The management of the upper limb in cerebral palsy is often complex and challenging. Effective treatment requires a multidisciplinary approach involving paediatricians, occupational therapists, physiotherapists, orthotists and upper extremity surgeons. Interventions are generally aimed at improving function and cosmesis by spasticity management, preventing contractures and correcting established deformities. Treatment objectives vary according to each child and range from static correction of deformities to ease nursing care, to improvements in dynamic muscle balance to augment hand function. Botulinum toxin A therapy has been shown to relieve spasticity and improve function in the short term. Surgery is also effective but requires careful patient selection, as many children with cerebral palsy are not candidates for surgery. Occupational therapy and physiotherapy have small treatment effects alone but are essential adjuncts to medical and surgical management.
aDepartment of Orthopaedics
bDepartment of Occupational Therapy
cDepartment of Plastic and Reconstructive Surgery
dHugh Williamson Gait Analysis Laboratory, Royal Children's Hospital and University of Melbourne, Melbourne, Australia
Sponsorship: This work was supported in part by a Clinical Centre of Research Excellence grant from the National Health and Medical Research Council of Australia.
Correspondence and requests for reprints to H. Kerr Graham MD, FRCS (Ed), FRACS, Orthopaedic Department, Royal Children's Hospital, Flemington Road, Parkville 3052, Victoria, Australia
Tel: +61 3 9345 5450; fax: +61 3 9345 5447;