Advice for Patients with Contractures

In patients with contractures, the practitioners at ABILITY have found upper extremity orthoses assist in maintaining skin hygiene, especially with pediatric patients. The orthoses can also decrease the potential for skin infection.

Here is an article ABILITY thought would be more informative on this issue.

Are We Giving Kids a Hand? Wrist and Hand Splints in the Management of Cerebral Palsy

By Phil Stevens, MEd, CPO, FAAOP
Content provided by The O&P EDGE

In 2008, the International Society for Prosthetics and Orthotics (ISPO) convened a consensus conference in Oxford, England, called Recent Developments in Healthcare for Cerebral Palsy: Implications and Opportunities for Orthotics. I participated in the event by conducting a systematic literature review on the orthotic management of the hips, trunk, spine, and upper limbs.1 Unfortunately, there was not much research about wrist and hand splints to review. There was a small series of early case studies and anecdotal reports published in the 1980s and early 1990s; however, from 1994 to 2008, the time frame that I had been assigned to examine, there was only a single published study, and it came out just months before the conference was held.

Recent years have seen a rapid expansion of the available literature on the topic, and this article will provide a better answer to the question that could only be marginally answered during the 2008 ISPO review: Are there established benefits associated with the bracing of the wrist and/or hand with static and/or dynamic splints in children with cerebral palsy (CP)?

Phrased more broadly, patients with CP often present with limitations in their affected extremities including thumb adduction (or thumb-in-palm deformity), ulnar deviation at the wrist, and wrist and finger flexion. To what extent and in which populations do wrist and hand splints appear to aid in functional ability?

Defining the Treatment Population

CP is an umbrella diagnosis, encompassing a broad range and spectrum of disorders. Clinicians are increasingly aware of the Gross Motor Function Classification System (GMFCS), which is now widely used to classify individuals based on their mobility limitations. As a profession, we are generally less aware of the Manual Ability Classification Scale (MACS), a similar classification scale used to delineate the functional abilities of the upper limb.2

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