Abstract
Introduction: Children with cerebral palsy (CP) have limitations in hand function due to weakness and spasticity, with long term effects causing shortening and stiffness of muscles in the hand and arm. The soft neoprene thumb abductor splint is prescribed by occupational therapists to correct these impairments. There is insufficient evidence for the effectiveness of this splint on upper limb function in children with CP with a thumb-in-palm deformity within the South African public health context.
Methods: A non-blinded randomised intervention study was carried out in a CP clinic at a tertiary level public hospital. Twenty-eight CP children between the age of 18 and 68 months, presenting with thumb-in-palm deformity, functioning on a Level II to IV on the Gross Motor Function Classification Scale (GMFCS) participated in the study.
The Quality of Upper Extremity Skills Test (QUEST) was used to assess upper limb function in terms of dissociated movement, grasps, weight bearing and protective extension to obtain baseline information. Both the intervention and control groups received monthly individual occupational therapy and a home programme over a three month period. The intervention group additionally received a soft neoprene thumb abduction splint.
Results: No statistically significant differences between the intervention and control groups were found. Clinically relevant between group differences indicated by effect sizes were found however with large effect sizes for the total QUEST score and weight bearing.
The effect size for improvement within the intervention group was large for dissociated movement and weight bearing with and without the splint on as well as for grasps with the splint on. Only dissociated movement showed a clinically relevant medium effect size for change within the control group. Protective extension decreased within both groups except for the intervention group with the splint on.
The caregivers/parents perceived the home programme as easy to follow, and those who were prescribed the splint mostly reported that it was easy to use.
Conclusion: Soft neoprene thumb abduction splints have a positive effect on weight bearing and upper limb function in children with thumb-in-palm deformity, particularly with the splint on. Further research is recommended in the area of splinting in CP
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