairments and their impact on activity measures in children with unilateral cerebral palsy. Eur J Paediatr Neurol 16:475–484CrossRefGoogle Scholar
  32. Klotz MC, van Drongelen S, Rettig O, Wenger P, Gantz S, Dreher T et al (2014) Motion analysis of the upper extremity in children with unilateral cerebral palsy – an assessment of six daily tasks. Res Dev Disabil 35:2950–2957CrossRefGoogle Scholar
  33. Konczak J, Dichgans J (1997) The development toward stereotypic arm kinematics during reaching in the first 3 years of life. Exp Brain Res 117:346–354CrossRefGoogle Scholar
  34. Kreulen M, Smeulders MJ, Veeger HE, Hage JJ (2007) Movement patterns of the upper extremity and trunk associated with impaired forearm rotation in patients with hemiplegic cerebral palsy compared to healthy controls. Gait Posture 25:485–492CrossRefGoogle Scholar
  35. Krumlinde-Sundholm L, Ek L, Eliasson AC (2015) What assessments evaluate use of hands in infants? A literature review. Dev Med Child Neurol 57(Suppl 2):37–41CrossRefGoogle Scholar
  36. Kuhtz-Buschbeck JP, Stolze H, Johnk K, Boczek-Funcke A, Illert M (1998) Development of prehension movements in children: a kinematic study. Exp Brain Res 122:424–432CrossRefGoogle Scholar
  37. Mackey AH, Walt SE, Stott NS (2006) Deficits in upper-limb task performance in children with hemiplegic cerebral palsy as defined by 3-dimensional kinematics. Arch Phys Med Rehabil 87:207–215CrossRefGoogle Scholar
  38. McClure PW, Michener LA, Sennett BJ, Karduna AR (2001) Direct 3-dimensional measurement of scapular kinematics during dynamic movements in vivo. J Shoulder Elb Surg 10:269–277CrossRefGoogle Scholar
  39. Michaelsen SM, Luta A, Roby-Brami A, Levin MF (2001) Effect of trunk restraint on the recovery of reaching movements in hemiparetic patients. Stroke 32:1875–1883CrossRefGoogle Scholar
  40. Morasso P (1983) Three dimensional arm trajectories. Biol Cybern 48:187–194CrossRefGoogle Scholar
  41. Pataky TC (2010) Generalized n-dimensional biomechanical field analysis using statistical parametric mapping. J Biomech 43:1976–1982CrossRefGoogle Scholar
  42. Perez M, Ziviani J, Guzzetta A, Ware RS, Tealdi G, Burzi V et al (2016) Development, and construct validity and internal consistency of the grasp and reach assessment of Brisbane (GRAB) for infants with asymmetric brain injury. Infant Behav Dev 45:110–123CrossRefGoogle Scholar
  43. Randall M, Imms C, Carey LM, Pallant JF (2014) Rasch analysis of the melbourne assessment of unilateral upper limb function. Dev Med Child Neurol 56:665–672CrossRefGoogle Scholar
  44. Rau G, Disselhorst-Klug C, Schmidt R (2000) Movement biomechanics goes upwards: from the leg to the arm. J Biomech 33:1207–1216CrossRefGoogle Scholar
  45. Romeo DM, Guzzetta A, Scoto M, Cioni M, Patusi P, Mazzone D et al (2008) Early neurologic assessment in preterm-infants: integration of traditional neurologic examination and observation of general movements. Eur J Paediatr Neurol 12:183–189CrossRefGoogle Scholar
  46. Ronnqvist L, Domellof E (2006) Quantitative assessment of right and left reaching movements in infants: a longitudinal study from 6 to 36 months. Dev Psychobiol 48:444–459CrossRefGoogle Scholar
  47. Ronnqvist L, Rosblad B (2007) Kinematic analysis of unimanual reaching and grasping movements in children with hemiplegic cerebral palsy. Clin Biomech (Bristol, Avon) 22:165–175CrossRefGoogle Scholar
  48. Rudisch J, Butler J, Izadi H, Zielinski IM, Aarts P, Birtles D et al (2016) Kinematic parameters of hand movement during a disparate bimanual movement task in children with unilateral cerebral palsy. Hum Mov Sci 46:239–250CrossRefGoogle Scholar
  49. Sakzewski L, Boyd R, Ziviani J (2007) Clinimetric properties of participation measures for 5- to 13-year-old children with cerebral palsy: a systematic review. Dev Med Child Neurol 49:232–240CrossRefGoogle Scholar
  50. Schneiberg S, Sveistrup H, McFadyen B, McKinley P, Levin MF (2002) The development of coordination for reach-to-grasp movements in children. Exp Brain Res 146:142–154CrossRefGoogle Scholar
  51. Shumway-Cook AW, Woollacott MH (1995) Motor control: theory and practical applications. Williams and Wilkins, BaltimoreGoogle Scholar
  52. Steenbergen B, Hulstijn W, de Vries A, Berger M (1996) Bimanual movement coordination in spastic hemiparesis. Exp Brain Res 110:91–98CrossRefGoogle Scholar
  53. Steenbergen B, van Thiel E, Hulstijn W, Meulenbroek RGJ (2000) The coordination of reaching and grasping in spastic hemiparesis. Hum Mov Sci 19:20CrossRefGoogle Scholar
  54. Taylor N, Sand PL, Jebsen RH (1973) Evaluation of hand function in children. Arch Phys Med Rehabil 54:129–135Google Scholar
  55. Thelen E, Corbetta D, Kamm K, Spencer JP, Schneider K, Zernicke RF (1993) The transition to reaching: mapping intention and intrinsic dynamics. Child Dev 64:1058–1098CrossRefGoogle Scholar
  56. Thorley M, Lannin N, Cusick A, Novak I, Boyd R (2012) Reliability of the quality of upper extremity skills test for children with cerebral palsy aged 2 to 12 years. Phys Occup Ther Pediatr 32:4–21CrossRefGoogle Scholar
  57. Utley A, Sugden D (1998) Interlimb coupling in children with hemiplegic cerebral palsy during reaching and grasping at speed. Dev Med Child Neurol 40:396–404Google Scholar
  58. Wolff AL, Raghavan P, Kaminski T, Hillstrom HJ, Gordon AM (2015) Differentiation of hand posture to object shape in children with unilateral spastic cerebral palsy. Res Dev Disabil 45–46:422–430CrossRefGoogle Scholar
  59. Wu G, van der Helm FC, Veeger HE, Makhsous M, Van Roy P, Anglin C et al (2005) ISB recommendation on definitions of joint coordinate systems of various joints for the reporting of human joint motion – part II: shoulder, elbow, wrist and hand. J Biomech 38:981–992CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Lisa Mailleux
    • 1
  • Cristina Simon-Martinez
    • 1
  • Hilde Feys
    • 1
  • Ellen Jaspers
    • 2
  1. 1.Research Group for Neuromotor RehabilitationKU LeuvenLeuvenBelgium
  2. 2.Neural Control of Movement LabETH ZurichZurichSwitzerland

Section editors and affiliations

  • Sebastian I. Wolf
    • 1
  1. 1.Movement Analysis LaboratoryClinic for Orthopedics and Trauma Surgery; Center for Orthopedics, Trauma Surgery and Spinal Cord Injury;Heidelberg University HospitalHeidelbergGermany

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