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CREDIT ARTICLE #076.

Effect of Wrist Hand Splints on Grip, Pinch, Manual Dexterity, and Muscle Activation in Children with Spastic Hemiplegia: A Preliminary Study
Patricia A. Burtner, PhD, OTR/L Janet L. Poole, PhD, OTR/L Theresa Torres, BA
Occupational Therapy Graduate Program, Department of Pediatrics, University of New Mexico, Albuquerque, New Mexico
ABSTRACT: The effect of wrist/hand orthoses on force production, dexterity, and upper extremity muscle recruitment was investigated in children with and without cerebral palsy (CP) to determine if splint design affects 1) hand function and 2) muscle activation. Ten children with hemiplegic CP used hands with spasticity (n ¼ 10) and five age-matched control children used dominant and nondominant hands (n ¼ 10) in three splint conditions (no, dynamic, static) during grip, pinch, and peg-board tests while electromyography (EMG) recorded muscle activation. Children with spasticity increased their grip (p ¼ 0.008) and dexterity (p ¼ 0.02) when wearing dynamic splints and pinch (p ¼ 0.04) with no splints. All children had significantly less wrist EMG activity during grip with static splints; only children with CP had greater compensatory shoulder activation. Preliminary findings suggest that dynamic splints increased function of children with CP while static splints decreased muscle activation at wrist and increased compensatory shoulder muscle recruitment. J HAND THER. 2008;21:36–43.

Amanda Manhke Medora, OTR/L Rose Abeyta, OTR/L
University of New Mexico, Albuquerque, New Mexico

Joanne Keene, MOT, OTR/L
KIDPOWER Inc., Albuquerque, New Mexico

Clifford Qualls, PhD
Department of Mathematics and Statistics, Clinical Research Center, University of New Mexico School of Medicine, Albuquerque, New Mexico

Grip, pinch, and manual dexterity are primary hand functions that support one’s daily activities. When children have difficulty developing these functions due to neuromuscular disorders such as cerebral palsy (CP), they experience decreased performance in activities such as school assignments, self care, and play with their peers.1 Muscle impairments due to the presence of spasticity in this population of children often lead to limitations in range of motion, timing accuracy, force production, and hand
Correspondence and reprint requests to Patricia A. Burtner PhD, OTR/L, FAOTA, Occupational Therapy Graduate Program, Department of Pediatrics, HSSB #215, School of Medicine MSC09-5240, University of New Mexico, Albuquerque, NM 87131-0001; e-mail: <pburtner@unm.edu>. 0894-1130/$ e see front matter Ó 2008 Hanley & Belfus, an imprint of Elsevier Inc. All rights reserved. doi:10.1197/j.jht.2007.08.018

manipulation skills.2 Orthoses and splints are commonly used to improve the position, range, quality of movement, and function of a person’s arm or hand.3 CP is a neurodevelopmental disorder caused by nonprogressive lesions in single or multiple locations in the immature brain in utero, during or shortly after birth. The disorder produces motor impairment and often sensory deficits evident in early infancy.4 Significant functional limitations are observed in 80% of the upper limbs of individuals with CP having hemiparesis or quadriparesis.5 The presence of spasticity in the upper extremity (UE) of these children often results in 1) stereotypical movement patterns of internal rotation of the shoulder, 2) elbow flexion with pronation of the forearm, 3) ulnar deviation and flexion of the wrist,6 and 4) thumb-in-palm and/or finger-swan neck deformities.7 The use of

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pinch.20.95). 6F 3M. of Handsy 10 10 5 5 M ¼ male. but also allow some movement.12 Although several case reports document subjective changes in children with CP using static splints. dexterity.8 SD 2.11. another study using static splints that immobilize wrists reported decreased muscle activation. or armehand posture. and release of objects. static. Means and Standard Deviations of Age* for Each Group Group Control Cerebral palsy (CP) total Right hemiplegia Left hemiplegia Muscle Activation Changes with Splints In one study.16 In contrast. 