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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.
Insights
This study introduces a novel 3D-printed dynamic upper extremity orthosis (DUEO) for children with cerebral palsy (CP). The custom DUEO, combined with therapy, shows promising results in improving upper extremity function for children with severe hand impairment.
Area of Science:
- Biomedical Engineering
- Rehabilitation Medicine
- Pediatric Orthopedics
Background:
- Children with cerebral palsy (CP) and severe hand impairment have limited upper extremity (UE) orthotic options.
- Existing orthoses may not adequately address the complex needs of individuals with higher Manual Ability Classification System (MACS) levels.
Purpose of the Study:
- To design and fabricate a customized, low-cost, functional, 3D-printed dynamic upper extremity orthosis (DUEO).
- To evaluate the effect of this DUEO on UE function in children with unilateral UE CP (MACS Levels III-V) through a comprehensive assessment.
Main Methods:
- A pilot study involving five participants (ages 13-17) with CP and unilateral UE involvement (MACS Levels III-V).
- Custom DUEOs were fabricated and used during eight occupational therapy sessions focused on bimanual UE training.
- Pre- and post-treatment assessments included the Assisting Hand Assessment (AHA), Melbourne Assessment 2 (MA-2), Pediatric Motor Activity Log-Revised (PMAL-R), and Pediatric Quality of Life Inventory: CP Module (PedsQL:CP).
Main Results:
- All participants showed improved scores on at least one outcome measure post-treatment.
- Four participants achieved minimal clinically important differences (MCID) on the AHA.
- Improvements were observed in MA-2 subtests, PMAL-R, and PedsQL:CP domains for multiple participants.
Conclusions:
- A novel, customized 3D-printed dynamic orthosis, when used with occupational therapy, shows promise for enhancing UE function in children with severe hand impairment and lower MACS levels.
- This intervention facilitates gains in UE function, offering a new therapeutic avenue for this population.
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.
