Zancolli Classification Hand Function Scale

Zancolli Classification attain run short ScaleZancolli smorgasbord feed office staff surmount was formed by Eduardo Zancolli in two hundred3. He first utilize this scale in measureing the children with noetic paralyse who underwent rehabilitative surgery. In this scale he explained about the grasping and release patterns in the midst of the wrist and fingers and bargain air of the fitful children. He explained the make pass appearance in degrees and that, degrees of extension can be measured employ goniometer. The responses of the scale was throwd as 0, 1, 1a, 2a, 2b and 3.Scoring0 Patients can brood the wrist more(prenominal) than 20 0 with the fingers ext final st mounted.1a Patients can extend the wrist mingled with 0 and 20 0 with the fingers extended1b Patients can extend the wrist between -200 and -10 with the fingersextended2a Patients can extend the wrist with the finger flexed.The fingers can too be extended, but with more than 20 0 of wrist crease.2 b Patients cannot extend the wrist with the finger flexed.The fingers can be extended, but with more than 200 of wrist flexion.3 Extension of the fingers and wrist is impossible.InterpretationMaximum take aim is 3Minimum summate is 0.The lowest news report indicates no misshapenness and highest score indicates severe deformity.3.8.3. CryotherapyThe shape cryotherapy comes from the Greek word cryo cockeyeds bleak and the word therapy baseborns cure. It has been around since the 1880-1890s. The ancient Greeks knew the secrets of wellness Cryotherapy (Greek cryo cold, therapeia cure) is a term used for treatment based on exposing the human body to very(prenominal) low temperatures for brief mensess at a time. Cryotherapy came into broad use in the c atomic number 18 of sports injuries during the 1970s.Articles Needed1. A plinth to position the subject2. glass Packs3. A stopwatch4. Towels 25. Bowl with cotton ball6. odor7. GoniometerProcedureStep 1 Explain the procedure to the c be donorStep 2 Arrange all the articlesStep 3 pose the child by removing the clothing from the elbow to fingersStep 4 direct of spasticity and upset purpose is assessed development Ashworth scaleand zancolli sorting pop off manipulation scale.Step 5 Wrap the ice pack in a wet towel.Step 6 The area is cleaned with spirit cotton and the upper limb of the childwas positioned on pillow.Step 7 Place the confined pack on the flexor compartment of the forearmStep 8 will the pack in place with dry towelStep 9 by and by(prenominal) 5 minutes assess for any adverse effectuate like rashes.Step 10 The ice pack was applied for 20 minutes and then removed and driedStep 11 secure the child comfor circumventStep 12 Replace the articlesStep 13 Level of spasticity and sacrifice conk is measured by and by 10 days.3.9. HYPOTHESESH01 thither is no prodigious going between data-based separate and adjudge classify in the aim of spasticity and hand move out front cryoth erapy among children with noetic paralysis.H1 thither is a material remnant in the direct of spasticity and hand work on onwards and subsequently cryotherapy among children with rational paralysis of observational sort out.H02 there is no substantive fight in the take of spasticity and hand conk forward and after intervention among children with cerebral paralysis of insure root.H2 There is a significant disagreement between data-based and concord root word in the aim of spasticity and hand function after cryotherapy among children with cerebral palsy.3.10. buffer zone STUDYPilot arena was conducted to find out feasibility and practicability, rigour and reliability of the study. The study was conducted at Aashirwad special school for a period of 6 days. A total of 6 samples were selected for the study in bare(a) random sampling technique. Personal information was collected. A pre legal opinion was by means of with(p) utilize Ashworth scale and Zanco lli classification hand function scale followed that cryotherapy was administered by the research worker for 30 minutes daily for each child for a period of 6 days. Post scrutiny was done on the sixth day. Data collected was tabulated and analyze using descriptive statistical methods. The results showed that, there was a significant advancement in children after cryotherapy. whence the study was feasible and practicable.3.11. MAIN STUDYThe main study was conducted to meet the objectives of the generate study. The information was collected at Families for Children for a period of 30 days. The children were selected jibe to purposive sampling technique. Total of 30 samples were allocated alternatively into observational and carry root word. The researcher explained the procedure to care givers of the children and obtained consent from the care givers. Demographic data was collected first. A pre assessment was done using Ashworth scale and Zancolli classification hand functi on scale for the children with cerebral palsy. Cryotherapy was administered to the child by the researcher for duration of 20 minutes daily for a period of 10 days to each child in a comfor circuit board environment. The built in bed quiz was done using the same tool at the