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

Abstract

SIR-Our recent review on the effect of surgery of the spastic hand of children with cerebral palsy (CP) indicated that only studies with a low level of evidence were available, i.e. 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. 2-4 Unfortunately, it remained unclear, whether the putatively better hand function was the result of a better positioning of the hand and fingers and ⁄ or changes in muscle coordination induced by tendon transfer. Therefore, we started a pilot study in order to obtain insight into changes in muscle coordination and quality of reaching movements after surgical muscle transfers of the upper extremity in adolescents with unilateral CP. We hypothesised that surgery would result in more coordinated and more efficient muscle recruitment, i.e. in lower muscle activation rates, a reduction in recruitment of all arm muscles in concert, and in a temporal coordination which more closely resembles that of typically developing adolescents.4-7 In addition we evaluated whether surgery would result in qualitative improvement of motor behaviour during reaching. Three adolescents with unilateral CP who had surgery for their spastic hand to improve grip strategy and functional use of the paretic hand were studied. Hand posture, movement quality, and muscle coordination during a simple reaching task were assessed preoperatively and three times during the first postoperative year.

Activity gains after upper limb surgery for spasticity in patients with spinal cord injury

“…Hand surgery for spasticity aims to change the position of the hand and improve quality of hand movement patterns and motor programmes (van Munster et al., 2009). With a dysfunctional grip, the arm and shoulder have to compensate.…”

Bimanuality is improved by hand surgery in children with brain lesions

“…Previous studies of hand surgery in children with CP have mainly focused on unimanual ability of the operated hand [8,[18][19][20][35][36][37][38]. With the development of the AHA, we now have a suitable test to measure the effectiveness of the plegic hand also during bimanual use.…”