2F 1M. Results suggested more normalized muscle activation with the device. pinch. muscle activation patterns of the UE muscles of ten children with CP were compared during reaching with and without a hand-positioning device.21 The mean ages and standard deviations in months for the control and CP groups. Participants were selected as a convenience sample and were in regular classroom placement with good academic progress or in preschool settings with preacademic developmental skills at age level. grasp. yControl children tested using dominant and nondominant hands. and static splint conditions. dynamic wrist splints that provide wrist support for more optimal hand function. METHOD Participants Fifteen children enrolled in the study: ten children diagnosed with spastic hemiplegic CP (five with left hemiplegia. 2) all children would have decreased muscle activation at the wrist and compensatory shoulder muscle activation when wearing the static splint that immobilized the wrist. pinch. p ¼ 0. 4F No. and EMG activity of selected UE muscles while participants with and without CP wore no. and 3) in all splint conditions children with spasticity will score lower than control children in dominant and nondominant hands. 3F 4M. however. All children rated as level 3 (Poor Active Assist) or 4 (Active Assist) on the Modified House Functional Classification System. Specific hypotheses were 1) children with spasticity would have increased grip.2 8. and dynamic splints. df ¼ 2.7 Gender 2M. gender representations. and dexterity when wearing the dynamic splint that provided more optimal wrist and hand positioning but allowed active movement. Static splints are designed to be rigid for controlled support (immobilization) of the involved joint for improved function. and the number of hands tested per group are reported in Table 1.9 Effect of Splints Because dynamic splints have moving parts that allow the individual a range of voluntary controlled movement.splints is one approach often recommended to prevent shortening in spastic muscles over time5 and to assist in motor control functions such as grip. five with right hemiplegia) and five agematched control children. Because children with CP are only splinted on hands with spasticity.3 3.17e19 In contrast.5 8. There were no significant age differences between the three groups (F ¼ 0.14 only one study documented specific hand function changes in a case-study research design15 reporting increases in measures of grip strength.2 8. dexterity. The children ranged in age from 4 to 13 years. For control children. to determine if splint design affected function whether or not muscle differences were present.10 Two previous studies provide anecdotal support for the use of dynamic splints8.11 with children with spastic CP. Children with spastic hemiplegia were recruited through the regional university rehabilitation hospital. and active thumb range of motion.05. dynamic.8 The types of splint designs commonly used are dynamic splint (providing positioning with some mobility present) and static splint (providing complete immobilization at the joint splinted) designs. and private practices. we recorded changes in this extremity in equal numbers of children with right and left hemiplegia. The purpose of our preliminary study was to compare grip. To date. JanuaryeMarch 2008 37 . we tested both hands to provide data from dominant and nondominant hands for comparison. no significant relationship was found between the type of splint and changes in hand use. no EMG studies have been completed to compare muscle activation patterns in children with CP in no. it has been proposed that their use may prevent contractures while allowing opposing antagonist muscle force to counter the force of the spastic muscle. *Age in years. F ¼ female. Children with and without spasticity were included N 5 10 5 5 Mean 8.7 4 3.17 Three recent studies of subjects without musculoskeletal or neurological impairments suggested that static splints may create additional stress on the proximal joint musculature as measured by electromyography (EMG). local school districts. These TABLE 1. which over time may lead to disuse atrophy in the wrist muscles and overuse of more proximal muscles.13. may not produce this additional strain on proximal muscles. children with hemiplegic CP tested using hand with spasticity.

