Hand Functioning in Children with Cerebral Palsy

Abstract

Brain lesions may disturb hand functioning in children with cerebral palsy (CP), making it difficult or even impossible for them to perform several manual activities. Most conventional treatments for hand dysfunction in CP assume that reducing the hand dysfunctions will improve the capacity to manage activities (i.e., manual ability, MA). The aim of this study was to investigate the directional relationships (direct and indirect pathways) through which hand skills influence MA in children with CP. A total of 136 children with CP (mean age: 10 years; range: 6–16 years; 35 quadriplegics, 24 diplegics, 77 hemiplegics) were assessed. Six hand skills were measured on both hands: touch-pressure detection (Semmes–Weinstein esthesiometer), stereognosis (Manual Form Perception Test), proprioception (passive mobilization of the metacarpophalangeal joints), grip strength (GS) (Jamar dynamometer), gross manual dexterity (GMD) (Box and Block Test), and fine finger dexterity (Purdue Pegboard Test). MA was measured with the ABILHAND-Kids questionnaire. Correlation coefficients were used to determine the linear associations between observed variables. A path analysis of structural equation modeling was applied to test different models of causal relationships among the observed variables. Purely sensory impairments did seem not to play a significant role in the capacity to perform manual activities. According to path analysis, GMD in both hands and stereognosis in the dominant hand were directly related to MA, whereas GS was indirectly related to MA through its relationship with GMD. However, one-third of the variance in MA measures could not be explained by hand skills. It can be concluded that MA is not simply the integration of hand skills in daily activities and should be treated per se, supporting activity-based interventions.

Translation, cross-cultural adaptation and validation of the ABILHAND-Kids for the Brazilian Portuguese

“…However, no significant association was observed with the results obtained with nondominant hand (r=0.33, p=0.139). These findings partially corroborate with the results reported in the original version, which showed significant association with dominant (r=0.69, p<0.001) and non-dominant hand evaluation (r=0.71, p<0.001) 28 . This difference between original and Brazilian versions might be due to the difference of volunteers' topography.…”

“…In the original version, 25% of patients were quadriplegic, 17% diplegic and 56% hemiplegic. We observed a significant relationship between the Brazilian version of ABILHAND-Kids and PPT dominant hand (r=0.58, p=0.005) and nondominant hand scores (r=0.59, p=0.005) 28 . These findings corroborate results reported in the original version, which showed significant correlations with dominant (r=0.68, p<0.001) and with non-dominant hands (r=0.57, p=<0.001).…”

“…Children with CP were instructed to insert one pin at a time in a board as quickly as possible in a fixed time. The number of inserted pins is the final score 27,28 . For the assembly test, CP children were asked to put together pins, washers and collars with both hands and the number of parts assembled was scored.…”

“…For the assembly test, CP children were asked to put together pins, washers and collars with both hands and the number of parts assembled was scored. The test compiles five separate scores from test procedures, including dominant hand (30 s), non-dominant hand (30 s), both hands (30 s), and assembly (60 s) 27,28 . Grip strength is a hand function evaluation and an indicator of general health.…”

Effects of Modified Constrained Induced Movement Therapy to Improve the Upper Limb Functional Activities and Gross Manual Dexterity on Hemiparetic Cerebral Palsy Children

“…The practice may be formal and structured involving behavioral shaping strategies or be less formal. Modified CIMT is vary in the frequency, duration, and type of constraint in treatment regimen [6][7][8][9][10].…”