An estimated 75% of the 10,000 children diagnosed with cerebral palsy each year will have a form called spastic cerebral palsy, which is characterized by chronic muscle tightness that makes movement and coordination difficult.
Many of these will be further classified as having hemiplegic spastic cerebral palsy, which affects only the arm and leg on one side of the body. Often times, hemiplegic CP causes greater disability in the arm and hand than in the leg.
The resulting limitations with arm and hand movements can make everyday tasks such as eating and dressing quite difficult for children to learn.
For this reason, much research has focused on different therapies that may increase upper limb function in those with hemiplegic cerebral palsy. And, while many of these have discovered positive effects for the arm as a whole, a new study sought to focus solely on improving hand function and dexterity through a method called task training.
Researchers Study Task Training After Noting Benefits for Stroke Patients
Researchers at South Korea’s Gachon University envisioned the benefits of task-oriented training after noting earlier studies showed improvement in arm and hand function in children through sensory-integration, neurodevelopmental treatment or constraint-induced movement therapy.
Sensory integration therapy uses repetitive activities to stimulate the senses, in the hope that a child’s brain will adapt and react more efficiently over time. Neurodevelopmental treatment guides patients through completion of specific tasks to promote motor learning. Constraint-induced movement therapy utilizes restriction of a healthy limb while practicing repetitive use of a disabled limb to attempt to improve function in the affected limb.
The study team also noted that task-oriented training had previously been shown to help arm and gait function in stroke patients, as well as function of the entire arm and mobility as a whole in children with cerebral palsy. Therefore, they proposed studying its effects more specifically on hand dexterity and strength in children with spastic hemiplegic cerebral palsy.
What is Task-Oriented Training?
Task oriented training practices specific everyday tasks with the intention of teaching the patient to learn or re-learn a skill. This differs from therapies that focus simply on regaining movement, or those which break a task down into several parts that are learned separately and later reconstructed.
Some examples of task-specific training are learning to stand up, walk, answer a telephone, unscrew a lid or brush teeth. In recent decades this modality has been used increasingly in the rehabilitation of stroke patients.
Study Focused on Improving Upper Limb Function
For this study, the research team followed 12 children between the ages of 5 and 13 who were diagnosed with spastic hemiplegic cerebral palsy. All participants registered at a level 1 or 2 on the gross motor function classification system, meaning they are generally able to walk short distances, climb stairs with assistance or even jump in some cases.
Children were divided into 2 groups of six, with one group receiving only traditional occupational therapy and the other group receiving both occupational therapy and task oriented training twice per week over a period of 4 weeks.
The task specific training consisted of several reaching, stacking and stretching activities focused on helping hand function, as well as grip strength testing.
What researchers discovered was a significant improvement in hand dexterity using a Box and Block Test in the group that had received task oriented training for the duration of the study in comparison to the group that did not. However, there was no significant improvement in grip strength from the task specific training.
What can you do for your child?
Based on the results of this study, children with upper arm disability due to spastic hemiplegic cerebral palsy might benefit from an ongoing therapy program that includes task-specific training.
As a parent, you can discuss your child’s specific therapy program with their rehabilitation expert to determine if they are already integrating task specific activities. If not, it may be beneficial to suggest modification.
Also, ask your child’s therapist for any task-specific activities you can work on with your child at home in the areas they struggle most. Improving just one daily activity can open up new paths for independence.
Moon, J, et al. The effects of task-oriented training on hand dexterity and strength in children with spastic hemiplegic cerebral palsy: a preliminary study. Journal of Physical Therapy Science. (October 29, 2017). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5684012/
Lopez, J. Task Training Seems to Improve Hand Dexterity in Kids with Cerebral Palsy, Study Finds. Cerebral Palsy News Today. (January 3, 2018). Retrieved fromhttps://cerebralpalsynewstoday.com/2018/01/03/task-training-improves-hand-dexterity-kids-with-cerebral-palsy/
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Cerebral Palsy is the most common form of childhood disability in America, affecting nearly 1 out of every 500 births and as many as a million young people at any given time.