triceps..22 Child norms are available for both grip and pinch strength from previous studies. The splints were worn during testing only and splint/no splint order was established by a predetermined random assignment and recorded for each test. Jackson. 4) identified cognitive delay or mental retardation. two splints were fabricated for both hands. The participant was then cued to start and complete trials of 1) grip strength (three repetitions). dynamic spiral wrist hand splints.S. Noraxon Electromyography (Noraxon U.. During the first session.. Exclusion criteria for participation in the study included 1) fixed contractures or deformities that would prohibit range of motion required to perform research task. For the purpose of this study. Although no norms are available for the adapted version of this test. extensor carpi radialis longus. and wrist were recorded to rule out contractures as outlined in exclusion criteria. comparative data from matched control children provided some information about this dexterity measure. CA) was used to measure lateral pinch strength. with the shoulders relaxed and the elbows able to rest on the table. The static splint design was a volar wrist immobilization splint made (by JLP) with thermoplastic material that allowed no or minimal wrist movement.23e25 Adapted Nine Hole Peg Test A peg-board test based on the Nine Hole Peg Test26 was designed to test dexterity in subjects because they were unable to complete the regular test due to spasticity. and Wrist: flexor carpi radialis.). The second session was scheduled within a twoweek period. that is. participants were scheduled for two sessions. 3) neuropharmacology intervention six months before the study to reduce spasticity. Elbow: biceps. 2) orthopedic hand surgery within the past six months. pectoralis major. Inc. elbow. Both instruments were calibrated and procedures followed were those recommended by the American Society of Hand Therapists. Instrumentation Grip and Pinch Strength A JamarÒ hand dynamometer (Jamar Inc. for a total of four splints. AZ) Surface EMGs recorded muscle activity of eight muscles involved with reach and grasp at the different joint levels as follows: Shoulder: anterior deltoid medial deltoid. From left to right: static.participants all had the diagnosis of spastic hemiplegia. Both splints were fabricated with 15e20 degrees of wrist extension. 38 JOURNAL OF HAND THERAPY . Active and passive range of motion (ROM) for major joint actions at the shoulder. etc. Procedures After obtaining an informed consent from the parents and assent from children older than seven years of age. MI) was used to measure grip strength and a B & LÒ pinch gauge (B & L Engineering. with moderate spasticity that would warrant splinting. Splints used in the study. and 5) other significant neurological impairments (seizures. The participants with CP had splints fabricated for only the hand with spasticity. The score FIGURE 1. children were fitted with custom static and dynamic splints fabricated by the research team. surface EMG electrodes were placed on the eight muscles and maximum voluntary contraction of each muscle was recorded.A. recorded was the number of seconds needed to remove nine round pegs from the peg-board. The EMG wires were tethered from the subject to the computer data acquisition system. Tustin. Before testing. 5 inches by 5 inches. The dynamic splint was a spiral design and also made (by JLP) from thermoplastic material and allowed 30 degrees of movement at the wrist. with nine 1-inch diameter by 3inch long dowels was fabricated to accommodate for decreased grasp in children with spasticity. Scottsdale. The participant was asked to sit at a table adjustable to individual work heights. superior trapezius. Because the control children were tested using both their dominant and nondominant hands. a peg-board. visual impairment. Materials Two types of splints were used in this study as shown in Figure 1.

