BACKGROUND: Children with cerebral palsy may have poor hand function due to muscle weakness and dystonia. Hand and thumb orthoses could be used to prevent contracture and deformity but also to improve hand function. Plastic wrist hand orthosis (WHO) is the most commonly used, but it aims to prevent joint contracture rather than functional effects. This study was conducted to determine if a thumb brace made of neoprene, a type of synthetic fiber that is widely used, can help improve hand function in children with cerebral palsy.
METHODS: Children with limited upper limb and hand function due to cerebral palsy were recruited. Children younger than five years old and those who could not cooperate with functional evaluations because of intellectual disability were excluded. Participants’ clinical information was collected, including age, sex, and diagnosis. We measured Manual Motor test (MMT), spasticity, Manual Ability Classification System (MACS), House's functional classification system, and Zancolli's classification of wrist and finger deformity. Grip strength and hand functions were assessed without the orthoses, after wearing the thumb splint (McKie® Thumb Splint, a type of neoprene thumb opposition splint), and after wearing thumb splint with supinator strap, with randomized order of evaluation. Hand function was assessed using Box and block test, Functional dexterity test, and Jebsen Hand Function Test. The mean, median, standard deviation(SD), and 95% confidence interval (CI) were obtained. To figure out the change with the orthoses, data were calculated with ratio of intervention (the thumb orthosis and thumb orthosis with supinator strap) and baseline. P-values of the ratio were derived by performing Wilcoxon signed-rank test at the 0.05 significance level.
RESULTS: In total, six participants were enrolled. Their MACS levels were 5, 2, 3, 2, 2, and 5, House’s classification were 1, 4, 4, 4, 4 and 2, and Zancolli’s deformity were 3, 2a, 2a, 2a, 2a, and 3, respectively. Table 1 shows descriptive statistics and P-values of hand function tests and grip and pinch strength tests. No statistical significance was noted between baseline and thumb orthosis and between baseline and thumb orthosis with supinator strap. Figures 1 and 2 show the tendency of improvement or not, which is calculated with ratio (thumb orthosis/baseline, thumb orthosis with supinator strap/baseline).
CONCLUSION: Previous studies have shown that using a brace to assist thumb opposition improves hand function. However, our study could not convince the hand function improvement in children with cerebral palsy with neoprene thumb orthosis. Some of the function improved, but further study is needed with a larger number of participants to figure out the effectiveness. |
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Table 1. Descriptive statistics and P-values; (A) Raw data of evaluations (B) P values of ratio of intervention (the thumb orthosis and thumb orthosis with supinator strap) and baseline using median value at the 0.05 significance level.
Figure 1. (A) Thumb orthosis/baseline ratio, (B) Thumb orthosis with supinator strap/baseline ratio of hand function test; Displayed in yellow for improvement based on 1.0, and blue otherwise
Figure 2. (A) Thumb orthosis/baseline ratio, (B) Thumb orthosis with supinator strap/baseline ratio of grip and pinch strength test ; Displayed in yellow for improvement based on 1.0, and blue otherwise
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