Bimanuality is improved by hand surgery in children with brain lesions

Pontén, Eva; Ekholm, Catarina; Eliasson, Ann‐Christin

doi:10.1097/bpb.0b013e328348aa69

Cited by 18 publications

(29 citation statements)

References 47 publications

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“…A summary of the included studies is presented in Table SI. The three prospective studies stated measurement time points in advance and two retrospective studies described the use of a standard protocol which included follow‐up time‐points . Five studies provided information about missing data and loss to follow‐up (Table SI) .…”

Section: Resultsmentioning

confidence: 99%

“…Patients' functional performance of activities was evaluated with the Assisting Hand Assessment (AHA) and the Shriners Hospital Upper Extremity Evaluation (SHUEE) spontaneous functional analysis . Significant improvement on the spontaneous functional use (SHUEE spontaneous functional analysis and AHA) was found in all four studies . For the AHA, a change of five AHA units or more does (with 95% certainty) reflect a real change exceeding any random measurement error …”

Section: Resultsmentioning

confidence: 99%

“…32 Significant improvement on the spontaneous functional use (SHUEE spontaneous functional analysis and AHA) was found in all four studies. [14][15][16][17] For the AHA, a change of five AHA units 19 --0.81 BBT Very low 16 14 2.0 (5.9) À1.85 to 4.65 >0.05 27 15 2.3 (4.9) 0.36-4.13 0.21 HFC Very low 24 20 <0.01 <0.01 20 22 1.95 (1.4) 1.32-2.58 <0.001 56 23 2.7 (1.7) 0.22-2.23 <0.001 15 18 3.0 (-) -0.002 26 25 1.7 (1.7) 0.98-2.35 <0.001 19 24 3.2 (1.2) 2.59-3.70 <0.001 17 21 1.8 (-) -<0.001 SHUEE SFA Very low 40 17 4.0 (-) -<0.001 16 14 6.5 (11.0) 0.37-12.56 <0.05 AHA Very low 18 16 6.2 (3.7) 4.34-8.0 <0.001 16 14 3.1 (5.4) 0.21-5.92 <0.05 31 15 6.7 (4.2) 5.14-8.21 <0.001 COPM-P Very low 35 15 3. or more does (with 95% certainty) reflect a real change exceeding any random measurement error. 33…”

Section: Activity-based Outcome Measuresmentioning

confidence: 99%

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Effects of upper extremity surgery on activities and participation of children with cerebral palsy: a systematic review

Louwers

Warnink‐Kavelaars

Daams

et al. 2019

Develop Med Child Neuro

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AimTo evaluate and synthesize the evidence for effects of upper extremity surgery (UES) on activities and participation of children and adolescents with cerebral palsy (CP).MethodThe databases MEDLINE, Embase, and PsycINFO were searched for publications up to September 2018. Studies included were comparative studies with or without concurrent comparison groups or case series with pretest/posttest outcomes with a minimal sample size of 10 participants; those that reported the effects of UES with a follow‐up time of at least 5 months; those including patients diagnosed with CP aged up to 20 years; and those that used a validated activity‐based instrument. Risk of bias was assessed using the ROBINS‐I (Risk Of Bias In Non‐randomised Studies ‐ of Interventions) tool and quality assessment was performed using the Grading of Recommendations Assessment, Development and Evaluation.ResultsTwelve studies, involving 310 children and adolescents, were included. The ability and perception of the patient to use the hand(s) and perform activities (measured with the Shriners Hospital Upper Extremity Evaluation, Assisting Hand Assessment, and House Functional Classification) improved significantly after UES. The quality of evidence was very low for each of the activity outcomes of interest.InterpretationThe very low evidence prohibits recommendations on the use of UES to guide clinical practice. More high‐quality comparative studies are needed to obtain better insight into the effects of UES on activities and participation.What this paper adds Low quality of evidence for effects of upper extremity surgery (UES) on activities and participation.Limited evidence for improvement in activities and participation after UES.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Activity-based Outcome Measuresmentioning

confidence: 99%

See 1 more Smart Citation

Effects of upper extremity surgery on activities and participation of children with cerebral palsy: a systematic review

Louwers

Warnink‐Kavelaars

Daams

et al. 2019

Develop Med Child Neuro

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“…This is supported by findings in other studies from five months to seven years postoperatively. 13,[16][17][18]31 The ability to actively extend the wrist and fingers was improved. Even patients in Zancolli(m) 1b improved wrist and finger extension ( Table 2).…”

Section: Discussionmentioning

confidence: 95%

Increased use of the affected hand one and a half years after surgical correction for cerebral palsy and subsequent intensive hand therapy