2.4) 5.16.1 (4. L hemiplegia) as a grouping factor and the three splint conditions (no.9)* 6. pinch.9)* 20.0.003 0.7 (2. df ¼ 3. p .3) 41. The analysis was done separately for combined muscles at each joint (shoulder.16. 0.0 (1.9)y 9.7) 36.001 Lateral pinch (lb) Mean (SD) No Dynamic Static Peg dexterity (sec) Mean (SD) No Dynamic Static CP ¼ children with cerebral palsy.001).5 (31. However. L ¼ left.0)* Nondominant (n ¼ 5) 22 (8.22.4 (2. Hemi ¼ hemiplegia.8 (0.9 (1. 0.8)y 18.5 (7. Note: Significances reflect analyses on log transformed data. p ¼ 0.16.7) 1.002 . df ¼ 3. yScores are significantly higher on grip and pinch and/or lower on pegs than children in L hemiplegia CP group only. Post hoc analyses included oneway ANOVAs used to identify group differences for each splint condition.0) 47.1. pinch. dexterity differences were seen only when control children used their dominant Statistical Data Analysis Means and standard deviations for the different clinical measures of the groups were computed.3 (5.7)* 6. dynamic.1) 51.8 (11. control children again scored better (lower time scores) than children with CP in the no splint condition (F ¼ 9. 0.8. dexterity).5 (6. In the no splint condition.6) 4.01 0. Mean EMG responses for each muscle in each condition were then normalized to a percentage of the maximum voluntary contraction of that specific muscle (% MVC). arm.2 (2. no splint) are displayed in Table 2.4 (8. Paired t-tests were used to identify splint differences for two combined groups (CP. dynamic.001 0.6) 29. significant grip differences between control and CP groups using the dynamic splint were found only in the dominant hand.2) lateral pinch (three repetitions). df ¼ 3.8)* 5.6 (1. Control children (dominant and nondominant hands) demonstrated significantly greater grip strength (F ¼ 14.6)* L Hemi (n ¼ 5) 1.7 (1.6)y 6.7 (1.8)* 6. static) as the repeated factor. pinch. JanuaryeMarch 2008 39 .3. only children with L hemiplegia scored significantly lower (F ¼ 5. Control).4)y 6. IEMG (full wave rectified and low pass filtered 60 Hz signal) was analyzed by comparing the area under the EMG signal in microvolts (mV) during the different splint conditions.1.1) 10. 0. dynamic.1 (5.16.9)* 18.2) Splint No Dynamic Static Dominant (n ¼ 5) 23. The overall analysis was repeated measures ANOVA with four hand conditions (control dominant. p .01) than control children.6)* 9.001 0. R ¼ right. df ¼ 3.001) than CP groups (R and L hemiplegia) in no and static splint conditions. wrist) and each function (grip.002 .8) 5.9 (1.6)* 8.8 (1.5) 1.002) when wearing the dynamic or static splints as compared with control children.0. and dexterity were obtained by integration of the linear envelope.4) Overall p-Value .1 (6.6 (0.002 0. *Scores are significantly higher on grip and pinch and/or lower on pegs than both groups of children with CP. The number of repetitions given were according to standardized methods established during previous studies.6 (27.2 (28.05 level. Significance level was set at the 0.3 (1.7) 29. RESULTS Means and standard deviations for grip.0. p .4 (6.9 (21. and 3) one trial (following one practice trial) of the peg-board test. During peg-dexterity tests.001) and static splint condition (F ¼ 10. Data were log transformed to equalize the variance between the children with CP and control children for subsequent analyses.7 (26.16.001 0.1 (1. Lateral pinch strength was significantly lower in children with CP (F ¼ 7.6 (1.7)* 5.8)y 9. static) as the repeated factor.6)* 9. R hemiplegia.26 Data Analysis EMG Analysis for Integrated EMG For each participant. when using the dynamic splint.5)* 9.3 (24. TABLE 2.8 (0. however.2) 0. and dexterity tests by hand groupings and splint conditions (static. Group Differences on Clinical Hand Measures by Splint Condition Group Control Measure Grip (lb) Mean (SD) CP R Hemi (n ¼ 5) 7.1 (2.2 (6. control nondominant.4) 2. df ¼ 3.9 (16.8)* 23. average integrated EMG (IEMG) values for each trial of grip.1) 1. p . Control children using the nondominant hand scored significantly higher than the children with L hemiplegia only.7 (1. The main analysis of EMG data was by repeated measures ANOVA comparing children with CP to control children as the grouping factor and the three splint conditions (no.

