Thirty-two children with hand dysfunction due to cerebral palsy were examined before tendon transfer and muscle release, and 9 months postoperatively. AIl children improved their performance regardless of the degree of impaired hand function. The main advantage of surgery was a more functional position of the hand with increased wrist extension and forearm supination. There were also increased functionality of handgrips, grip strength, and dexterity. Impaired sensibility before surgery did not influence the outcome. Individual goals were set preoperatively. Individual functional goals outlined before surgery were met by most children. Children identi6.d as having mild impairments gained new functional skills related to everyday activity (selfcare and leisure), while children with severely impaired hand function demonstrated enhanced grasping ability, as well as a better cosmetic appearance.Children with cerebral palsy (CP) often have impaired hand function (Ingnm 1966 Eliasson et al. 1991Eliasson et al. , 1992Eliasson et al. , 1995, paresis and weakness in specific hand and arm muscles (Sahrmann and Norton 1977, Burke 1988), and spasticity (ix. exaggerated stretch reflexes and vclocitydependent resistance to passive movements) in other hand muscles (Lance 1980). Imbalance between antagonistic muscles influences the position of the arm. This often results in adduction and inward rotation at the shoulder, flexion of the elbow, pronation of the forearm, flexion of wrist and fingers, and thumb-in-palm deformity (Zancolli et al. 1983). Secondary contractures and joint defomiities also reduce the range of motion. The abnormal hand posture influences the ability for rcfined grasping of objects of different orientation and shape. It also impedes the child's vision of the object when grasping. Visual feedback is critical for precision movements Ueanncrod 1986). while the posture of the hand makes these children rely mainly on tactile information when contactingand grasping objects. Earlier reports. however, indicate that about 50% of children with hemipkgia exhibit impaired tactile sensation, which could further reduce their ability to control grasping movements (Ixsnq 1971, Uvebrant 1788. van Heest et al. 19%).Surgery of the arm and hand in children with CP aims to recstablish the balance between the spastic flexor muscles and the weaker extensor muscles. The surgical procedures involve spastic muscle release and tendon transfer. Earlier reports commonly focus on surgical techniques and describe changes in hand position and motion in more general terms (Green 1942(Green , 1962 Goldner 1974 Goldner , 1975 Operations, including siniultaneous correction of forearm, wrist, and thumb deformities are commonly recommended but rarely evaluated. Studies completed by Matsuo et al. (1990) and Koth et al. (1993) have attempted to evaluate improvement in daily activity following these procedures.In this report, improvements in hand function after simultaneous corrections were evaluated quantitatively according to the effect o...

The present study was performed to investigate if, in a short term perspective, bimanual hand function in children with brain damage improves as an effect of hand surgery. Assisting Hand Assessment (AHA), Goal Achievement Scale, consolidated House Functional Classification, Zancolli Classification, and the active range of motion were measured before surgery and 5-14 months after surgery in 18 children, aged 6-16 years, mean of 11 years. AHA improved from 44.5 AHA units (range 20-66) to 52.5 AHA units (range 25-69) (P<0.005) on a 0-100 AHA unit scale. Active motion improved (P<0.005). Rating of selected goals improved from 2.6 to 6.4, on a 10-grade scale. On a short term, hand surgery improved not only the grip, but also the ability to use the hemiplegic hand in bimanual activities.

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