Effectiveness of hand splints on upper limb skills and functional activities in children with cerebral palsy: a review

Rohina Kumari, Surbhi ., Sakshi Saharawat


Cerebral Palsy is a non-progressive neurological disorder in which children may experience similar physical limitations, including those related to upper limb skills that affect the child's ability to participate in age-specific activities. The use of hand-splints in children with neurological conditions is little reported, they continue to be widely used to improve upper limb skills and functional activities. This review was done to investigate the use and effects of hand splints in Cerebral Palsy patient as orthotic treatment found to be very positive result in correcting and maintaining the achieved results. Electronic database search was conducted using Google scholar, Science direct, Pub Med, Cochrane Library and reference lists from all retrieved articles. Common problems in upper limb due to CP are flexion contractures of the fingers and wrist due to spasticity, pronation deformity of the forearm, thumb-in-palm deformity and hand-related disabilities, all lead to decrease in grip and muscle strength. Hand splints are often used to help a weak or ineffective joint or muscle to enhance a person's arm or hand posture, mobility, quality of motion, and function. The findings suggest that children with CP experience increased grip strength and fine motor dexterity when using different hand splints. This review summarizes the present state of understanding the extent to which orthotic management in CP can improve in the patient’s skills and functional activities by improving the muscle strength and hand function, also offers clinical suggestions for prescribing orthosis in order to optimize efficacy.


Cerebral palsy, Upper extremity, Spasticity, Hand splints, Hand function

Full Text:



Virgínia D, Pt V. Muscle stiffness and strength and their relation to hand function in children with hemiplegic cerebral palsy. Dev Med Child Neurol. 2006;48:728-33.

Giuliani A. Dorsal Rhizotomy for Children with Cerebral Palsy : Support for Concepts of Motor Control. Mov Sci Ser. 1991;71(3).

Damiano DL, Christopher L, Vaughan MFA. Muscle Response To Heavy Resistance Exercise In Children With Spastic Cerebral Palsy. Dev Med Child Neurol. 1995;(37):731-9.

Agarwal A, Verma I. Cerebral palsy in children : An overview. J Clin Orthop Trauma. 2012;3(2):77-81.

Burtner PA, Otr L, Poole JL, Otr L, Torres T, Abeyta R, et al. Effect of Wrist Hand Splints on Grip, Pinch, Manual Dexterity, and Muscle Activation in Children with Spastic Hemiplegia : A Preliminary Study. J Hand Ther. 2008;(21):36-43.

Jackman M, Novak I, Lannin N. Effectiveness of hand splints in children with cerebral palsy : a systematic review with meta-analysis. Dev Med CHILD Neurol. 2013;138-47.

Arner M, Nicklasson S, Sommerstein K. Hand Function in Cerebral Palsy. Report of 367 Children in a Population-Based Longitudinal Health Care Program. J Hand Surg Am. 2008;33:1337-47.

Teplicky R, Law MDR. The Effectiveness of Casts, Orthoses, and Splints for Children with Neurological Disorders. Infants Young Child. 2002;(15):42-50.

Autti-Ra¨mo¨ I, Suoranta J, Anttila H, Malmivaara A MM. Effectiveness of Upper and Lower Limb Casting and Orthoses in Children with Cerebral Palsy An Overview of Review Articles. Cereb palsy. 2006;(85):89-103.

Morris C, Bowers R, Ross K, Stevens P, Phillips D. Orthotic management of cerebral palsy : Recommendations from a consensus conference. NeuroRehabilitation. 2011;28:37-46.

Wilton J. Casting , splinting , and physical and occupational therapy of hand deformity and dysfunction in cerebral palsy. Hand Clin. 2003;19:573-84.

Fess EE. A History of Splinting : To Understand the Present , View the Past. J Hand Ther. 2002;97-132.

Rosenbaum P, Stewart D. The World Health Organization International Classification of Functioning, Disability, and Health: A Model to Guide Clinical Thinking, Practice and Research in the Field of Cerebral Palsy. Semin Pediatr Neurol. 2004;11(1):5-10.

Brennan JB. Response to stretch of hypertonic muscle groups in hemiplegia. Br Med J. 1959;1504-7.

Kreimeyer D, Gallagher T. A Comparison of Dorsal and Volar Resting Hand Splints in the Reduction of Hypertonus. Amencan J Occup Ther. 1982;36(10).

Langlois S, Mackinnon JR, Pederso L. Hand splints and cerebral spasticity: A review of the literature. Can Occup Ther Found. 1989;56(3).

Bonder BR. Comparative Effects Of Three Hand Splints On Bilateral Hand Use , Grasp , And Ann-Hand Posture In Hemiplegic Children : A Pilot Study. Occup Ther Res. 2015;75-92.

Leibowitz JHF and JM. Improvement in Grasp Skill in Children In With Hemiplegia With the MacKinnon Splint. Res Dev Disabiliries Vol. 1988;9:145-51.

Goodman GSB, Key. The Effects of a Short Thumb Opponens Splint on Hand Function in Cerebral Palsy: A Single-Subject Study. Am J o/Occupa/ional Ther. 1991;45(8):726-31.

Elliott C, Reid S, Hamer P, Alderson J, Elliott B. Lycra arm splints improve movement fluency in children with cerebral palsy. Gait Posture. 2011;33(2):214-9.

Lannin NA, Ada L. Neurorehabilitation splinting : Theory and principles of clinical use. Neuro Rehabilitation. 2011;28:21-8.

Morris C, Bowers R, Ross K, Stevens P, Phillips D. Orthotic management of cerebral palsy : Recommendations from a consensus conference. NeuroRehabilitation. 2011;28:37-46.

Barroso PN, Vecchio SD, Xavier YR, Sesselmann M, Araújo PA, Pinotti M. Improvement of hand function in children with cerebral palsy via an orthosis that provides wrist extension and thumb abduction. Clin Biomech. 2011;26(9):937-43.

Hughes A, Uct OT, Wits OT. The effect of neoprene thumb abduction splints on upper limb function in children with cerebral palsy. South African J Occup Ther. 2017;47(3):3-10.

Tone MOF, Weight I, Splint B, An AS, Modality A. Management of tone and hand functions in cerebral palsy. 2014;3(35):9173-8.

Louwers A, Katinka AM, Frans F, Anita N. Immediate effect of a wrist and thumb brace on bimanual activities in children with hemiplegic cerebral palsy. Dev Med CHILD Neurol. 2011;(2009):321-6.

Ozer K. Neuromuscular electrical stimulation and dynamic bracing for the management of spasticity in children with cerebral palsy. Dev Med Child Neurol. 2006;(48):559-63.

Teplicky R, Law MDR. The Effectiveness of Casts , Orthoses and Splints for Children with Neurological Disorders. inf young Child. 2002;15(1):42-50.

Carmick J. Use of Neuromuscular Electrical Stimulation and a Dorsal Wrist Splint to Improve the Hand Function of a Child With Spastic Hemiparesis. Phys Ther. 1997;77(6):661-71.

Blcrit E, Ballantyne J, Horsman PC. A study of a dynam c proximal stability splint in the management of children with cerebral palsy. Dev Med Child Neurol. 1995;37:544-54.

Reid DAS. Influences of a hand positioning device on upper extremity control of children with cerebral palsy. 1992;15-29.

Stevens P. Are we giving kids a hand? Wrist and hand splints in the management of cerebral palsy. 2014. Available at: Article/2014-12_01. Accessed on 20th December, 2020.