end of 10th day of intervention.3.12. TECHNIQUE OF DATA synopsis AND INTERPRETATIONA frequency table was formulated for all significant information. Descriptive and inferential statistical method was used for data analysis. t running game for bloodsucking samples was used to find the significance of cryotherapy. t test for free-lance samples was used to find out the parity of spatial relation test scores among observational and turn back collection.DATA ANALYSIS AND INTERPRETATIONThe say-so of cryotherapy prior to still stretching on the level of spasticity and hand function among children with CP was assessed and analyzed. The participants of the study were children with spastic cerebral palsy. Tot ally 30 samples were selected for the study and randomly divided into observational and construe conference. The intervention selected for the present study was cryotherapy for 20 minutes before supine stretching on the level of spasticity and hand function. The level of spasticity was assessed before and after cryotherapy by using Ashworth scale. achieve function was assessed before and after cryotherapy using Zancolli classification hand function scale.The collected data were themeed and analyzed using descriptive and inferential statistical methods.SECTION I4.1. demographic VARIABLESThe following demographic variables are distributed in the form of tables and graphs. The demographic variables are age (in years), sex and types of cerebral palsy among children with spastic cerebral palsy. disconcert 4.1.DISTRIBUTION OF DEMOGRAPHIC VARIABLESAMONG CHILDREN WITH rational paralysis(N=30)DemographicVariables data-based group get the hang groupNo. of participants parcel(%)No. o f participantsPercentage(%)Age (years)6-93205339-1253374712-15747320 sexualityMale533427Female10671173Types of CPDiplegic533747Quadriplegic1067853The table shows the distribution of demographic variables like age (years), sex, and type of CP that are children with spastic cerebral palsy. The age distribution children with spastic cerebral palsy range from 6-15 years in which 47% of children from observational group range from 12-15 years and in come across group they range from 9-12 years respectively. 20% of children from experimental group and overlook group range from 6-9 years and 12-15 years respectively. 33% of children from experimental group and understand group range from 9-12 years and 6-9 years respectively. In two(prenominal) the group legal age of children were female eyepatch 33% in experimental group and 27% in control group were male. In twain(prenominal) groups, majority of children were quadriplegic while 33% in experimental group and 47% in control group were diplegic.FIG 4.1AGE DISTRIBUTION OF CHILDREN WITH spastic rational palsyFIG 4.2GENDER DISTRIBUTION OF CHILDREN WITH SPASTIC cerebral PALSYFIG 4.3DISTRIBUTION OF TYPES OF CP AMONG CHILDRENWITH CEREBRAL PALSYSECTION II4.2. 1. ASSESSMENT ON THE train OF SPASTICITY AMONGCHILDREN WITH CEREBRAL PALSYThe ashworth scale consists of 5 guide scale used to assess the level of spasticity among children with cerebral palsy in both experimental and control group. The assessment was done for both the hands before and after cryotherapy. put over 4.2.ASSESSMENT ON THE level OF SPASTICITY (ON RIGHT HAND) AMONG CHILDREN WITH CEREBRAL PALSY to begin with AND AFTER CRYOTHERAPY(N=30)Level of spasticity experimental groupControl groupBefore later onBefore latern%n%n%n%No spasticity13Mild spasticity1311372727Moderate Spasticity144731013431343The table shows that in experimental group majority of children with spasticity (47%) had moderate spasticity before the intervention whereas majority (37%) had lowly spasticity after intervention. In control group there was no changes after intervention. The scores on comparison showed reduction in the level of spasticity among children with cerebral palsy on chastise hand.TABLE 4.3.ASSESSMENT ON THE direct OF SPASTICITY (ON LEFT HAND) AMONG CHILDREN WITH CEREBRAL PALSY BEFORE AND AFTER CRYOTHERAPY(N=30)Level of spasticity experimental groupControl groupBefore later onBeforeAftern%n%n%n%No spasticity13Mild spasticity13124027620Moderate Spasticity14473101343930The table shows that in experimental group majority of children with spasticity (47%) had moderate spasticity before the intervention whereas majority (40%) had nuts spasticity after intervention. In control group majority (43%) had moderate spasticity before intervention and mild variety occurs after intervention. The scores on comparison show reduction in the level of spasticity among the experimental group children with cerebral palsy on left field(a) hand.4.2.2. ASSESSM ENT ON HAND FUCTION AMONG CHILDREN WITHCEREBRAL PALSYThe zancolli classification hand function scale used to assess hand function among children with cerebral palsy in both experimental and control group. The assessment was done for both the hands before and after cryotherapy.TABLE 4.4.ASSESSMENT ON HAND do AMONG CHILDREN WITH CEREBRAL PALSY BEFORE AND AFTER CRYOTHERAPY(N = 30) march onExperimental conclaveControl groupBeforeAfterBeforeAfter implicate recall% call back base% soaked guess%MeanMean%Right3.2641.86372.6532.6653 