Hansen

Tromborg

2013

Hand Therapy

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Introduction: Good hand function is essential for carrying out daily activities. People with unilateral cerebral palsy often have spasticity in their affected hand and arm, which makes it difficult to perform bimanual tasks. The aim of this study was to measure changes in grip span, strength and functional use of the affected hand when assisting in two-handed activities after surgical correction for cerebral palsy and subsequent intensive hand therapy. Methods: Since 1999, we have been evaluating all patients with unilateral cerebral palsy who had the potential for surgical correction of their forearm and hand, followed by intensive hand therapy at our university hospital. We tested their grip span, strength and use in two-handed activities preoperatively and six and 18 months postoperatively. Results: Between 1999 and 2011, 39 patients have had a corrective operation with tendon transfer to correct a deformity of the wrist and most have had a correction of the thumb as well. All received subsequent hand therapy until six months after the operation. Grip span, strength and changes in the functional use of the affected hand when assisting in two-handed activities all increased significantly (p<0.01), six and 18 months postoperatively. Discussion: Patients demonstrated a more useful affected hand in everyday activities and results persisted after the rehabilitation ceased at six months. Our findings support surgical correction for cerebral palsy followed by intensive hand therapy improves hand position and hand function.

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“…In paediatric literature, the AHA has been described as ‘setting the criterion standard in quantifying activity limitation’ . The AHA has been applied as a primary outcome measure to evaluate various upper limb interventions like constraint‐induced movement therapy, bimanual therapy, hand surgery, splinting, action–observation training, and injections of botulinum neurotoxin‐A . Furthermore, the AHA has been used for studying longitudinal development of bimanual hand function in children with unilateral CP and for exploring neuroradiological predictors for development of hand function …”

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confidence: 99%

Psychometric properties of a revised version of the Assisting Hand Assessment (Kids‐AHA 5.0)

Holmefur

Krumlinde‐Sundholm

2015

Develop Med Child Neuro

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AHAAssisting Hand Assessment AIM The aim of this study was to scrutinize the Assisting Hand Assessment (AHA) version 4.4for possible improvements and to evaluate the psychometric properties regarding internal scale validity and aspects of reliability of a revised version of the AHA.METHOD In collaboration with experts, scoring criteria were changed for four items, and one fully new item was constructed. Twenty-two original, one new, and four revised items were scored for 164 assessments of children with unilateral cerebral palsy aged 18 months to 12 years. Rasch measurement analysis was used to evaluate internal scale validity by exploring rating-scale functioning, item and person goodness-of-fit, and principal component analysis. Targeting and scale reliability were also evaluated. For people with a congenital unilateral disability, it is natural and functional to use the well-functioning hand for unimanual tasks. However, most tasks in everyday life typically involve the use of both hands together. How efficiently the affected hand can be used as an assist, collaboratively with the preferred hand, is perhaps the most relevant aspect of hand function for people with a unilateral disability. The Assisting Hand Assessment (AHA) measures and describes how effectively children with unilateral disability, in particular children with congenital unilateral cerebral palsy (CP) or obstetric brachial plexus palsy, use their affected hand when performing bimanual tasks. In the AHA, scoring is conducted from observation of the child's spontaneous way of handling play objects that require bimanual hand use, not their best capacity to grasp, release, or manipulate objects when specifically asked to use their affected hand. This makes the AHA a measure of typical performance of the child and places it in the activity and performance domain of the International Classification of Functioning, Disability and Health. [1][2][3] Since its first publication in 2003, the AHA has had a large uptake both for clinical use, with users in 35 countries, and for research. In paediatric literature, the AHA has been described as 'setting the criterion standard in quantifying activity limitation'. 4 The AHA has been applied as a primary outcome measure to evaluate various upper limb interventions like constraint-induced movement therapy, [5][6][7] effectively and which items are not yet performed effectively but are the next in difficulty order. These items are considered to be on a level of difficulty that is a slight challenge but most likely for the child to achieve next, which makes them suitable targets for interventions. The first version of the AHA containing 22 items was developed for children aged 18 months to 6 years; 15 this was revised in 2007 to cover the age range 18 months to 12 years. 16 The AHA scale covering this age range is called the Kids-AHA and consists of the Small Kids-AHA for children 18 months to 6 years and the School Kids-AHA for children 6 to 12 years. Even though the AHA has sound psychometric properties and has...

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Bimanuality is improved by hand surgery in children with brain lesions

Cited by 18 publications

References 47 publications

Effects of upper extremity surgery on activities and participation of children with cerebral palsy: a systematic review

Effects of upper extremity surgery on activities and participation of children with cerebral palsy: a systematic review

Increased use of the affected hand one and a half years after surgical correction for cerebral palsy and subsequent intensive hand therapy

Psychometric properties of a revised version of the Assisting Hand Assessment (Kids‐AHA 5.0)

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