Does surgical management of the hand in children with spastic unilateral cerebral palsy affect functional outcome?
The aim of this review was to examine the literature on the effects of surgery of the spastic hand in children with cerebral palsy on functional outcome and muscle coordination. We performed a search of the relevant literature in Medline, Embase, and Biological Abstracts from 1966 to June 2006. The search resulted in eight studies on the effect of surgery on functional outcome and three studies on the effect of surgery on muscle coordination. Heterogeneity in outcome measures precluded meta-analysis. The studies revealed that -- at the level of impairment -- surgery has a positive effect on supination and dorsiflexion of the wrist. At the level of function, surgery might improve grip strategy and induce an increase of the repertoire of grips and spontaneous use of the hand. The evidence for the functional effects is, however, limited. Whether the possibly improved function is mediated by alterations in muscle coordination patterns remains unclear. The muscle coordination studies provided inconclusive results. We concluded that surgery improves the position of the hand and there are indications that it might improve hand function. Future research should address the question: does surgery improve hand function and, if so, is this due solely to a better hand position or does change in muscle coordination play an additional role?
van Munster
Judith C
JC
Centre for Rehabilitation, University Medical Center Groningen, Groningen, The Netherlands.
Maathuis
Karel G B
KG
Haga
Nienke
N
Verheij
Nienke P
NP
Nicolai
Jean-Philippe A
JP
Hadders-Algra
Mijna
M
D000293:Adolescent; D000328:Adult; D002547:Cerebral Palsy / Q000503:physiopathology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D007839:Functional Laterality / Q000502:physiology*; D006225:Hand / Q000601:surgery*; D018737:Hand Strength / Q000502:physiology; D006801:Humans; D007223:Infant; D009048:Motor Skills / Q000502:physiology; D009128:Muscle Spasticity / Q000503:physiopathology / Q000601:surgery; D011596:Psychomotor Disorders / Q000503:physiopathology / Q000601:surgery; D016896:Treatment Outcome