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Event-related Potentials During Target-response Tasks to Study Cognitive Processes of Upper Limb Use in Children with Unilateral Cerebral Palsy
Published on: January 11, 2016
Does surgical management of the hand in children with spastic unilateral cerebral palsy affect functional outcome?
Judith C van Munster1, Karel G B Maathuis, Nienke Haga
1Centre for Rehabilitation, University Medical Center Groningen, Groningen, The Netherlands.
Insights
Surgery for spastic hands in children with cerebral palsy improves hand position and may enhance function. Further research is needed to clarify the role of muscle coordination in these functional improvements.
Area of Science:
- Pediatric Orthopedics
- Neurorehabilitation
- Developmental Pediatrics
Background:
- Cerebral palsy (CP) frequently affects hand function due to spasticity.
- Surgical interventions aim to improve hand positioning and function in children with CP.
- The impact of surgery on muscle coordination and functional outcomes requires thorough investigation.
Purpose of the Study:
- To review existing literature on the effects of spastic hand surgery in children with cerebral palsy.
- To evaluate the impact of surgery on functional outcomes and muscle coordination.
- To identify gaps in current research regarding surgical interventions for spastic hands in CP.
Main Methods:
- Comprehensive literature search of Medline, Embase, and Biological Abstracts (1966–2006).
- Inclusion of studies focusing on surgical effects on functional outcome and muscle coordination.
- Analysis of eight studies on functional outcome and three on muscle coordination.
Main Results:
- Surgery positively impacts wrist supination and dorsiflexion at the impairment level.
- Potential improvements in grip strategy, grip repertoire, and spontaneous hand use observed at the functional level.
- Evidence for functional benefits is limited; muscle coordination effects remain unclear with inconclusive results.
Conclusions:
- Surgical intervention effectively improves hand positioning in children with cerebral palsy.
- Indications suggest potential improvements in hand function post-surgery.
- Future research should elucidate the mechanisms of functional improvement, distinguishing between improved hand position and altered muscle coordination.
Abstract:
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?
