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Hand function in children with radial longitudinal deficiency
Anna Gerber Ekblom1, Lars B Dahlin, Hans-Eric Rosberg
1Karolinska Institutet, Department of Clinical Science and Education, Södersjukhuset, Section of Hand Surgery, Stockholm, Sweden. anna.gerber.ekblom@ki.se
Insights
In children with radial longitudinal deficiency, wrist and digit range of motion significantly impacts activity and participation. Forearm angulation is less critical than joint mobility for daily function.
Area of Science:
- Pediatric Orthopedics
- Rehabilitation Medicine
- Developmental Pediatrics
Background:
- Children with radial longitudinal deficiency face challenges in manual activities due to forearm and wrist deformities, and impaired hand function.
- Factors contributing to activity limitations include short/bowed forearm, radial wrist deviation, absent/non-functional thumb, limited finger motion, and reduced grip strength.
Purpose of the Study:
- To investigate the relationship between body structure/function and activity/participation in children with radial dysplasia.
- To evaluate how specific physical impairments correlate with functional outcomes in pediatric radial longitudinal deficiency.
Main Methods:
- Twenty children (ages 4-17) with Bayne type II-IV radial longitudinal dysplasia were assessed.
- Evaluated body structure/function (range of motion, grip strength, radiographs) and activity (Box and Block Test, Assisting Hand Assessment [AHA]).
- Assessed participation using the Children's Hand-use Experience Questionnaire (CHEQ) and analyzed correlations.
Main Results:
- Children exhibited reduced wrist (49.6°) and digit (447°) range of motion, and lower grip strength (2.7 kg) compared to norms.
- Mean scores for AHA (55.9) and CHEQ Grasp efficiency (69.3) indicated functional limitations.
- Total digit range of motion correlated with AHA (p=0.042), and total wrist motion correlated with CHEQ Time (p=0.043).
Conclusions:
- Total range of motion in digits and wrist is more crucial for a child's activity and participation than wrist angulation in radial longitudinal deficiency.
- Interventions focusing on improving joint mobility may enhance functional outcomes in these children.
Background:
In children with hypoplasia or aplasia of the radius (radial longitudinal deficiency) manual activity limitations may be caused by several factors; a short and bowed forearm, radial deviation of the wrist, a non-functional or absent thumb, limited range of motion in the fingers and impaired grip strength. The present study investigates the relation between these variables and activity and participation in children with radial dysplasia.
Methods:
Twenty children, age 4-17 years, with radial longitudinal dysplasia Bayne type II-IV were examined with focus on the International Classification of Functioning and Health, version for Children and Youth (ICF-CY) context. Body function/structure was evaluated by measures of range of motion, grip strength, sensibility and radiographic parameters. Activity was examined by Box and Block Test and Assisting Hand Assessment (AHA). Participation was assessed by Children's Hand-use Experience Questionnaire (CHEQ). Statistical correlations between assessments of body function/structure and activity as well as participation were examined.
Results:
The mean total active motion of wrist (49.6°) and digits (447°) were less than norms. The mean hand forearm angle was 34° radially. Ulnar length ranged from 40 to 80% of age-related norms. Grip strength (mean 2.7 kg) and Box and Block Test (mean 33.8 blocks/minute) were considerably lower than for age-related norms. The mean score for the AHA was 55.9 and for CHEQ Grasp efficiency 69.3. The AHA had significant relationship with the total range of motion of digits (p = 0.042). Self-experienced time of performance (CHEQ Time) had significant relationship with total active motion of wrist (p = 0.043). Hand forearm angle did not show any significant relationship with Box and Block Test, AHA or CHEQ.
Conclusion:
In radial longitudinal deficiency total range of motion of digits and wrist may be of more cardinal importance to the child's activity and participation than the angulation of the wrist.
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