unexpended3.1621.7342.73552.5351Hand function on both right and left hand among children with cerebral palsy of experimental group shows that there was an make betterment in hand function after intervention, when compared with the scores before intervention. In control group there was a mild changes in the right and left hand assessment scores after intervention. and then the score reveals that the experimental group children had decreed improvement in the hand function compared to control group children.SECTION III4.3.1. relation ON THE level OF SPASTICITY AND HANDFUNCTION AMONG CHILDREN WITH CEREBRAL PALSY INEXPERIMENTAL AND suppress assemblage BEFORE interpositionBefore intervention, assessment on the level of spasticity and hand function was done among experimental and control group. The obtained scores were analyzed using t test for independent samples, to prove the effectivity of the intervention.TABLE 4.5.COMPARISON ON THE LEVEL OF SPASTICITY AND HAND FUNCTION AMONG CHILDREN WITH CEREBRALPALSY IN EXPERIMENTAL GROUP AND enclose GROUP BEFORE INTERVENTIONGroupLevel of spasticityHand functionRight HandLeft handRight HandLeft handMeanMean % metre divagationtMeanMean% amount exittMeanMean%Standard DeviationtMeanMean %Standard DeviationtExperimental2.26570.50.32500.511.23.2640.841.63.1450.830.4Control2.3580.32.6570.572.65212.7540.9(N=30)The above table depicts the obtained t esteem cipher for the level of spasticity and hand function of experimental group and control group before intervention. The level of spasticity on right hand of children among experimental group the blind drunk character score was 57% (0.57) and the control group was 58% (0.3). The level of spasticity on left hand of children among experimental group the soaked percentage score was 50% (0.51) and the control group was 57% (0.57). The hand function on right hand of children among experimental group the call up percentage score was 64% (0.84) and the control group was 52% (1.07). The level of spasticity on right hand of children among experimental group the beggarly percentage score was 45% (0.8) and the control group was 54% (0.9). thusly the retrieve percentage scores show that there is a supreme disagreement in the level of spasticity and hand function among children with cerebral palsy.t test for independent samples is used to test the significance in baseborn difference among the experimental and control groups. The m ensurable t set on the level of spasticity, the right hand score (0.33) and left hand score (1.26) are lesser than the table protect at 0.05 level of significance. The cipher t look on on hand function, the right hand score (1.62) and left hand score (0.38) are lesser than the table value at 0.05 level of significance. so the null hypothesis, There is a no significant difference between experimental group and control group in the level of spasticity and hand function before cryotherapy among children with cerebral palsy is accepted.4.3.2. ANALYSIS ON THE LEVEL OF SPASTICITY AND HAND FUNCTIONAMONG CHILDREN WITH CEREBRAL PALSY exploitation ashworth scale, the level of spasticity and hand function among the children with cerebral palsy was assessed in both experimental and control group. The assessment was done for both the hands. The obtained scores are analyzed using t test dependent samples, to test the effectiveness of cryotherapy prior to unresisting stretching.TABLE 4.6.MEA N, STANDARD DEVIATION, t VALUE ON THE LEVEL OF SPASTICITY AND HAND FUNCTION (ON RIGHT HAND) BEFORE AND AFTER CRYOTHERAPY(N=30)GroupLevel of spasticityHand FunctionBeforeAfterMean differencetBeforeAfterMean differencetMeanStandard deviationMeanStandard deviationMeanStandard deviationMeanStandard deviationExperimental2.260.571.130.51.1310.41**3.20.81.860.71.339.8**Control2.30.32.20.70.131.462.61.072.61.010.060.74** significant at 0.01 levelThe above table reveals the distribution of close and ensample deviation of the obtained scores before and after cryotherapy among experimental group and control group children with cerebral palsy. The level of spasticity among experimental group showed a mean difference of 1.17 while there was mild difference in the control group. Thus the mean score in the level of spasticity shows that there was a positive difference in the reduction of spasticity among children with cerebral palsy of experimental group. Hand function of the experimental grou p showed a mean difference of 1.33 and the control group mean difference is about 0.06 Thus the mean scores show that there is a positive improvement in hand function among children with cerebral palsy of experimental group.t test was used to test the significance in mean difference. The calculated t value on the level of spasticity in the experimental group was 10.4 which was compared with the table value at 0.01 level of significance. The calculated t value on hand function in the experimental group was 9.8 which was compared with the table value at 0.01 level of significance. The calculated value was higher than the table value. Hence the research hypothesis, There is a significant difference in the level of spasticity and hand function before and after cryotherapy