A systematic evaluation of the effect of thumb opponens splints on hand function in children with unilateral spastic cerebral palsy.

OBJECTIVE: To examine the effects of a neoprene thumb opponens splint on hand function during a self-selected activities of daily living task in children with unilateral spastic cerebral palsy with thumb-in-palm position of the affected hand. DESIGN: Systematic evaluation of seven cases using a multiple baseline design across individuals. SETTING: Outpatient clinic. SUBJECTS: Seven children with unilateral cerebral palsy (2-7 years old), Manual Ability Classification System level 2-3 participated in the study. INTERVENTIONS: Neoprene thumb opponens splints (McKie splint) were used. Children were followed for about four months. Baseline period ranged from 4 to 9 weeks, intervention period was two months and duration of follow-up one month. MAIN MEASURES: Hand function was assessed using goal attainment scaling and visual analogue scales. Data was assessed visually. RESULTS: In four children goal attainment scaling and/or visual analogue scale scores increased after introducing the splint. These effects remained when splints were not worn. Two children only benefited from the splint when it was worn. Thumb opponens splints were tolerated well by all children who participated in this study. CONCLUSIONS: Thumb opponens splints may have a positive effect on hand function in children with unilateral spastic cerebral palsy.

Test-retest and inter- and intrareliability of the quality of the upper-extremity skills test in preschool-age children with cerebral palsy.

OBJECTIVE: To investigate the test-retest, inter-, and intraobserver reliability of the Quality of Upper Extremity Skills Test (QUEST) in young children with cerebral palsy (CP). DESIGN: For test-retest reliability, a test-retest design was used; for the intra- and interobserver reliability, the videotaped test was scored on 2 occasions by 1 observer and by various observers. SETTING: Groups of preschool-age children in 2 general rehabilitation centers. PARTICIPANTS: Twenty-one children with CP (12 boys, 9 girls) aged 2 to 4.5 years (mean, 39 mo). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Spearman correlation coefficient. RESULTS: The data indicated that test-retest reliability was strong (rho range, .85-.94). Intraobserver agreement (rho range, .63-.95) and agreement between various observers (rho range, .72-.90) were moderate to strong. CONCLUSIONS: Test-retest and inter- and intraobserver reliability of the QUEST in preschool-age children with CP is good.

Does surgical management of the hand in children with spastic unilateral cerebral palsy affect functional outcome?

The aim of this review was to examine the literature on the effects of surgery of the spastic hand in children with cerebral palsy on functional outcome and muscle coordination. We performed a search of the relevant literature in Medline, Embase, and Biological Abstracts from 1966 to June 2006. The search resulted in eight studies on the effect of surgery on functional outcome and three studies on the effect of surgery on muscle coordination. Heterogeneity in outcome measures precluded meta-analysis. The studies revealed that -- at the level of impairment -- surgery has a positive effect on supination and dorsiflexion of the wrist. At the level of function, surgery might improve grip strategy and induce an increase of the repertoire of grips and spontaneous use of the hand. The evidence for the functional effects is, however, limited. Whether the possibly improved function is mediated by alterations in muscle coordination patterns remains unclear. The muscle coordination studies provided inconclusive results. We concluded that surgery improves the position of the hand and there are indications that it might improve hand function. Future research should address the question: does surgery improve hand function and, if so, is this due solely to a better hand position or does change in muscle coordination play an additional role?