Impact of Upper Extremity Impairment and Trunk Control on Self-Care Independence in Children With Upper Motor Neuron Lesions.
Jeffrey W Keller, Annina Fahr, Jan Lieber and 2 others
PMID 34464449WHAT IT FOUND
Trunk control explains more self-care independence in children with upper motor neuron lesions than arm movement quality, spasticity, or strength.
Therapists should prioritize trunk stability training, as it provides the stable base required for the upper limbs to function effectively during daily tasks.
Key findings
01In the final model, trunk control accounted for 43.2% of the variance in self-care independence, significantly more than spasticity (12.3%) and strength (2.3%).
02Upper extremity selective voluntary motor control (SVMC) was the second most important factor (23.1%), significantly outperforming strength.
03Strength was the least important predictor of self-care independence, likely because most participants had enough strength to move their joints, making movement quality more critical than raw power.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The sample included only mildly to moderately impaired children (mostly MACS levels I-III), so results may not apply to children with severe impairments (MACS IV-V). Patients with significant cognitive deficits were excluded because they could not follow instructions, limiting generalizability to those populations. The study design is cross-sectional; it identifies associations between impairments and independence but does not prove that improving trunk control will cause better self-care. Strength was assessed using dynamometry, which may not capture functional strength needed for daily tasks, and only a small range of movements was tested.
Declared interests
The study was funded by the Swiss National Science Foundation. The funders played no role in the design, conduct, or reporting of the study.
The easy way to misread this
Do not interpret these results as evidence that trunk training improves self-care independence. The study shows an association between trunk control and independence, but it did not test an intervention. Additionally, do not apply these findings to children with severe motor impairments (MACS level IV-V) or significant cognitive deficits, as they were excluded from the sample.