International Journal of Community Medicine and Public Health

Kumari R et al. Int J Community Med Public Health. 2021 May;8(5):2614-2618

http://www.ijcmph.com

pISSN 2394-6032 | eISSN 2394-6040

Review Article

DOI: https://dx.doi.org/10.18203/2394-6040.ijcmph20211799

Effectiveness of hand splints on upper limb skills and functional activities in children with cerebral palsy: a review

Rohina Kumari1*, Surbhi2, Sakshi Saharawat2

1Department of Prosthetics and Orthotics, Ishwar Institute of Prosthetics and Orthotics, The TN Dr. MGR Medical University, Chennai, Tamil Nadu, India

2Department of Prosthetics and Orthotics, ISIC Institute of Rehabilitation Sciences, Guru Gobind Singh Indraprastha University, New Delhi, India

Received: 21 February 2021

Revised: 01 April 2021

Accepted: 02 April 2021

*Correspondence:

Rohina Kumari,

E-mail: rohinayadav02@gmail.com

Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Cerebral Palsy is a non-progressive neurological disorder in which children may experience similar physical limitations, including those related to upper limb skills that affect the child's ability to participate in age-specific activities. The use of hand-splints in children with neurological conditions is little reported, they continue to be widely used to improve upper limb skills and functional activities. This review was done to investigate the use and effects of hand splints in Cerebral Palsy patient as orthotic treatment found to be very positive result in correcting and maintaining the achieved results. Electronic database search was conducted using Google scholar, Science direct, Pub Med, Cochrane Library and reference lists from all retrieved articles. Common problems in upper limb due to CP are flexion contractures of the fingers and wrist due to spasticity, pronation deformity of the forearm, thumb-in-palm deformity and hand-related disabilities, all lead to decrease in grip and muscle strength. Hand splints are often used to help a weak or ineffective joint or muscle to enhance a person's arm or hand posture, mobility, quality of motion, and function. The findings suggest that children with CP experience increased grip strength and fine motor dexterity when using different hand splints. This review summarizes the present state of understanding the extent to which orthotic management in CP can improve in the patient’s skills and functional activities by improving the muscle strength and hand function, also offers clinical suggestions for prescribing orthosis in order to optimize efficacy.

Keywords: Cerebral palsy, Upper extremity, Spasticity, Hand splints, Hand function

INTRODUCTION

Cerebral Palsy is a neurological disorder caused by non-progressive lesions at single or multiple locations in the immature brain in the uterus during or shortly after birth and characterized by movement and posture disorders that result from brain development disorders leading to primary and secondary sensory, neuromuscular and musculo-skeletal system impairments. The prevalence is not well known, but figures in the developed world are 1.5-5.6 cases per 1000 live births and the incidence is higher in males than in females (ratio of 1.33:1). Although some therapeutic approaches have underestimated the significance of characteristics such as strength and intrinsic muscle properties for motor function in individuals with CP, evidence suggests that these characteristics play an important role in the movement patterns observed in these children.1-4

Grip, pinch and manual dexterity are the key functions of the hand that assist the everyday activities. If children are unable to acquire these functions due to neuromuscular conditions such as cerebral palsy (CP), they report diminished success in tasks such as school assignments, self-care, and play with peers. Muscle impairments due to the prevalence of spasticity in this children's population also lead to limitations in the range of motion, timing accuracy, development of force and skills of hand manipulation.5

Table 1: Different types of splints used in upper extremity.
Table reproduced from source PDF page 2
Table 2: Impact of splints in upper extremity.
Table reproduced from source PDF page 2, part 1 of 2
Table reproduced from source PDF page 3, part 2 of 2

Up to 60 percent of this population experiences significant hand capacity related difficulties and for this reason it is critical to be successful and evidence-based in therapeutic approaches. While little empirical evidence supports the use of hand splints in children with neurological disorders, they are often commonly used in an attempt to enhance upper limb skills and functional activities.6-11

Hand splints are often used to help a weak or ineffective joint or muscle to enhance a person's arm or hand posture, mobility, quality of motion, and function. Within the definition of the ICF (International Classification of Functioning , Disability and Health), hand splints can be defined as an external factor (such as physical support) that influences the overall relationship of ICF domains that can influence the function and structure of a child's body, as well as activity and participation.12,13,5

DISCUSSION

According to ISPO (2008), both static and dynamic approaches to splinting across the wrist have been shown to support functional dexterity. In comparison, the dynamic splinting strategy, with respect to grip strength, tended to encourage a stronger grip than either the static splint or no splint treatment.32

Many widely used neuro rehabilitation splints are applied with the goal of inhibiting spasticity with an end result of improving performance. It obviously relies on the assumption that is a splint that inhibit spasticity and that spasticity inhibition contributes to increased activity. Spasticity was thought to increase due to the tactile stimulation of the palm surface of the hand, resulting in unwanted muscle contractions. Many therapists, based on these assumptions, recommend splinting only on the dorsal surface of the hand. Along with concerns that splinting the flexor surface of the hand would "cause" spasticity, some clinicians also assume that certain positions "break" spasticity patterns. Most therapists believe that the hand must be held neutrally with the wrist and the finger separated and extended to prevent spasticity. While splinting will minimize hyper-reflex stimulation by immobilizing the joint, this does not mean that spasticity will be reduced in the long term when the splint is removed.21

The splint gave the child the opportunity to learn how to functionally and independently use the grasp, release, and opposition, without anyone holding the wrist position for him.29

The findings suggest that children with hemiplegic CP may experience increased grip strength and fine motor dexterity when using dynamic splints. Static splints had reduced muscle activity in the forearm muscles during grip and at the completion of grip and dexterity tasks recruited more shoulder muscles than children control. Therefore, repeated use of static wrist splints can lead to muscle atrophy in the forearm muscles and increased activation of the shoulder muscles during tasks can result in fatigue and increased stress of the proximal shoulder muscles.5

The cutaneous input and finger adduction resistance provided by a finger spreader may generate a similar patterned response and can explain the reduced spasticity that is assumed to occur with the use of this splint. The reflex inhibiting pattern was integrated into a dorsal frame, volar finger pan design that emphasized wrist extension and extension of interphalangeal joints as well as abduction of fingers and extension of thumbs. Immediately after application a decrease in flexor tone was consistently noted. Further research confirmed results of a reduction in hypertonicity.16

CONCLUSION

The study indicates that the splinting of an upper limb is a unique task. Nonetheless, it's hard to imagine a child adjusting splints according to their activities. Considering the factors affecting compliance and overall treatment in CP Patient, splints should be designed with comfortable structure and suitable appearance. Starting splint regimen within earlier ages and considering the child habits and preferences along with the treatment plan and prescribed regimen for the orthosis can revolutionize the overall outcome. The ultimate effect of treatment may then be enhanced (in both physical and psychological aspects). Although further investigation in this field is required, it would seem that decisions about bracing of the wrist and hand should be taken on a case-by-case basis, meeting each patient's needs. Treatment with hand splints has insignificant adverse effects, and this common chronic disease will reduce morbidity. Conservative treatment of cerebral palsy has a beneficial effect on the upper limb skills and functional activities of the people affected.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: Not required

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