Comparative Effects of Three Hand Splints on Bilateral Hand Use, Grasp, and Arm-Hand Posture in Hemiplegic Children: A Pilot Study

Abstract

Enhancement of hand function in cerebral palsied children is a priority of occupational therapists working with this population. While splinting is used as an adjunct to active treatment with many other patient groups, it is not as consistently used with these children. This pilot study was designed to investigate the effects of hand splinting on bilateral hand use, grasp skill, and arm-hand posture in hemiplegic cerebral palsied children, using three different splints: the orthokinetic cuff, the short opponens thumb splint, and the MacKinnon splint. Each was selected based on its reported utility in reducing spasticity and thereby enhancing function. A counterbalanced experimental design was used with the 12 subjects wearing all three splints in a randomly assigned order. Splints were worn 8 hours per day for 6 weeks, with a 2-week interval between splints. Measures were developed for documentation of the three dependent variables. Analysis of the data revealed no significant relationship between splint type and change in the dependent variables. However, when scores for clusters of subjects were analyzed significant differences in response to the splints were identified Improvement in bilateral hand use was associated with the orthokinetic cuff and the MacKinnon splint; grasp skill improved most significantly with the MacKinnon splint. Arm-hand posture did not seem to be affected by splint wear. The study was limited by a lack of standardized measures of bilateral hand use and grasp skill for children, suggesting a need for development of such measures In addition, further investigation of the effectiveness of the MacKinnon splint on improving functional skills with cerebral palsied children is indicated.

Development of the Assisting Hand Assessment: A Rasch-built Measure intended for Children with Unilateral Upper Limb Impairments

“…The need for the development of standardized measures of bilateral hand use for children with hemiplegia has long been recognized [15]. In children with unilateral arm/hand dysfunction who experience difficulties with occupational performance, the most important issue concerning the actual hand function may well be how effectively the child uses the affected hand in situations when bimanual use is preferable or required.…”

Hand Splints and Cerebral Spasticity: A Review of the Literature

“…The MacKinnon splint incorporates the placement of dowelling across only the metacarpal heads, rather than the entire flexor surface of the fingers, and maintains the wrist in extension (Exner, & Bonder, 1983;MacKinnon, Sanderson, & Buchanan, 1975). MacKinnon and her colleagues stated that this splint provided pressure on the volar aspect of the metacarpal heads and activated the intrinsic muscles, thereby reducing the tone in the finger flexors and the adductor pollicis.…”

Occupational therapy for children with cerebral palsy: a systematic review

“…The RCT 61 reported no signi cant differences in the motor skills outcome measure between the three types of splints evaluated (Table 3). Three ODs [65][66][67] ( Table 2) evaluated the use of Lycra garments.…”

“…One high-quality crossover RCT 61 and three low-quality ODs 62-64 evaluated the ef cacy of (arm-) hand splints ( Table 2). The RCT 61 reported no signi cant differences in the motor skills outcome measure between the three types of splints evaluated (Table 3).…”