among children with cerebral palsy of experimental group is accepted. The calculated t value in control group on the level of spasticity was 1.46 and hand function was about 0.7 which was found to be lesser than the ta ble value. Therefore the null hypothesis, There is no significant difference in the level of spasticity and hand function before and after cryotherapy among children with cerebral palsy of control group is accepted. Thus the mean value reveals that cryotherapy prior to passive stretching was effective in reducing the level of spasticty and improving hand function among children with cerebral palsy of experimental group.TABLE 4.7.MEAN, STANDARD DEVIATION, t VALUE ON THE LEVEL OF SPASTICITY AND HAND FUNCTION (ON LEFT HAND) BEFORE AND AFTER CRYOTHERAPY(N=30)GroupLevel of spasticityHand FunctionBeforeAfterMean differencetBeforeAfterMean differencetMeanStandard deviationMeanStandard deviationMeanStandard deviationMeanStandard deviationExperimental20.511.130.340.869.5**3.10.831.70.611.48.57**Control2.260.5720.630.21.872.70.972.530.90.21.87** meaningful at 0.01 levelThe above table reveals the distribution of mean and standard deviation of the obtained scores before and after cryotherapy among experimental group and control group children with cerebral palsy. The level of spasticity among experimental group showed a mean difference of 0.86 while there was mild difference in control group. Thus the mean score in the level of spasticity shows that there was a positive difference in the reduction of spasticity among children with cerebral palsy of experimental group. Hand function of the experimental group showed a mean difference of 1.4 and while there was 0.2 mean difference in the control group. Thus the mean scores show that there is a positive improvement in hand function among children with cerebral palsy of experimental group.t test was used to test the significance in mean difference. The calculated t value on the level of spasticity in the experimental group was 9.5 which was compared with the table value at 0.01 level of significance. The calculated t value on hand function in the experimental group was 8.57 which were compared with the table value at 0.01 le vel of significance. The calculated value was higher than the table value. Hence the research hypothesis, There is a significant difference in the level of spasticity and hand function before and after cryotherapy among children with cerebral palsy of experimental group is accepted. The calculated t value in control group on the level of spasticity was 1.87 and hand function was about 1.87 which was found to be lesser than the table value. Therefore the null hypothesis, There is no significant difference in the level of spasticity and hand function before and after cryotherapy among children with cerebral palsy is accepted. Thus the mean value reveals that cryotherapy prior to passive stretching was effective in reducing the level of spasticity and improving hand function among children with cerebral palsy of experimental group.FIG 4.4COMPARISON ON THE LEVEL OF SPASTICITY BEFORE AND AFTER INTERVENTION OF EXPERIMENTAL GROUP AND CONTROL GROUPFIG 4.5.COMPARISON ON HAND FUNCTION BEFORE AND AFTER INTERVENTION OF EXPERIMENTAL GROUP AND CONTROL GROUP4.3.3. COMPARISON ON THE LEVEL OF SPASTICITY AND HANDFUNCTION AMONG CHILDREN WITH CEREBRAL PALSY INEXPERIMENTAL AND CONTROL GROUP AFTER INTERVENTIONAfter intervention, assessment on the level of spasticity and hand function was done among experimental and control group. The obtained scores were comparatively analyzed using t test for independent samples, to prove the effectiveness of the interventionTABLE 4.8.COMPARISON ON THE LEVEL OF SPASTICITY AND HAND FUNCTION AMONG CHILDREN WITH CEREBRAL PALSY IN EXPERIMENTAL GROUP AND CONTROL GROUP AFTER INTERVENTIONGroupLevel of spasticityHand functionRight HandLeft HandRight HandLeft HandMeanMean %Standard DeviationtMeanMean%Standard DeviationtMeanMean %Standard DeviationtMeanMean %Standard DeviationtExperimental1.13280.54.8**1.13280.344.5**1.86370.712.74*1.7340.613.53*Control2.2550.72500.62.65212.5510.9* Significant at 0.05 levelThe above table depicts the obtained t value calcul ated for the level of spasticity and hand function of experimental group and control group after intervention. The level of spasticity on right hand of children among experimental group the mean percentage score was 28% (0.5) and the control group was 55% (0.7). The level of spasticity on left hand of children among experimental group the mean percentage score was 28% (0.34) and the control group was 50% (0.6). The hand function on right hand of children among experimental group the mean percentage score was 37% (0.71) and the control group was 52% (1). The hand function on left hand of children among experimental group the mean percentage score was 34% (0.6) and the control group was 51% (0.9). Thus the mean percentage scores show that there is a positive difference in the level of spasticity and hand function among children with cerebral palsy.t test for independent samples is used to test the significance in mean difference among the experimental and control groups. The