title: Formation of social and household skills in children with hand defects.
abstract: OBJECTIVE
  The aim of this study was to consider the peculiarities of forming social and household skills, and the criteria for their evaluation, as well as an assessment of functional capacity, in children with hand defects both before and after surgical treatment and rehabilitation courses using a system of games.
  
  
  METHODS
  We elaborated and implemented a program of social rehabilitation of preschool children with congenital and acquired hand defects for the development of their functional capabilities and the formation of social and household skills after surgical treatment and prosthetics using play therapy methods. As part of this work, 140 preschool children aged 3-7 years underwent social rehabilitation. Most of the children had congenital hand defects-122 children (87 %): 96 children (79 %) with ectrodactylia, adactylia, hypoplasia, aplasia, hand splitting, club hand, or partial gigantism; 26 children (21 %) with congenital syndactylism and constricted bonds and 18 children (13 %) with acquired defects (burn deformity, amputation). 110 children (79 %) had reached the stage of surgical correction; 30 children (21 %) reached the stage of prosthetics. Most of the children participating in the experiment (78 children, 56 %) had defects of fingers on one hand. The program aimed at solving specific rehabilitation tasks: formation and improvement of all possible types of grip under the existing defect including those after surgery and prosthetics; development of tactile sensations in fingers; development of fine motor skills; increase in range of motion in all joints of the damaged hand; development of attention and concentration; formation of social and household skills appropriate to age; and development of the ability to achieve the set task.
  
  
  RESULTS
  Analysis of the level of social and household skills of children with hand defects undergoing rehabilitation treatment at the hospital depending on the age prior to medical and social rehabilitation showed that preschool children with hand defects in the age category of 3 years demonstrated the highest results in the level of social and household skills (31 %) as compared with children in other age categories. The indicators for children aged 4 and 5 years were slightly lower, 25 and 26 %, respectively. The lowest values were recorded among children aged 6: 20 %.
  
  
  CONCLUSIONS
  Statistically significant parameters of the level of functional capacity of hand grip and social and household skills in children with hand defects obtained in the course of the investigation indicated that the use of play therapy measures significantly increased the effect of medical treatment irrespective of the type of defect. These data indicate that play therapy measures given immediately after surgery or prosthetics can significantly increase the efficiency of rehabilitation even in its early stages.
authors.affiliation: St. Petersburg Orthopaedic Center of Expertise, Prosthetics and Rehabilitation of Disabled, Bestuzaevskay Str, 50, St. Petersburg, 195067, Russia, nat-klimon@yandex.ru.
authors.forename: Nataly
authors.initials: N
authors.lastname: Klimon
authors.forename: Alexander
authors.initials: A
authors.lastname: Koryukov
authors.forename: Nina
authors.initials: N
authors.lastname: Loseva
authors.forename: Elena
authors.initials: E
authors.lastname: Starobina