4)* 32.6 (11.6) 25.04 0.5) 3. splinting remains a practice that is used to treat adults and children with spastic hemiplegic CP. During grip. however. Peg scores were significantly lower (p ¼ 0.2 (1.6 (3. Control children showed no significant differences in grip and pinch in the different splint conditions.9 (7.5 (4.12 Our second hypothesis that both groups of children would have decreased muscle activation of wrist musculature and increased muscle activation of shoulder and elbow musculature when wearing static wrist splints as compared with the dynamic or no splint conditions was partially supported. During peg testing.2 (4. df ¼ 2. data from both hands (n ¼ 10) of the control children and both CP groups (R and L hemiplegia. Wrist IEMG (% MVC) was significantly lower in all children wearing static splints. In addition. the arm (p ¼ 0.10 0.2) 2.02) when children with CP wore the dynamic splint as compared with peg scores with no or static splints.23. Note: Significances reflect analyses on log transformed data. significant differences were seen only when compared with children with L hemiplegia. and what type of splint design to use. To further investigate the effect of splint design on grip. and the wrist muscles (p ¼ 0.1)y Static 20.6) 6.2) 2.2 (15. children with CP recorded greater IEMG (% MVC) activity in the shoulder (p ¼ 0.4 (15. On post hoc analysis.07) in peg-dexterity tasks with less time required to complete the task when they used the dynamic splint.36.6 (3.05). yPeg scores were significantly lower time than no or static splints.01).04) were also identified with greater pinch recorded in the no splint condition as compared with their pinch strength when they wore static splints. n ¼ 10) were combined and compared by paired t-tests (see Table 3).8 (7. however.02). but similar shoulder muscle recruitment was recorded when using the dynamic splint (see Table 4). or dexterity in the different splint conditions. and wrist IEMG activations (% MVC) were not significantly different between the two groups or in the three splint conditions.2 (4. Our first hypothesis investigating splint differences.3)* 3.27 Despite these controversies. 0.5 (1. pinch.9.4) 6. p ¼ 0.11.5 (4. Increased grasp was also documented in the two previous studies using dynamic splints.7 (25. how long to wear a splint. there was a trend (p ¼ 0. *Significant at p .2 (9. Significant pinch differences (p ¼ 0.3) 4.0 (6. and lower dexterity time scores when wearing dynamic wrist hand splints as compared with static or no splints was partially supported. shoulder.008) when using the dynamic splint.0 (1.4) 6. .8) 4.TABLE 3. a groupesplint interaction was noted in shoulder muscles (repeated measure analysis of variance [RM ANOVA].9) Dynamic 19. that both groups of children would demonstrate increased grip strength. Mean (SD) Group Control Total hands (n ¼ 10) Measures Grip (lb) Pinch (lb) Peg dexterity (sec) Grip (lb) Pinch (lb) Peg dexterity (sec) No 22. children with CP had greater grip and dexterity with the dynamic splint and greater pinch with no splint.01). all children had significantly less muscle . hand.6) Overall p-Value 0. Splint Differences on Clinical Hand Measures by Group Splint Condition. No groups or splint condition differences were noted in the arm muscles.35 0.02 CP Total hands (n ¼ 10) CP ¼ children with cerebral palsy. 0.7) 6. arm. F ¼ 3.1 (6.03) than control children with no significant differences by splint condition (see Table 4). Our study hypotheses were supported in part by our results. When grip was measured in the two groups of children in the different splint conditions. Control children did not have significant changes in grip. and dexterity. children with CP had significantly less IEMG at the wrist than control children in all splint conditions. 40 JOURNAL OF HAND THERAPY During pinch recordings. pinch. Results of IEMG muscle recruitment (% MVC) during clinical measures were analyzed by muscle groups surrounding three UE joints to delineate the effect of immobilization at the wrist joint. Post hoc analysis showed % MVC in shoulder muscles was greater in the CP group than controls for no splint and static splint conditions.7) 3.07 (trend) 0. children with CP had greater grip strength (p .4) 18. When using their non dominant hand. DISCUSSION Limited empirical evidence supporting splint use has resulted in continued controversies as to the efficacy of splint use: whether or not to splint.05 level. Note: Mean scores of control subjects were significantly higher than children in CP group in grip and pinch and significantly lower for pegs (p . pinch strength. The purpose of this study was to investigate the efficacy of two splints commonly used with this population of children.6) 4.11 0.

