An Assessment of the Applicability of Shriners Hospital Upper Extremity Evaluation as a Decision-making Tool and Outcome Measure in Upper Limb Cerebral Palsy in Indian Children

BACKGROUND: The aim of this study was to assess the applicability and performance of the Shriners Hospital Upper Extremity Evaluation (SHUEE) and to determine its usefulness in clinical decision-making and as an outcome measure with reference to Indian children suffering from cerebral palsy. MATERIALS AND METHODS: The SHUEE videos of 40 children with cerebral palsy with spastic hemiplegia or asymmetrical diplegia were analyzed and scored. Seven children had undergone upper extremity surgery based on a preoperative evaluation. All seven had a postoperative evaluation. Pre- and postoperative scores were compared. Intra- and interobserver reliability was assessed. The level of familiarity and comfort of the children with the assigned tasks was gauged. RESULTS: Analysis of the scores revealed that patients could be categorized into three discrete groups based on the modified House scores and Spontaneous Functional Analysis (SFA) scores, which helps in identifying the patients who would benefit from surgical intervention. In the seven children who were operated, there was a mean increase in the postoperative SFA (2.97, P = 0.259), Dynamic Positional Analysis (3.15, P = 0.229) and Grasp/Release Analysis (4.96, P = 0.334) scores, though the differences were not statistically significant. There was excellent intraobserver (r - 0.98) and interobserver reliability (r - 0.97, 0.96) based on the intraclass correlation coefficient. The children were familiar with the assigned tasks and were not duly uncomfortable while attempting to perform them. CONCLUSIONS: SHUEE is a useful modality to assess upper limb function in Indian children with cerebral palsy, and can be used as a decision-making tool and mode of documentation.