calculate d t value on the level of spasticity, the right hand score (4.87) and left hand score (4.5) are higher than the table value at 0.01 level of significance. The calculated t value on hand function, the right hand score (2.74) and left hand score (3.53) are higher than the table value at 0.05 level of significance. Hence the hypothesis, There is a significant difference between experimental group and control group in the level of spasticity and hand function after cryotherapy among children with cerebral palsy is accepted. This proves that, cryotherapy prior to passive stretching has its influence in reduction of spasticity and improvement in hand function.RESULTS AND DISCUSSIONThe study was conducted at Families for Children, Coimbatore, with the focus on determining the effectiveness of cryotherapy prior to passive stretching on the level of spasticity and hand function among children with cerebral palsy. The samples of the study were 30 children with spastic cerebral palsy at Famili es for Children, and they were randomly allocated to experimental and control group. Cryotherapy was applied prior to passive stretching, to cut out the level of spasticity and improve hand function. To assess the level of spasticity and hand function, the researcher used Ashworth Scale and Zancolli classification hand function scale. The intervention was provided for 20 minutes prior to passive stretching for 10 days. The pretest score and post test scores were compared. The findings are discussed under the following headings.5.1. FINDINGS RELATED TO DEMOGRAPHIC VARIABLE5.1.1. Age dispersalIn the present study, out of 30 samples, 15 children were randomly depute to experimental group and 15 children were assigned to control group. Age distribution in experimental group revealed that, majority of children with spastic cerebral palsy (47 %) were between 12-15 years of age, 33% were between 9-12 years and 20 % were between 6-9 years. Age distribution in control group revealed that, majority of children (47 %) were between 9-12 years, 33% were between 6-9 years and 20% were between 12-15 years. Boyd RN (2012) conducted an interventional study by providing progressive resistance breeding for CP children (between the age group of 6-15 years) who are ambulatory in order to improve muscle strength. The study findings showed improvement in muscle strength though there was no change in the walking ability.5.1.2. Gender DistributionGender distribution of children showed that, majority of children was females in both experimental (67 %) and control (73 %) group. A study on effectiveness of neuromuscular electrical input over cryotherapy along with passive stretching as a customary protocol on improving hand function in patients with spastic cerebral palsy by Devidas S Patil (2011) showed that, improvement of hand function was seen in both male and female children.5.1.3. Type of Cerebral palsyAssessment on the type of cerebral palsy showed that, majority of children were quadriplegic in both experimental (67 %) and control (53%) group. A study on cleverness of cold therapy on spasticity and hand function in children with cerebral palsy by Gehan et al.,(2010) revealed that, cryotherapy was effective in reducing spasticity and improving hand function in both diplegic and quadriplegic children.5.2. ASSESSMENT OF LEVEL OF SPASTICITY AND HAND FUNCTIONAMONG CHILDREN WITH CEREBRAL PALSYThe children with the diagnosis of mild and moderate spastic cerebral palsy were selected for the study. The level of spasticity was measured using Ashworth scale. The tool is a 5 point scale in which the researcher extends the limb from the maximal flexion to maximal extension until the soft resistance is felt. The child limb moved through its full range of motion with one second by counting one thousand and one. The level of resistance felt is scored using 5 point scale. Hand function was assessed using Zancolli classification hand function scale in which the rese archer assesses the degree of flexion and extension in the wrist and finger flexors by using goniometer. The degree of responses was scored as 0, 1a, 1b, 2a, 2b, 3.Akinbo et. al., (2007) conducted a similar study on effect of neuromuscular electrical comment and cryotherapy on spasticity and hand function. A quasi experimental pretest posttest control conception was adopted in the study with sample size of 20. The level of spasticity was assessed using Ashworth scale in which the patient limb was extended from the maximal flexion to maximal extension until the soft resistance is felt. Hand function was assessed using zancolli classification hand function scale. The degree of flexion and extension was assessed using goniometer.5.3. ADMINISTER CRYOTHERAPY PRIOR TO PASSIVE STRETCHINGAMONG CHILDREN WITH CEREBRAL PALSYAfter assessing the level of spasticity and hand function, Cryotherapy was administered prior to passive stretching. The child is hardened in a supine position with uppe r limb supported on a pillow. The area is cleansed with spirit and cotton. The wrapped ice pack is placed on the flexor compartment of the forearm for 20 minutes and then dried. whence the child had passive st