Wesdock Kimberly A, Kott Karen, Sharps Chester
Motion Analysis Laboratory, BioMotion at Children's Hospital, 2924 Brook Road, Richmond, VA 23220-1298, USA.
J Hand Ther. 2008 Oct-Dec;21(4):386-97. doi: 10.1197/j.jht.2008.01.001.
Evaluation of hand function for treatment planning and outcome documentation in individuals with cerebral palsy (CP) proves challenging. Because of the complexity of multisystem involvement and time constraints during physician clinic visits, we developed a comprehensive evaluation protocol to assist with team surgical decision making in CP. We report findings from three adolescents with hemiplegic CP who were evaluated pre-/post-intervention using measures of impairment (clinical examination procedures), activity (Pediatric Evaluation of Disability Inventory and Jebsen-Taylor Test of Hand Function), and participation (goal attainment scaling). An intervention to improve hand function consisted of single-event multilevel orthopedic surgery and postsurgical therapy. Wrist/finger biomechanics and active range of motion improved after the intervention. The targeted surgical intervention and undefined therapy intervention, however, seemed to have little influence on activity and participation. The descriptive results of these exemplar cases suggest that, instead of assisting only with surgical decision making, the evaluation protocol should focus on specific postsurgical therapy plans in addition to surgical/therapy decision making.
对脑瘫（CP）患者进行手部功能评估以用于治疗规划和结果记录具有挑战性。由于多系统受累的复杂性以及医生门诊期间的时间限制，我们制定了一项全面的评估方案，以协助CP患者团队进行手术决策。我们报告了三名偏瘫型CP青少年的评估结果，他们在干预前后分别使用了损伤指标（临床检查程序）、活动指标（儿童残疾评估量表和杰布森 - 泰勒手部功能测试）和参与指标（目标达成量表）进行评估。一项旨在改善手部功能的干预措施包括单事件多级骨科手术和术后治疗。干预后，手腕/手指的生物力学和主动活动范围有所改善。然而，有针对性的手术干预和不明确的治疗干预似乎对活动和参与影响不大。这些典型案例的描述性结果表明，评估方案不应仅协助手术决策，还应在手术/治疗决策之外，关注具体的术后治疗计划。
