Recovery of the precision grip in children after traumatic brain injury.

OBJECTIVE

To identify quantitative parameters that are sensitive enough to detect impairments and improvements of grasping in children after traumatic brain injury (TBI) by analyzing the isometric fingertip forces of a precision grip-lift task.

DESIGN

Follow-up and case-control study.

SETTING

Tertiary pediatric trauma rehabilitation center in Germany.

PARTICIPANTS

Thirteen children (age range, 5-14 y) with moderate or severe TBI. Trauma severity was assessed with the Glasgow Coma Scale (score range, 3-9) and the Injury Severity Score (range, 16-66 points). Control data were obtained from 13 age- and gender-matched healthy children.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Children were examined 3 times (t0, t1, t2). The first date of examination (t0) was defined by the Barthel Index (part B, >20 points). Reexaminations followed after 1 (t1) and 5 (t2) months of inpatient rehabilitation. Quantitative measures included 3 grip-force parameters, 2 load force parameters, 1 parameter of the coordination between grip force and load force, and 3 timing parameters in a precision grip-lift task. Clinical improvements and recovery of activities of daily living were described with the Barthel Index (qualitative measure).

RESULTS

Peak grip force, maximum negative load force, grip force in the static phase and its standard deviation, and grip-force/load-force ratio at maximum grip force showed significant improvements during the observation period (5 mo). Also, the preparation phase and preload duration, but not the load duration, changed significantly.

CONCLUSIONS

Impairments and the recovery of grasping in children after TBI can be objectified with quantitative analyses of the precision grip. Several grip-force and timing parameters were sensitive for the description of restitution processes.