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

Abstract

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?Cerebral palsy (CP) describes a group of disorders of the development of movement and posture, causing activity limitation that is attributed to non-progressive disturbances which occurred in the developing fetal or infant brain. The motor disorders of CP are often accompanied by disturbances of sensation, cognition, communication, perception, and/or behaviour, and/or by a seizure disorder. 1 Impaired arm and hand function are major problems of children with CP, which contribute to disability in daily functioning. Pathophysiological mechanisms which play a role in these problems are paresis of specific muscles and spasticity and/or reduced muscle length associated with spasticity and disuse. Imbalance between agonistic and antagonistic muscles influences the position of the arm and hand. Secondary contractures and joint deformities often result in adduction and inward rotation of the upper arm, flexion of the elbow, pronation of the forearm, flexion of wrist and fingers, and thumb-in-palm deformity. These impairments contribute to the difficulties experienced in reaching, pointing, grasping, releasing, and manipulating objects. The abnormal hand posture influences the ability for refined grasping of objects of different orientation or shape. 2 One of the treatment options in children with CP is surgery. Surgical treatment, which may include release of spastic muscles and tendon transfers, focuses on improving muscle

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

“…Previous reviews have demonstrated positive effects of UES in children and adolescents with CP on upper limb function (i.e. dexterity, range of motion at the wrist and forearm, and grip strength) . Our review evaluated the effect on patients' functional and perceived performance measured with validated activity‐based outcome measurements rated by clinicians or patients/caregivers.…”

“…dexterity, range of motion at the wrist and forearm, and grip strength). [38][39][40] Our review evaluated the effect on patients' functional and perceived performance measured with validated activity-based outcome measurements rated by clinicians or patients/caregivers. Patients' functional performances were measured in five studies [14][15][16][17]19 on quantifiable tasks with the SHUEE, AHA, JHFT, or BBT and in seven studies 17,18,[21][22][23][24][25] by a classification.…”

Evaluation of hand function in patients with unilateral cerebral palsy who underwent multilevel functional surgery: a retrospective observational study

“…In a recent review, Van Muster indicates that many of them consist of case series providing a low level of evidence. These studies suggest a positive effect on hand position, manipulation strategy, grip repertoire and spontaneous use, but it remains unclear whether surgery influences daily activity (9).…”

‘Does surgical management of the hand in children with unilateral spastic cerebral palsy affect muscle coordination and quality of reaching?’

“…series of cases. 1 The existing information indicated that surgery seems to have a positive effect on supination and dorsiflexion of the wrist, may improve grip strategy, and may induce an increase of the repertoire of grips and spontaneous use of the hand. The effect of surgery of the spastic hand on muscle coordination had only been addressed by three studies in a relatively systematic way.…”

“…Such plans are widely recommended in the United Kingdom and United States for children with chronic conditions. [1][2][3] Wolff and colleagues looked at the process of developing and content of personal resuscitation plans for children with life-limiting conditions concluding these to be acceptable for families. 4 There have been cases, leading to High Court action, where Accident and Emergency department staff have disregarded the verbal wishes of parents to initiate or not to initiate resuscitation for disabled children presenting with an acute deterioration in their condition.…”