Bull. Fac. Ph. Th. Cairo Univ., Vol. 14, No. (2) Jul. 2009 75 Influence of Elbow Immobilizer on Hand Function in Children with Athetoid Cerebral Palsy Gehan M. Abd El-Maksoud *, Nevein M. Gharib** and Samah A. El-Shemy* * Department of Physical Therapy for Growth and Developmental Disorders in Children and its Surgery, Faculty of Physical Therapy, Cairo University. ** Department of Physical Therapy for Neuromuscular Disorders and its Surgery, Faculty of Physical Therapy, Cairo University. ABSTRACT The purpose of this study was to investigate the effect of using elbow immobilizer during the application of occupational therapy program on improving the hand function in children with athetoid cerebral palsy (CP). Forty children with athetoid CP of both sexes (18 girls and 22 boys); their ages ranged from five to eight years (mean age 6.51 ± 0.97 years), participated in this study. They had fluctuating tone in the upper limb, involuntary movement in form of athetosis and could sit alone or even with support. Children were randomly divided into two groups of equal number; study and control groups. Children in study group received a designed occupational therapy program while wearing the elbow immobilizer. Those in control group received the same occupational therapy program without wearing the elbow immobilizer. Treatment was conducted three times / week for successive three months to both groups. Hand function was evaluated before and after treatment by using the Grasp and Release Test (GRT) and the Peabody Developmental Motor Scale-2 (PDMS-2). The post-treatment results showed a statistically significant improvement of the GRT in both groups (in favor of the study group). Moreover, there was a significant improvement of the PDMS-2 scores in the study group. The present study concluded that wearing elbow immobilizer during the application of occupational therapy program has a potential benefits to improve the hand function in children with athetoid CP. Keywords: Elbow immobilizer, Hand function, Athetosis, Cerebral palsy, Occupational therapy. INTRODUCTION erebral palsy (CP) is a well-defined neurodevelopmental condition beginning in infancy and persisting throughout life. It encompasses a group of disorders in the development of movement and posture that cause activity limitations and are attributed to non progressive disturbances occurring in the developing fetal or infant brain 1 . Based on the clinical signs, there are several types of children with CP which include spastic, dyskinetic, hypotonic, ataxic, and mixed types. Dyskinetic CP has several forms as athetosis, dystonia, chorea and tremors. Athetosis is the most common form, which is characterized by slow involuntary movement of the face and extremities particularly affecting the distal musculatures2. Athetoid CP, like all CP types, is caused by brain damage. The damage creating athetoid CP symptoms is located in the cerebellum or basal ganglia. These areas of the brain help in controlling the movement. Specifically, the cerebellum and basal ganglia are responsible for processing the nerve signals enabling coordinated, smooth movement and maintaining body posture. Damage to these areas can make people develop slow, random, involuntary movements 3 . Athetoid CP is characterized by fluctuations in muscle tone between being too tight and too loose. It usually affects the whole body instead of a particular region. Interestingly, a large percentage of people with athetoid CP have above average intelligence. Children with athetoid CP have trouble holding themselves in an upright, steady position for sitting or walking, and often show lots of movements of their face, arms and upper body that they don't mean to make (random, involuntary movements). These movements are usually big. For some kids with athetoid CP, it takes a lot of work and concentration to get their hand to a certain spot (like to scratch their nose or reach for a cup). Because of their mixed tone and trouble keeping a position, they may not be able to hold onto things (like a toothbrush or fork or pencil) 4 . C