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Keywords:Adolescent Child Female Hand deformity Congenital Body functions of the hand and forearm Male Manual activity capacity a b s t r a c t Objectives: To evaluate manual activity capacity (i.e. activity capacity to perform hand activities) and its relation with body functions of the hand and forearm in children with congenital hand differences (CHD) Methods: We assessed 10e14 year-old children with CHD (N ¼ 106) using a functional handgrips test. Measurements of body functions included joint mobility and muscle strength. Patient characteristics were hand dominance and severity. Results: We found a stronger relation between body functions and manual activity capacity in nondominant hands than dominant hands. Dominant hands scored significantly higher on manual activity capacity than nondominant hands that were similarly impaired at body functions level. Severity of the CHD and body functions had only small effects on manual activity capacity. Conclusion: The relation between body functions and manual activity capacity is stronger in nondominant hands than dominant hands, indicating that improvement in body functions lead to larger changes in manual activity capacity in the non-dominant hand. This may suggest that in bilaterallyaffected children surgery should be done at the non-dominant hand first since this hand would benefit most from surgery-induced body functions improvement.

Children with a CHD generally have good bimanual performance and, on average, perform activities with active use of the affected hand. Therapy directed toward increasing manual capacity and finger muscle strength might assist in improving bimanual performance in children with CHD. Furthermore, the number of items on the PUFI could be reduced from 38 to 6 items in children with CHD.

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