3 (40.2 (29.6 (34) 69.5 (48) 61. *Shoulder activation during grip was significantly less at shoulder in CP group wearing dynamic splint.3) 67. pectoralis major.4 (28. activation with the static splint.5 (30.4) 62. mean (SD) No Shoulder Arm Wrist Dynamic Shoulder Arm Wrist Static Shoulder Arm Wrist Dexterity (% MVC). Our last hypothesis of group differences between children with and without CP was supported.TABLE 4.8 (48.3) 57.1 (26.1 (28. Wrist ¼ flexor carpi radialis and extensor carpi radialis muscles. Such findings suggest caution in the prolonged static splint use. mean (SD) No Shoulder Arm Wrist Dynamic Shoulder Arm Wrist Static Shoulder Arm Wrist Pinch (% MVC).5) 52.7) 92.9 (29.8) 59.1) 38.049y 0.2) 59.4 (30.6 (41.1 (26.5 (24.9 (34.8) 113.6 (29.8) 50.03 NS NS NS NS NS NS CP ¼ children with cerebral palsy.8 (40. % MVC ¼ percentage of maximum voluntary contraction in grouped muscles.5) 32.8) 81.4) 76.3) 46.1 (39.7) 100.9) 62. Arm ¼ biceps and triceps muscles.2) 43.7 (28) 30.29 who have documented differences in the coordination of grip and muscle force control of finger movements as JanuaryeMarch 2008 41 .5(25) 69.05* NS NS 24. Significantly greater shoulder muscle activation was seen only during grip with the CP group having greater activation than control in static and no splint conditions.6) 78.2 (32.4 (26.8) 63.9 (32.3) 72.8) 40.1 (29) 110 (45. because decreased muscle activation over time may result in muscle atrophy.5 (23.5) 97.5) 73. required significantly longer times to complete dexterity tasks in all splint conditions than their matched peers. Group Differences on IEMG (% MVC) Measures by Splint Condition and Muscle Groups Measure Splint Control (n ¼ 10) CP (n ¼ 10) Group p-Value Splint p-Value Interaction p-Value Grip (% MVC). These results are similar to Reid16 who documented more normal muscle activation during reaching in children with CP who wore hand splints.6 (36. Shoulder ¼ anterior deltoid. and superior trapezius muscles.6) 41.1 (50. yWrist activation was significantly less in wrist muscles in both groups wearing the static splint.9 (40. thus leading to increased compensatory movement in these splint conditions.02 0.4 (22. This shoulder activation may reflect an increase of muscle activity proximal to the joint that is fixed or immobilized. middle deltoid. Our results are similar to other researchers28.7 (35. suggesting more normalization of muscle activation with dynamic splints.02y NS NS 0. Children with hemiplegia were significantly lower on grip and pinch measures.4) 52.8) 103.1) 130 (71.5) 64 (23.6 (58.1 (23.01 0.8) 44.5 (53.2) 57. mean (SD) No Shoulder Arm Wrist Dynamic Shoulder Arm Wrist Static Shoulder Arm Wrist 30.1) 69.1) 57.1 (22.2 (339.1 (28.9) 69.3 (32.7) 62.4) NS NS NS NS NS NS NS NS NS 77.2 (19.2 (36.9) 57. similar shoulder IEMG (% MVC) were recorded in both groups when wearing dynamic splints.2) 31.7) NS NS 0. Interestingly.5 (45) 52.3 (54.2) 381 (394) 312 (359) 515 (517) 290 (203) 263 (252) 411 (464) 268 (251) 221 (212) 294 (257) 0.4 (14.

