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Cerebral Palsy and Hand Function Impairments: Expectations and Management

hand therapy for child with cerebral palsy hand function impairments

Cerebral palsy is a motor disability that can affect many different movements, including hand functions.

Children with cerebral palsy-related hand impairments may struggle to perform daily tasks on their own.

Luckily, there are many management interventions aimed at improving hand functions and boosting independence.

This article will explore how cerebral palsy affects hand function and the most effective ways to improve hand mobility.

Understanding Cerebral Palsy and Impaired Hand Functions

Impaired hand function in children with cerebral palsy is caused by damage to the brain, not the hand.

Depending on the severity of the brain damage, individuals may experience motor impairments in various regions of the body.

For example, cerebral palsy can affect one side of the body, only the legs, or the entire body.

As a result, not all individuals with cerebral palsy will experience impaired hand functions.

However, if they do have hand impairments, they may struggle with functions such as gripping, pointing, and performing tasks that require precision.

The following section will help you understand what hand impairments may look like in different types of cerebral palsy.

How Different Types of Cerebral Palsy Affect Hand Function

child demonstrating cerebral palsy hand movements

There are 4 types of cerebral palsy: spastic, dyskinetic, ataxic, and mixed. Each type of cerebral palsy can affect hand function differently.

Here’s an overview of how patients with different types of CP may struggle with hand function:

  • Spastic cerebral palsy patients often develop involuntary muscle contractions (spasticity). When this affects hand function, it may lead to clenched hands or fingers contracted in unnatural positions.
  • Dyskinetic cerebral palsy patients may experience fluctuations between high and low muscle tone. These patients may develop repetitive, twisting movements in their wrists.
  • Ataxic cerebral palsy patients often struggle with coordination and fine motor skills. When they try to reach for objects, they may experience involuntary shaking in the hands called intention tremors.
  • Mixed cerebral palsy patients usually experience symptoms of 2 or more types of cerebral palsy. 

Now that you understand how hand functions can be affected by cerebral palsy, below are management interventions that maximize movement.

Treatments to Improve Hand Function with Cerebral Palsy

There are various treatments to improve hand functions in individuals with cerebral palsy.

Consistent repetition is key for stimulating the brain to learn a new movement pattern. The more an individual practices new movement patterns, the more they promote neurological adaptions in the brain.

Neurological adaptations are possible due to neuroplasticity, which is the brain’s ability to rewire itself. Repetitive movements help the brain understand that there is a demand for that function and prompts neural rewiring to undamaged regions of the brain.

So how do you get children to perform as many repetitions as possible? Hand therapy for children with cerebral palsy is often activity-based. Rather than repeatedly executing the same hand exercise, children are more likely to perform repetitions if they are introduced to activities that keep them engaged and challenged.

Ultimately, improving hand functions in individuals with cerebral palsy consists of strengthening new movement patterns through massed practice. Think ‘use it to improve it.’

Next, we’ll provide 6 management interventions commonly utilized to improve hand functions in individuals with cerebral palsy:

1. Occupational Therapy

One of the primary goals of occupational therapy is to maximize an individual’s independence.

Occupational therapy focuses on improving a person’s mobility by practicing activities of daily living.

Individuals consistently practice using their hands to develop their fine motor skills and perform everyday tasks like using silverware, undoing buttons, and tying shoes.

2. Constraint-Induced Movement Therapy (CIMT)

child with cerebral palsy practicing hand therapy exercises

If an individual’s hand functions are only affected on one side of the body, a therapist may use constraint-induced movement therapy.

CIMT involves restraining use of the unaffected hand and promote intensive activity-based training with the affected hand.

By continuously using the affected hand, individuals stimulate their brain to rewire itself and strengthen hand functions on the affected side.

Some examples of activities a child might practice in CIMT include throwing a ball, picking up toys, and playing games on an iPad.

3. Hand-Arm Bilateral Intensive Therapy (HABIT)

Hand-arm bilateral intensive therapy is another method of treatment for one-sided hand impairment.

Children with one-sided cerebral palsy can develop developmental disregard or learned non-use, which occurs when they only use their unaffected arm.

To prevent developmental disregard, HABIT promotes the use of both hands at the same time to perform intensive activity-based training.

Examples of HABIT activities include playing the drums, holding onto a toy steering wheel, and catching a ball. By encouraging children to use both hands during play, they’re more likely to perform the repetitions necessary to develop bilateral coordination skills.

4. Splinting

A therapist will often recommend wearing a splint to promote proper form and prevent spasticity from worsening.

A splint gently stretches contracted muscles and maintains them in a functional position so that they do not revert to their clenched or contorted position.

5. Botox Injections

Individuals with severe spasticity in their hands may benefit from Botox injections.

Botox temporarily blocks the overactive nerve signals that cause muscle contractions by paralyzing a specific muscle group. As a result, individuals have the advantage of reduced spasticity in their hands and can focus on performing more repetitions to rewire their brains.

6. Surgery

If spasticity in the hands is severe and does not respond to other treatments, surgery may minimize contractures.

Surgery for spasticity consists of lengthening the muscles in the arms to relieve tightness in the hands. This may increase range of motion and may create long-term spasticity relief.

It’s important to understand that even with surgery, spasticity may gradually return. Therefore, patients should focus on consistently practicing hand movements while spasticity is minimized to promote rewiring of the brain.

Cerebral Palsy and Hand Function: Key Points

Many people with cerebral palsy have impaired hand functions and may learn how to improve functional use with therapy.

Because cerebral palsy is caused by damage to the brain, hand functions can be rewired to undamaged areas of the brain and developed through consistent repetition. The more a new movement is practiced, the stronger its neural pathways become.

Hopefully, this article helped you understand how cerebral palsy affects hand functions and what you can do to improve them. Good luck!

Photos from top to bottom: iStock/beest/SbytovaMN/Jovanmandic

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