Effectiveness of the Functional Hand Splint and Specific Tasks in the Domiciliary Environment Applied to Children With Unilateral Cerebral Palsy

Study Overview
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Brief Summary
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The main objective: To determine the effectiveness of a treatment that combines the application of a functional upper limb orthosis together with a home-based program of specific tasks in children with unilateral cerebral palsy versus a home-based program of specific tasks in improving structure and function, activity and participation. Hypothesis: The application of a functional upper limb orthosis together with a home-based program of specific tasks in children with unilateral cerebral palsy results in a greater improvement in structure and function, activity and participation compared to the implementation of a home-based specific task program.

Detailed Description
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Randomized clinical trial with blinding of the evaluator and the person analyzing the data. A home-based protocol of specific tasks will be performed in both groups and one of the groups will also receive a treatment with upper limb splinting. The assessment will be made by a single evaluator with 10 years of experience in the treatment of children with motor disabilities.

Official Title
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Effectiveness of the Functional Hand Splint and Specific Tasks in the Domiciliary Environment Applied to Children With Unilateral Cerebral Palsy. Randomized Clinical Trial

Conditions
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Hemiplegia and Hemiparesis, Cerebral Palsy Infantile

Intervention / Treatment
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* Device: Home-based protocol in specific tasks
* Device: Upper-limb splint


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Diagnosis of unilateral cerebral palsy (hemiplegia-hemiparesis). Ages between 5 and 12 years. Levels I-III of the Manual Ability Classification System (MACS) Levels I-III of the Gross Motor Function Classification System (GMFCS) Able to understand and respond to verbal instructions. Exclusion Criteria: Cognitive impairment identified by the school report. Hand orthopedic surgery in the last 6 months. Neuropharmacological intervention in the last 6 months. Allergy to upper limb orthosis material. Affectation of the manual function not due to the neurological condition (trauma, burn ...). Current treatments not compatible with the study. Other significant neurological affections (crisis, severe visual impairment ...).

Ages Eligible for Study
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Minimum Age: 5 Years
Maximum Age: 12 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Randomized Controlled Trial
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Intervention group<br>Upper-limb splint and home-based protocol in specific tasks | Device: Home-based protocol in specific tasks<br>* The home-based protocol in specific tasks will be an individualized protocol designed for the child according to the results of the baseline assessment and will require active participation. It is a program that is integrated into the daily routines of the child. A study investigator will tell the family the procedure to follow.<br>Device: Upper-limb splint<br>* In the case that treatment with splint is also received, a researcher of this study will take measurements of the hand and will provide the appropriate splint. The intensity of the application will be 5 days a week from monday to friday, for 6 hours a day, for a period of 6 weeks.<br>|
| Active Comparator: Control group<br>Home-based protocol in specific tasks | Device: Home-based protocol in specific tasks<br>* The home-based protocol in specific tasks will be an individualized protocol designed for the child according to the results of the baseline assessment and will require active participation. It is a program that is integrated into the daily routines of the child. A study investigator will tell the family the procedure to follow.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Primary Outcome_Change from baseline Assisting Hand Assessment measure. Measurement of bimanual performance in pre-established tasks | Activity measurement: Assisting Hand Assessment. Measurement of bimanual performance in pre-established tasks. It quantifies the effectiveness with which the child uses his affected hand in bimanual activities. | Pre-intervention; Post-intervention (6 weeks after); Follow up (8 weeks after the intervention). | 
| Primary Outcome_2. Change from baseline Children's Hand-use Experience Questionnaire measure. Measurement of bimanual performance in activities of daily living. | Participation and activity measurement: Children's Hand-use Experience Questionnaire. The objective of the questionnaire is to measure bimanual performance in activities of daily living. | Pre-intervention; Post-intervention (6 weeks after); Follow up (8 weeks after the intervention). | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Secondary Outcome_Change from baseline Box and Blocks Test measure. Measurement of unilateral gross manual dexterity. | Activity measurement: Box and Blocks Test assesses unilateral gross manual dexterity. | Pre-intervention; Post-intervention (6 weeks after); Follow up (8 weeks after the intervention). | 
| Secondary Outcome_2. Change from baseline Jebsen Hand Function Test measure. Measurement of a broad range of uni-manual hand functions required for activities of daily living. | Participation measurement: Jebsen Hand Function Test. The objective of this test is to assess a broad range of uni-manual hand functions required for activities of daily living.7 activities performed with the affected hand and healthy hand separately. | Pre-intervention; Post-intervention (6 weeks after); Follow up (8 weeks after the intervention). | 
| Secondary Outcome_3. Change from baseline House Thumb in Palm Deformity Classification. Classify the deformity level of thumb. | Structure and function measurement: House Thumb in Palm Deformity Classification. This tool classify the deformity levels taking into account the structure of the thumb. | Pre-intervention; Post-intervention (6 weeks after); Follow up (8 weeks after the intervention). | 
| Secondary Outcome_4. Change from baseline Neurological Hand Deformity Classification. This tool classify the deformity levels of wrist and fingers. | Structure and function measurement: Neurological Hand Deformity Classification. This tools classify the deformity levels taking into account the wrist, fingers. | Pre-intervention; Post-intervention (6 weeks after); Follow up (8 weeks after the intervention). | 
| Secondary Outcome_5. Change from baseline Grip and Pinch Strength measure. Measurement of pinch, wrist and foream strength. | Structure and function measurement: Grip and Pinch Strength. One will be used to Assess the grip of the thumb (Pinch Gauge Dynamometer) and another to assess the strength of the wrist and forearm (Hand and Wrist Dynamometer). | Pre-intervention; Post-intervention (6 weeks after); Follow up (8 weeks after the intervention). | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Cerebral palsy, Hemiplegia, Upper-limb splint, Home-based, Social Participation