Jan 11, 2018 Unique Approaches for Hand Impairments in Children with Cerebral Palsy

Disabilities of the hands and upper extremities are common in children with cerebral palsy. At Children’s Specialized Hospital we offer innovative treatment strategies to improve their lives.

Almost half of children with cerebral palsy have hand and/or upper extremity dysfunction, resulting in muscle weakness and tightness, increased muscle tone, spasticity, and involuntary shaking. In many CP patients the hands form tightly clenched fists, with forearms rotated down or pulled tightly towards the face. Such impairments present enormous challenges and negatively impact quality of life for patients and families.

As section chief of physiatry at Children’s Specialized Hospital, I oversee physiatry services for youngsters across the CP spectrum. There are only 250 pediatric physiatrists in the U.S., treating an underserved population. With eight board-certified pediatric physiatrists on staff, our CP rehabilitation program is one of the largest and most comprehensive in the country. Our multidisciplinary team includes physicians, a nurse practitioner, skilled nurses and therapists, and robust administrative support to help families access our services. We have an accredited fellowship program as well.

Our goals are to improve function and ease of care and provide patients with the tools to manage daily activities as much as they are physically able. For patients who are more severely affected, with less functional potential, the right treatment helps families and caregivers provide optimal care.

Among the treatments we offer:

  • Medications, including muscle relaxants and anticholinergics, are the cornerstone of CP treatment. Additionally, our skilled team of physicians offers extensive neurolysis services: botulinum toxin injections and alcohol nerve blocks to treat spasticity and dystonia. We use ultrasound guidance in these procedures, which isn’t found at many centers, to improve safety and accuracy. We also have access to expert pediatric anesthesiology services, optimizing treatment.
  • Physical and occupational therapy. Our therapists design exercise programs to boost mobility, strength and coordination. Our OT team includes two certified hand therapists with specialized training in upper extremity disorders. We use electric stimulation to improve strength and motor control. SAEBO, a mechanical dynamic splinting system, employs springs and pulleys to allow children greater use of their hands.
  • Casting, splinting, and bracing eases muscle tightness, expands range of motion and strengthens function. An orthotist on our team fabricates braces.
  • Adaptive equipment and technology. Technological advances provide patients with the tools to maximize function and independence. We find the proper controls for children to control their wheelchairs, including positioning and stabilizing accessories and hand and head switches. Software and other tools for adaptable learning enable patients to participate in academic programs. Eye-gaze hardware and software track a patient’s eye movements, allowing hands-free access to a computer.
  • Orthopedic surgery for CP patients is highly specialized. It can help ease tight muscles and correct limb positioning and deformities, improving function. Abram Kirschenbaum, MD, a member of our team, is one of a few pediatric hand surgeons in the state with expertise in corrective surgery for CP.  
  • Sports and recreation. We’ve found that engaging in rock climbing can promote muscular development and strength in children with CP. We have a mechanical tread wall—a vertical treadmill where we teach our patients adaptive rock climbing. We also offer a range of other recreation activities.

Our program serves children from birth to age 21, with services provided at 13 locations throughout the state. It’s rewarding to support these children and their families to improve quality of life.

To learn more or schedule an evaluation, call 1-888-244-5373.