Neuhaus BE. Cummings R. The effects of short thumb opponens splint in hand function in cerebral palsy: a single-subject study. 9. House JH. 2002. Phys Ther. Other researchers have reported differing results when grip is required for active movement tasks. Dev Med Child Neurol. 2005. 10. Upper extremity splinting and casting. 1981. Kashman N.41:748–57. 1997. 1999. 1998. Sochaniwskyj A. Bonder BR. 15. Am J Occup Ther. 4. St. Am J Occup Ther. 20. 21.5:24–38. Gordon AM. 2001. 17. because it enhances grip and dexterity. Lohman H.3:77–92. Impaired anticipatory control of isometric forces during grasping by children with cerebral palsy. Qualls C. 1987. Gwathmey FW. Leibowitz JM. 29.77:661–71. Olson SL. Poehling GG. Clin Orthop Relat Res. Exner CE. Am J Occup Ther. prolonged use may lead to muscle atrophy in the forearm muscles and increased activation of shoulder muscles during tasks may produce fatigue and increased stress of proximal shoulder muscles. Ager CL.253:62–74. Goodman G. Occup Ther J Res. Gelberman RH. Jansen CWS. participation restrictions in children with cerebral palsy. Kellor M. Burtner PA.53:434–40. 1997. Olivett BL. Roberts G. Res Dev Disabil. Spastic hemiplegia of the upper extremity in children. 22. 25. Ascher ER.38:107–13. Muscle force generation and force control of finger movements in children with spastic hemiplegia.17 reported increased muscle activation at the shoulders when static wrist splints were worn by individuals without pathology while lifting 1 pound cans.35:83–90. In: Glenn MB. 7.47: 337–42. Cortical thumb orthosis for children with spastic hemiplegic cerebral palsy. suggesting greater muscle activation for repetitive task completion. pp 59–166. 2002. orthoses. Thomas JJ. Eliasson AC.50:805–15. Hand Splinting Principles and Methods. 6. 27. Federman SM. Feldman P. Mosby Co. Reid DT. Arch Phys Med Rehabil. Dev Med Child Neurol. grasp. based on this small sample. 1996. 1990. 42 JOURNAL OF HAND THERAPY . 16. The effectiveness of casts. 12. Arch Phys Med Rehabil. Fidler MO. Cerebral palsy. This research was funded in part by the University of New Mexico Health Sciences Research Allocation Committee and the General Clinical Research Center DHHS/NIH/NCRR/ RR00997. Koman L. Beckung E. 19. Gordon AM. Cerebral palsy. Influences of a hand positioning device on upper extremity control of children with cerebral palsy. Dev Med Child Neurol.10:283–9. 1992. Fess E. 1984. Hasson SM. Currie D. et al. Int J Rehabil Res. Thus. Am J Occup Ther. Smits-Engelman ECM. 1998.68:214–6. splints for children with neurological disorders. Smith B. Mathiowetz V. 1987. Further investigation is necessary to determine efficacy of the different splints over time and in different functional activities to more clearly understand splinting use for children with spasticity. Occup Ther J Res. Neuroimpairments. Woollacott MH. Russell D. Bulthaup et al. 2004. MS: Mosby. Tscharnuter I.37:72–84. Infants Young Child. Management of the upper extremity. Louis. New York: Marcel Dekker. Teplicky R. The effect of an inhibitive weight-bearing splint on tone and function: a single case study. 1990. Louis. Waters PM. 28. Am J Occup Ther. Whyte J (eds). Improvement in grasp skill in children with hemiplegia with the MacKinnon splint. Law M. Grasp and pinch strength in children 5 to 12 years old. when wearing static wrist splints.44:309–16. Grip and pinch strength: norms for 6 to 19 year olds. St. Wiemer DM. Kinghorn J. Hand strength and dexterity: norms for clinical use. Iversen I. Acknowledgments The authors wish to thank the children and their families who agreed to participate in the study. Portions of this research were presented at the annual meeting of the American Occupational Therapy Association. Shilt J. 5. 