Evaluation of Hand Sensation and Function in Children With Cerebral Palsy Aydan Kurtaran, MD,* Barın Selc¸uk, MD,w Fatma Kumbara, MD,z Elif Yalc¸ın, MD,* Murat Erso ¨z, MD,* and Mu ¨fit Akyu ¨z, MD* Background: As many activities are affected consequently, im- pairment of hand function is important in cerebral palsy (CP). Aims: The aim of this study was evaluation of hand function and sensation in children with CP. Study Design: A cross-sectional study. Materials and Methods: Thirty-six children with CP and 18 healthy children were enrolled into the study. Grip strength of both the hands, lifting 2 objects 10 times weighing 200 and 400 g, superficial sensation, deep sensation, and cortical sensation of hands were evaluated in all children. Level of functional activity and presence of ambulation were also recorded. Results: There were statistically significant differences between CP and control groups with respect to grip strength of both hands, lifting an object weighing 400 g, and stereognosis (dis- crimination of 10 objects). Higher grip strength values were observed in ambulating patients. There were negative correla- tions between functional activity level (lower functional activity level score represented better function) and lifting 10 times an object weighing 200 and 400 g for both hands, and the number of discriminated objects among 10 for nondominant hand. Su- perficial sensation was normal in 94%, and graphestesia was normal in 47% of children with CP. Conclusion: Hand function and sensation are impaired in chil- dren with CP. Key Words: cerebral palsy, hand function, hand sensation (Neurosurg Q 2015;25:145–148) C erebral palsy (CP) is a sensory motor disease affecting posture and motor movement control. 1 In this disease, many systems and functions of the body may be affected. Impaired hand function is an important problem that may create obstacles for nutrition, writing, ambulation, and transfer activities. Most activities of daily living (ADL) require some kind of bimanual involvement, where one hand stabilizes or fixates the object to be manipulated. 2 Along with muscle spasticity and hypertonia, chil- dren with hemiplegic CP experience a loss of upper motor neuron excitation that is typically associated with poor selective motor control and weakness, and in some in- stances, sensory deficits. 3 It has been reported that arm- hand function is impaired in almost 50% of patients with CP. However, little attention has been paid to the arm- hand function compared with gross motor function of children with CP. 4 The basic motor functions of the hand is grasping, releasing, and holding. In CP, upper extremity problems can be categorized as motor (paresis, coordination dis- order) and sensory (proprioception, stereognosia, bar- ognosia, superficial sensation). Lack of coordination or sensory awareness of how to use the hand is often a major problem in a child with CP. 5 The success rate of surgical procedure aiming to correct deformity of the hand is as- sociated with the degree of sensory deficit. Thus, hand surgeons recommend preoperative evaluation of the sense. 6 This study aimed to investigate the hand functions and hand sensation of the children with CP. MATERIALS AND METHODS The study involved 36 children with CP who were hospitalized for rehabilitation and 18 healthy children (controls). The local ethics committee of our hospital approved the study protocol and informed consent was obtained from the subjects’ family. The age, sex, disease etiology, involvement type, ambulatory state, functional activity level, and dominant hand of the cases were in- quired. The body mass index (BMI) and bone age of the cases based on the hand radiograph were recorded. The grasp force of both hands were evaluated by using Jamar (Jackson, MI) hand dynamometer. Each of the cases was asked to lift 2 objects with weights of 200 and 400 g by each hand as high as 10 and 20 cm 10 times, and the number of the times they could lift was recorded. Stereognosia was evaluated based on the number of the 10 objects—for example, spoon, pencil, eraser, nap- kin, key, wood, ball, money, fork, pencil sharpener—that could be differentiated by the case. Sensory examination included light touch, pain, 2-point discrimination (TPD) From the *Ankara Physical Medicine and Rehabilitation Training and Research Hospital; zGu¨mu¨s ¸ig˘ne PMR Center, Ankara; and wDe- partment of PMR, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey. The work should be attributed to Ankara Physical Medicine and Re- habilitation Training and Research Hospital, Ankara, Turkey. The authors declare no conflict of interest. Reprints: Aydan Kurtaran, MD, Yıldız 4. cad. S ¸ehit Mustafa Dog˘an Sok. Gu¨ l Apt. 96/6, Ankara 06550, Turkey (e-mail: aydankurtaran@ mynet.com). Copyright r 2014 Wolters Kluwer Health, Inc. All rights reserved. ORIGINAL ARTICLE Neurosurg Q  Volume 25, Number 2, May 2015 www.neurosurgery-quarterly.com | 145