Pre- and postsurgical evaluation of hand function in hemiplegic cerebral palsy: exemplar cases

Evaluation of hand function for treatment planning and outcome documentation in individuals with cerebral palsy (CP) proves challenging. Because of the complexity of multisystem involvement and time constraints during physician clinic visits, we developed a comprehensive evaluation protocol to assist with team surgical decision making in CP. We report findings from three adolescents with hemiplegic CP who were evaluated pre-/post-intervention using measures of impairment (clinical examination procedures), activity (Pediatric Evaluation of Disability Inventory and Jebsen-Taylor Test of Hand Function), and participation (goal attainment scaling). An intervention to improve hand function consisted of single-event multilevel orthopedic surgery and postsurgical therapy. Wrist/finger biomechanics and active range of motion improved after the intervention. The targeted surgical intervention and undefined therapy intervention, however, seemed to have little influence on activity and participation. The descriptive results of these exemplar cases suggest that, instead of assisting only with surgical decision making, the evaluation protocol should focus on specific postsurgical therapy plans in addition to surgical/therapy decision making.