Rehabilitation of Hand Impairment in Children With Spastic Cerebral Palsy: A Narrative Review

Purpose: A broad range of rehabilitative therapies are currently being used and/or researched to improve functionality and prevent complications in hand impairments due to spastic cerebral palsy in children. However, outcomes are highly variable and no ideal rehabilitation strategy exists. The purpose of this research was to identify the current state of non-surgical therapies for spastic cerebral palsy in children, and to offer recommendations for the development of new treatment modalities. Methods: Articles were identified through searches of Pubmed and Scopus. Medical Subject Headings (MeSH) terms and key words were used as follows: (1) cerebral palsy, AND (2) child OR adolescent, AND (3) hand, AND (4) therapy OR rehab*, AND (5) randomized controlled trial OR random sampling OR double blind method OR single blind method OR systematic review. Results: In this study, a total of forty-one articles representing six approaches to therapy were reviewed. The approaches were traditional occupational therapy, hand-arm bimanual intensive therapy (HABIT), constraint-induced movement therapy (CIMT), botulinum toxin injections, mirror visual feedback, and robotic assisted motion. Additionally, this review identified key factors of therapy that are relevant to patient outcomes, including the age of the patient, intensity of therapy, and compliance of at-home training. Conclusions: Traditional therapy relies heavily on the frequency, duration, and consistency of the therapy. Thus, patient ability to attend sessions can limit the effect of therapy. HABIT, CIMT, and mirror visual feedback are effective approaches, but they are only applicable to unilateral impairments. Patients given Botulinum toxin injections show significant improvement, but injections every three to six months are a costly addition to therapy. Soft robotic rehabilitation is a promising extension of therapy; specifically, it could target the critical developmental window and fill the need for an easy-to-use device to improve at-home training compliance and intensity. Additionally, soft robotic rehabilitation would be applicable to a wide variety of clinical presentations. Regarding development of soft robotic devices, comfort and ease of use are of the upmost importance to encourage compliance. Additional considerations must be made for the target population; for example, the device must accommodate growth spurts and skeletal maturation.