title: Immediate effect of a wrist and thumb brace on bimanual activities in children with hemiplegic cerebral palsy.
abstract: OBJECTIVE
  The aim of this study was to determine the immediate effect of wearing a wrist and thumb brace on the performance of bimanual activities in children with spastic hemiplegic cerebral palsy.
  
  
  METHODS
  In a pre- and post-test cohort study of 25 children (age range 4-11y; mean age 8y 4mo [SD 2y 2mo]; 16 males, 9 females) with spastic hemiplegic cerebral palsy with a Zancolli classification hand score of I, IIA, or IIB (mild and moderate hand dysfunction; children with a Zancolli classification of III - severe hand dysfunction - were excluded from this study), performance of bimanual activities was evaluated with the Assisting Hand Assessment (AHA) on three occasions: one assessment with a static wrist and thumb brace placed on the affected hand and two other assessments without a brace. The differences between AHA scores obtained at the three assessments were evaluated using the repeated measures analysis of variance.
  
  
  RESULTS
  Performance of bimanual activities while wearing the brace improved significantly compared to performance without the brace (p<0.001). With the brace, the mean AHA score increased by 3.2 (95% confidence interval 2.1-4.3) from 59.1 to 62.3. The scores of the two assessments without the brace did not differ significantly.
  
  
  CONCLUSIONS
  In children with spastic hemiplegic cerebral palsy, bracing of the wrist and thumb immediately improves spontaneous use of the affected upper limb in bimanual activities, possibly because bracing permits a more functional hand position.
authors.affiliation: Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. a.m.louwers@amc.uva.nl
authors.forename: Annoek
authors.initials: A
authors.lastname: Louwers
authors.forename: Anke
authors.initials: A
authors.lastname: Meester-Delver
authors.forename: Katinka
authors.initials: K
authors.lastname: Folmer
authors.forename: Frans
authors.initials: F
authors.lastname: Nollet
authors.forename: Anita
authors.initials: A
authors.lastname: Beelen
mesh_terms: D001915:Braces; D002547:Cerebral Palsy / Q000534:rehabilitation*; D002648:Child; D002675:Child, Preschool; D005260:Female; D007839:Functional Laterality / Q000502:physiology*; D006801:Humans; D008297:Male; D026201:Musculoskeletal Manipulations / Q000379:methods*; D009460:Neurologic Examination; D011597:Psychomotor Performance / Q000502:physiology; D013933:Thumb / Q000503:physiopathology*; D016896:Treatment Outcome; D014953:Wrist / Q000503:physiopathology*