Task specific training and functional hand splinting for children with cerebral palsy or brain injury

Abstract

Cerebral palsy and brain injury are common conditions of childhood that can have devastating effects on a child’s ability to use their hands. Occupational therapists use a range of treatment modalities to address difficulties with hand function in this population. Hand splints and task specific training are two treatment options that may be used. There is a lack of evidence to support hand splinting, whilst task specific training is supported by high level evidence in children with neurological conditions. In practice, these treatments may be provided in isolation or concurrently. There is currently limited evidence exploring the benefits of combining hand splints with task specific training. AIM The aim of this research was to explore the efficacy of functional hand splints and task specific training. The task specific training approach utilised was the Cognitive Orientation to daily Occupational Performance (CO-OP) Approach. METHODS This research used quantitative and qualitative methods to explore the research question. A systematic review with meta analyses was conducted to explore the current evidence regarding hand splints and upper limb task specific training. A study protocol was then devised and two concurrent randomised controlled trials completed exploring (a) the immediate effect of a hand splint, and (b) the use of a functional hand splint, compared to and combined with the CO-OP Approach. Parent interviews were conducted exploring the experience of undertaking CO-OP with their child with cerebral palsy or brain injury. Secondary analyses of RCT results were conducted to explore individual characteristics of children who responded best to CO-OP. RESULTS Meta-analyses investigating non-functional upper limb splints found a small positive effect of splints compared to no splints (SMD=0.81), although benefits were reduced 2 to 3 months after splint wearing stopped (SMD=0.35). Results of the RCT showed that functional hand splints did not lead to improvements in grasp and release immediately following application, compared to no splint (p=0.348). Participating in CO-OP was more effective than receiving a splint and practicing goals at home (GAS p=0.010). Functional hand splints did not add benefit when combined with CO-OP (COPM p=0.807). CO-OP was shown to lead to goal achievement for children with cerebral palsy or brain injury, and parents perceived CO-OP to be a beneficial treatment option for their child. CONCLUSIONS CO-OP may be an effective task specific training option for children with cerebral palsy or brain injury. There may be little benefit to prescribing functional hand splints concurrently with task specific training. There remains a lack of evidence to guide the use of upper limb splinting in this population.