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Published on: April 14, 2023
Design and Use of a 3D-Printed Dynamic Upper Extremity Orthosis for Children With Cerebral Palsy and Severe Upper
Lori B Ragni1, Stacy Kirsch Dlugacz2, Cali Sadowsky3
1Lori B. Ragni, MS, OTR/L, BCP, is Supervisor, Pediatric Occupational Therapy, Rusk Rehabilitation, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY.
Importance:
Children with cerebral palsy (CP) and severe hand impairment have limited options for upper extremity (UE) orthoses.
Objective:
To (1) design and fabricate a customized low-cost, functional, three-dimensional (3D) printed dynamic upper extremity orthosis (DUEO) and (2) examine, using a comprehensive evaluation, the effect of the orthosis on the UE function of children with unilateral UE CP, Manual Ability Classification System (MACS) Levels III to V.
Design:
Pilot study. Assessments were performed pretreatment and immediately posttreatment.
Setting:
Hospital-based outpatient occupational therapy department.
Participants:
Five patients, ages 13 to 17 yr, with CP and unilateral UE involvement MACS Levels III to V.
Intervention:
Custom forearm thumb opponens orthosis and the DUEO were designed and fabricated by a multidisciplinary team for use during eight 1-hr occupational therapy sessions targeting bimanual UE training.
Outcomes And Measures:
Pretreatment and posttreatment assessments included the Assisting Hand Assessment (AHA), Melbourne Assessment 2 (MA-2), Pediatric Motor Activity Log-Revised (PMAL-R), and the Pediatric Quality of Life Inventory: CP Module (PedsQL:CP).
Results:
All participants had higher posttreatment scores on at least one measure. Four had minimal clinically important differences (MCID) on the AHA. Three met MCID criteria on MA-2 subtests (one negative change). Four demonstrated improvement on the PMAL-R (one participant achieved an MCID score), and three reported improvements in more than one PedsQL:CP domain.
Conclusions And Relevance:
This novel 3D-printed device, in combination with occupational therapy, shows promising evidence that children who score in lower MACS levels can show gains in UE function. What This Article Adds: This study demonstrates that a customized, 3D-printed dynamic orthosis, in combination with occupational therapy intervention, can facilitate UE function in children with severe hand impairment.
