Design and Use of a 3D-Printed Dynamic Upper Extremity Orthosis for Children With Cerebral Palsy and Severe Upper Extremity Involvement: A Pilot Study

Abstract

Abstract Importance: Children with cerebral palsy (CP) and severe hand impairment have limited options for upper extremity (UE) orthoses. Objective: To (1) design and fabricate a customized low-cost, functional, three-dimensional (3D) printed dynamic upper extremity orthosis (DUEO) and (2) examine, using a comprehensive evaluation, the effect of the orthosis on the UE function of children with unilateral UE CP, Manual Ability Classification System (MACS) Levels III to V. Design: Pilot study. Assessments were performed pretreatment and immediately posttreatment. Setting: Hospital-based outpatient occupational therapy department. Participants: Five patients, ages 13 to 17 yr, with CP and unilateral UE involvement MACS Levels III to V. Intervention: Custom forearm thumb opponens orthosis and the DUEO were designed and fabricated by a multidisciplinary team for use during eight 1-hr occupational therapy sessions targeting bimanual UE training. Outcomes and Measures: Pretreatment and posttreatment assessments included the Assisting Hand Assessment (AHA), Melbourne Assessment 2 (MA–2), Pediatric Motor Activity Log–Revised (PMAL–R), and the Pediatric Quality of Life Inventory: CP Module (PedsQL:CP). Results: All participants had higher posttreatment scores on at least one measure. Four had minimal clinically important differences (MCID) on the AHA. Three met MCID criteria on MA-2 subtests (one negative change). Four demonstrated improvement on the PMAL–R (one participant achieved an MCID score), and three reported improvements in more than one PedsQL:CP domain. Conclusions and Relevance: This novel 3D-printed device, in combination with occupational therapy, shows promising evidence that children who score in lower MACS levels can show gains in UE function. What This Article Adds: This study demonstrates that a customized, 3D-printed dynamic orthosis, in combination with occupational therapy intervention, can facilitate UE function in children with severe hand impairment.