Surgery of the spastic hand in cerebral palsy: Report of the Committee on Spastic Hand Evaluation

The Effect of Altered Hand Position and Motor Skills on Stereognosis

“…In the first trial in the hemiplegic hand position, subjects correctly identified a mean of 7.6 objects (range, [5][6][7][8][9][10][11]. No subject correctly identified all 12 objects.…”

“…Poor surgical results are not uncommon, and they have been attributed to incorrect indications and imperfections in surgical techniques and procedures. 5,6 A multi-component approach to preoperative evaluation includes elements such as cognition, type of tone, degree of involvement, and social concerns as markers for surgical intervention to identify appropriate patients, procedures, and expectations and to improve results. Sensory status is also consistently included in the preoperative assessments described in the literature.…”

“…Sensory status is also consistently included in the preoperative assessments described in the literature. [1][2][3][4][5][6][7][8][9][10] Stereognosis is usually considered part of the sensory examination and is an intricate and multi-component evaluation. For this paper, it is considered "the ability to perceive the form of an object by using the sense of touch."…”

“…9 Many assessment protocols use stereognosis as an indicator of the functional potential of the upper extremity, with decreased stereognosis indicating a decreased likelihood of functional gains after surgery. 6,9,14,17,18 Other studies refute the hypothesis that preoperative sensibility influences surgical results. Van Heest et al report that of 134 children treated surgically, 50% had impaired 2-point discrimination and 75% had impaired stereognosis, but there was not an adverse effect on surgical results correlated with impaired sensibility.…”

A microcosting study of the surgical correction of upper extremity deformity in children with spastic cerebral palsy

“…5 Improvement can be realized for children who are selected carefully through complete physical examination, motor and sensory function assessment, and clinical evaluation of impairment of daily life activities. 6 By international convention, this selection is done by a multidisciplinary team consisting of at least a hand surgeon, occupational therapist, and rehabilitation specialist. This multidisciplinary team tailors each surgery to a patient's individual problems and needs.…”