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Implications of providing wrist-hand orthoses for children with cerebral palsy: evidence from a randomised controlled
Christine Imms1, Margaret Wallen2, Catherine Elliott3,4,5
1Department of Paediatrics, The University of Melbourne, and Murdoch Children's Research Institute, Parkville, Australia.
Insights
Rigid wrist-hand orthoses may offer incremental benefits for passive wrist range in children with cerebral palsy within the first year. However, recruitment challenges limited long-term findings and highlighted the need for careful consideration of adverse events.
Area of Science:
- Rehabilitation medicine
- Pediatric orthopedics
- Neurology
Background:
- Cerebral palsy (CP) frequently causes hand impairments, affecting motor function.
- Wrist and hand deformities are common in children with CP, necessitating effective interventions.
- Multidisciplinary care is standard for managing CP, but specific orthotic interventions require further investigation.
Purpose of the Study:
- To evaluate the efficacy of rigid wrist-hand orthoses, in addition to usual care, for reducing hand impairments in children with cerebral palsy.
- To assess the impact of a specific rigid wrist-hand orthosis protocol on passive wrist range of motion.
Main Methods:
- A pragmatic, multicenter, assessor-blinded randomized controlled trial was conducted.
- The study aimed to enroll 194 children aged 5-15 years with specific wrist flexor spasticity.
- Participants were randomized to receive a rigid wrist-hand orthosis worn nightly or to the control group, with analysis using intention-to-treat principles.
Main Results:
- The trial was stopped early due to insufficient recruitment, with 74 children randomized.
- Evidence suggested a positive impact of the rigid wrist-hand orthosis on passive wrist extension at 6 and 12 months.
- Insufficient participant numbers beyond 18 months precluded conclusive long-term findings.
Conclusions:
- Rigid wrist-hand orthoses may provide short-term (6-12 months) improvements in passive wrist range for children with CP.
- The study identified challenges in recruiting for large randomized controlled trials in this population.
- Longitudinal monitoring and discussion of potential adverse events are crucial when prescribing these orthoses.
Purpose:
To investigate the effects of providing rigid wrist-hand orthoses plus usual multidisciplinary care, on reducing hand impairments in children with cerebral palsy.
Methods:
A pragmatic, multicentre, assessor-blinded randomised controlled trial aimed to enrol 194 children aged 5-15 years, with wrist flexor Modified Ashworth Scale score ≥1. Randomisation with concealed allocation was stratified by study site and passive wrist range. The treatment group received a rigid wrist-hand orthosis, to wear ≥6 h per night for 3 years. Analysis included repeated measures mixed-effects linear regression models, using intention-to-treat principles.
Results:
The trial stopped early due to insufficient recruitment: 74 children, across all Manual Ability Classification System levels, were randomised (n = 38 orthosis group; n = 36 control). Mean age was 10.2 (SD 3.1) years (orthosis group) and 9.1 (SD 2.8) years (control). Data showed some evidence that rigid wrist-hand orthosis impacted passive wrist extension with fingers extended in the first year [mean difference between-groups at 6 months: 13.15° (95%CI: 0.81-25.48°, p = 0.04); 12 months: 20.94° (95%CI: 8.20-33.69°, p = 0.001)]. Beyond 18 months, participant numbers were insufficient for conclusive findings.
Conclusion:
The study provided detailed data about short- and long-term effects of the wrist-hand orthosis and highlighted challenges in conducting large randomised controlled trials with this population. Trial Registration: Australia and New Zealand Clinical Trials Registry: U1111-1164-0572 IMPLICATIONS FOR REHABILITATIONThere may be incremental benefit, for children with cerebral palsy, at 6 and 12 months on passive wrist range from wearing a rigid wrist-hand orthosis designed according to this protocol.The rigid-wrist-hand orthosis evaluated in this study, which allowed for some tailoring for individual children's presentations, differed in design from past recommendations for "resting hand" positioning.Longitudinal follow up of children with cerebral palsy prescribed a rigid wrist-hand orthosis is essential to monitor any benefit.Minor adverse events were commonly experienced when wearing the orthosis and should be discussed prior to prescription of a rigid wrist-hand orthosis.
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