The good news is that everyone involved in treating a child with cerebral palsy or another neuromuscular disorder has always focused a lot of time and effort on helping the child to walk — or, at the very least, to maximize functioning in their legs and feet.

Historically, however, there has been less of a focus on treating spasticity in a child’s hands and arms.  Left untreated, this spas-ticity might lead to muscle contractures and deformities that are difficult or even impossible to correct later in life.

At Gillette Children’s, a group of occupational therapists and certified orthotists have come together to increase awareness about the importance of evaluating and treating a child’s spasticity in their arms and hands, and to look at opportunities for improving care.

“Simple splinting can help many children avoid muscle contractures (muscle shortening) and fisting that may otherwise cause permanent deformities,” explains occupational therapist Nancy Mitchell.

Severe contractures and fisting may also make a child’s hands so tight that air doesn’t circulate and the skin breaks down.  “You want to be able to open the hand so the child doesn’t get decubitus (an open skin lesion),” says Darius Picking, certified orthotist.  The fold in the elbow is another area for breakdown of the skin.

In addition to keeping muscles from shortening, hand splints can help some children use their hands more effectively.  For example, a functional splint worn during the day provides good alignment of the child’s thumb, hand and wrist.  At the same time, it allows the child to have movement in their hand (for writing or other activities). The child can then wear more rigid splints at night to provide the muscles with a good stretch to prevent contractures.

Early intervention is important

“The key (to effective splinting) is early intervention,” Picking says.  “It can help prevent big-time problems.”  Starting early in the child’s life can also result in greater acceptance and compliance by the child and family.

“Asking an 11-year-old to start wearing hand splints is a real hard sell,” Mitchell says.  “But if (hand splints) are introduced to the child along with their AFOs (ankle foot orthoses), when they are younger, they become part of the routine.”

On occasion, it can be a “hard sell” with parents, too, who might not understand the benefits of splinting the hands or arms, or don’t think their child’s contractures or fisting are severe enough to warrant it.

At the other extreme, Mitchell recalls one mother who was thankful for the suggestion.  “She said she’d been asking for help for years, but she couldn’t get other (health care providers) to acknowledge her child’s need.”

Mitchell and Picking are hopeful that by raising the level of awareness in families and health professionals alike, more children will be splinted, and perhaps reach greater function than expected.

Who might benefit from hand or arm splints?

Mitchell suggests that parents ask their child’s health care provider about arm or hand splints if their child has any of the following conditions:

• tightness in the hand or arm
• fisted hands
• poor range of motion in the wrist and hand
• trouble pulling the thumb out of the palm
• a wrist that is held in a bent-down position
• an elbow that won’t straighten