Daily Living Activities in Young Adults With Cerebral Palsy

Primary outcomes

1. Semmes-Weinstein monofilaments

   Time frame: 1 month

   This non-invasive technique assesses cutaneous sensory perception using nylon monofilaments of varying diameters that apply specific pressure forces. These forces range from 0.07 g (smallest) to 300 g (largest). In this study, monofilaments were applied to distinct areas innervated by different nerves: the distal phalanx of the first, second, and third fingers and the thenar eminence (median nerve), the fifth finger and hypothenar eminence (ulnar nerve), and the proximal phalanx of the first and second fingers on the dorsal side (radial nerve).

2. Two-point discrimination test

   Time frame: 1 month

   This test evaluates the ability to distinguish between two closely spaced pressure points on the skin, reflecting sensory acuity and receptor density. Distances typically range from 0 to 8 mm. Despite being widely used, standardization of pressure remains a challenge; a light, uniform pressure (10-15 g) is recommended. In this study, the same hand regions assessed with monofilaments were used. Proper simultaneous application was ensured to avoid perception bias.

3. Modified Ashworth Scale (MAS)

   Time frame: 1 month

   The MAS is widely used to evaluate muscle spasticity by measuring resistance to passive movement. The scale ranges from 0 (no tone increase) to 4 (severe rigidity), with the inclusion of score 1+ for greater sensitivity. In this study, assessments were performed on elbow and wrist flexor/extensor muscles, muscles involved in pronation/supination, and finger flexors/extensors. The scale helps quantify the degree of hypertonia, a common symptom in individuals with neurological conditions.

4. Digital dynamometer

   Time frame: 1 month

   Grip strength was measured using a handheld digital dynamometer, which quantifies isometric force output in kilograms. Testing was conducted with participants seated, shoulder adducted, elbow at 90º, forearm in neutral, and wrist extended 0º-30º. Both upper limbs were assessed. This measurement reflects overall upper limb strength and functional capacity, and is considered a reliable indicator of motor performance in clinical populations.

5. Box and Block Test

   Time frame: 1 month

   This test evaluates unilateral manual dexterity by counting the number of wooden blocks a participant can transfer from one side of a partitioned box to the other within 60 seconds. A 15-second practice trial was included to ensure familiarity with the procedure. It is a validated tool for individuals with neurological impairments and provides a quick, functional measure of hand coordination. Performance was assessed for both dominant and non-dominant hands.

6. Functional Independence Measure

   Time frame: 1 month

   The FIM assesses performance in Activities of Daily Living (ADLs) across two domains: motor (13 items) and cognitive/social (5 items). Each item is rated on a 7-point scale from total dependence (1) to complete independence (7), with a maximum total score of 126. It evaluates self-care, sphincter control, mobility, communication, and social cognition. This tool is widely used to determine the level of assistance required in daily life

7. Lawton and Brody Scale

   Time frame: 1 month

   This scale measures independence in Instrumental Activities of Daily Living (IADLs), such as using the telephone, managing medications and finances, shopping, cooking, and transportation. Scores range from 0 (dependent in all tasks) to 8 (independent in all tasks). It is particularly useful for evaluating more complex, community-based activities that are essential for independent living and is a standard tool in occupational therapy and geriatric assessment