Upper Extremity Sensation and Function in Children With Cerebral Palsy

Vibration sense assessment with a tuning fork is based on obtaining feedback from the patient regarding the sensation of vibration by touching the vibrating tuning fork to bone or a bony prominence. The patient is asked to close their eyes, and the vibrating tuning fork is usually placed on a bone at the extremities. The tuning fork (usually 128 Hz) is struck against the hypothenar eminence of the hand or the edge of a table to vibrate. The patient is then asked to state when the vibration ceases as the tuning fork is touched to the relevant area of their body.

Participants' stereognosis sense will be assessed by placing three familiar objects (key, spoon, clothespin) and three similar matching objects (e.g., button, safety pin, pencil) in their hands. Participants will be given objects to hold and asked to identify them while blindfolded. The object will remain in the participant's hand for a maximum of 30 seconds. They will receive scores ranging from 0 to 6, first for the dominant side and then for the non-dominant side.

The Semmes-Weinstein monofilament test is a method used to test the sense of touch in diseases that can cause various types of sensory loss. The Semmes-Weinstein Monofilament set starts with the thinnest monofilament, which should be felt at the normal level in the first stage of the test, and progresses to darker-colored monofilaments with increasing pressure. A monofilament is touched to the same area three times, and at least two of these must be correctly identified. Green indicates normal sensation, blue indicates decreased light touch sensation, purple indicates decreased protective sensation, and red indicates complete

Two-point discrimination measures an individual's ability to perceive two stimulus points simultaneously. Within the scope of the study, a discriminator will be used to evaluate individuals' two-point discrimination sense. The individual will be asked to close their eyes and will be tested by moving the discriminator's index finger over their fingertip. The assessment will start at the maximum distance and will be gradually reduced until the individual can no longer distinguish between the two points. When the individual perceives the two points as one in two out of three trials, the distance will be noted in mm. To apply as equal pressure as possible, light pressure will be applied to both ends of the discriminator simultaneously.

Upper extremity proprioception will be assessed using the Joint Position Sense (JPS) test in individuals. The Angulus (DPP, USA) mobile application will be utilized as the measurement tool for this test. Participants will be positioned in a supported sitting position with the forearm in pronation and the hand placed on the table. With the participant's eyes closed, the evaluator will passively bring the wrist to an approximate $30\^\\circ$ extension position and hold it for 10 seconds to allow the participant to perceive the position. The wrist will then be returned to the starting (neutral) position, and the participant will be asked to actively bring their wrist to the same perceived position. This process will be repeated three times for each side. The error score will be calculated as the absolute difference between the passive target angle and the angle produced during active repositioning. The average value of the three differences will be used for the final analysis.

The Jebsen-Taylor Hand Function Test (JTHFT) is a standardized and objective test of fine and gross motor hand function using tasks that mimic activities of daily living (ADL). The test consists of 7 subtests performed with the dominant and non-dominant hands. During the assessment, children will be seated in a back-supported chair with their feet flat on the floor. The writing subtest will not be administered to children who are too young to have learned to read and write. Both hands will be tested separately. Before each test item, the patient will be shown how to perform the task and will be instructed to perform the same activity first with one hand and then with the other. For each sub-item, the patient will start with the command "start" and the stopwatch will be stopped when they finish. The test completion time will be recorded for each sub-test.

The ABILHAND Kids survey will be used to assess hand dexterity, defined as the ability to manage daily activities requiring the use of the upper extremities, regardless of the strategies involved. Abilhand-Kids is a measure that can be used to assess hand skills in children with cerebral palsy. It contains 21 sub-items. The sub-items are scored as 0; cannot do, 1; has difficulty doing, and 2; does easily. The questions are usually answered by the parent, but if the child is old enough and has the appropriate cognitive level, they can also answer themselves.