1983. Silberberg N.45:726–31. Malvern. PA: Lea & Febiger.43:563–9. Coullon BA. Weber K. Actual muscle activation changes due to wearing splints were also noted. 24. VanHeest A. 3. activity limitations. 1990. 2nd ed. Bulthaup S. Dev Med Child Neurol. Philips C. 2. 13.. The Practical Management of Spasticity in Children and Adults. J Hand Ther. Cipriani DJ. 1971. 1986. Duysens J. Hagberg G. CONCLUSIONS Our findings suggest that children with hemiplegic CP patients may experience increased grip strength and fine motor dexterity when dynamic splints are used. Lancet. Forssberg H.34:216–25. Am J Occup Ther. 26. The effect of use of a wrist orthosis during functional activities on surface electromyography of the wrist extensors in normal subjects. Koman LA. clinicians might want to consider the use of the spiral splint.14:119–33. Thus. 1990. Coppard BM. 18. Tactile control of isometric fingertip forces during grasping by children with cerebral palsy. J Bone Joint Surg Am. MI: V. 23. Bazyk S. Johnson CL.compared with typically developing children. but better pinch strength when no splints are worn. Stance balance control with orthoses in a select group of children with spasticity. Kaplan N. 1986. Effect of splinting on reflex inhibition and sensorimotor stimulation in treatment of spasticity. Dev Med Child Neurol. An electromyography study of wrist extension orthoses and upper extremity function. Hand Clin. 11.363: 1619–31. Flegle JH. A dynamic approach to thumb-in-palm deformity in cerebral palsy. Comparative effects of three hand splints on bilateral hand use.15:15–29. Adult norms for the Nine-Hole Peg test of finger dexterity. Frost J. Forssberg H.25:77–83. Mendiola A. 1981. Volland G. Rameckers EAA.9:145–51. 8. 40:705–11. Use of neuromuscular electrical stimulation and a dorsal wrist splint to improve the hand function of a child with spastic hemiparesis. Introduction to Splinting: A Clinical Reasoning and Problem Solving Approach.15:42–50. 1999. Early Diagnosis and Therapy in Cerebral Palsy: a Primer on Infant Developmental Problems. 1992. Individuals with CP wearing static splints had decreased muscle activation in the forearm muscles during grip and recruited more shoulder muscles than control children when grip and dexterity tasks were completed. Scherzer AL. 1962. 1995. REFERENCES 1. Children with hemiplegic CP in our study also demonstrated greater EMG activation to complete a repetitive task (placing pegs) than control children in all splint conditions.63:216–25. 14. Mathiowetz V. Toby EB. armehand posture in hemiplegic children: a pilot study. pp 357e358. Eliasson AC. Am J Occup Ther. Carmick J. A survey of rationales for and against hand splinting in hemiplegia.

no splint d. Muscle activity during task performance was measured by a. increased when wearing static splinting #3. static splinting c. dynamic splinting b. kinesio taping #4. kinesio taping #5. EMG #2. There is only one best answer for each question.JHT Read for Credit Quiz: Article # 076 Record your answers on the Return Answer Form found on the tear-out coupon at the back of this issue. Wrist muscle activity a. The CP children showed the greatest improvement in function when wearing a. please batch your JHT RFC certificates in groups of 3 or more to get full credit. The results of this study may be applied with confidence to any population of patients with Upper Motor Neuron pathology a. true b. visual evaluation d. decreased when wearing static splinting d. decreased when wearing dynamic splinting c. MRI b. Compensatory shoulder muscle recruitment was noted to increase the most when wearing a. MMT c. no splint d. increased when wearing dynamic splinting b. #1. dynamic splinting b. static splinting c. false When submitting to the HTCC for re-certification. JanuaryeMarch 2008 43 .