Nova órtese de extensão de punho e abdutora de polegar para crianças com paralisia cerebral: avaliação de suas contribuições para o incremento da funcionalidade manual

Abstract

In cerebral palsy (CP) the hand and particularly the thumb are severely affected imposing high level of dysfunction. Decrease in the range of motion (RoM) of the trapezium-metarcarpo joint (TMC), alterations in the muscle force and manual ability perform are the main impairment in this clinical condition. The clinical type of spastic CP, evaluated in this study presented the postural profile of the hypertonic hand (wrist flexion and ulnar deviation, fingers flexion, thumb aduction). The orthotic therapy used as important part of CP rehabilitation program aims to improve this anatomic and functional pattern. In this study, an innovated wrist extension thumb abduction orthosis was developed (IWETA) to correct the hypertonic hand in 32 children (7.97 years; 5-12) with spastic hemiplegic CP. The methods to analyze 2D and 3D angular variations were used to determine static and dynamic RoMs, respectively during lateral and tripude pinches and cylindric prehension. Muscle strength was assessed by dynamometry and manual ability by Jebesen Taylors test. After wearing the orthosis the RoMs increased between 26 and 69% as determined by the static angular variation method. Using the dynamic method the RoMs gain were approximately (26 to 97%).The positive effect of the orthosis was also observed in the measurement of muscle strength (54%) and manual ability test (8 to 23%). The characterization of these variables was able to define quantitative parameters that evaluated joint performance. This study shows that it is possible to propose the use of the 2D technique in clinical setting. It is expected that the combination of the methodologies employed to evaluate the influence of the orthosis to ameliorate the hypertonic hand of CP children may provide technical advances in the manufacturing of orthotic devices in this clinical condition.