REHABILITATION OF THE HAND IN CHILDREN AND ADOLESCENTS AFTER BRAIN DAMAGE

Abstract

We present the function of the hand after brain injury and describe the mechanism and causes of the problems that later manifest as dysfunction of the upper limb and hand. We describe the corticospinal tract and its course and importance in the development of hand dysfunction. We describe the recovery and the stages that can be observed in the rehabilitation of the hand: from the initial flaccidity to the development of spasticity to the final restoration of strength and normalisation of tone. Since the reorganisation and plasticity of the cortex and corticospinal cord are important for the recovery of function, while the unfavourable plasticity and excessive excitability of the reticulospinal cord probably cause most of the problems, we describe these plasticity processes in more detail. We underpin the stimuli and modulations of neural plasticity with rehabilitation strategies, such as early interventions with repetitive targeted intensive therapy (motor training, constraint training, robotic training), appropriate non-invasive brain stimulation and pharmacological agents (including botulinum toxin application), as well as music therapy and sensory stimulation, all of which contribute to better recovery and restoration of hand function. We briefly present the tests we use to assess hand function and various occupational therapy methods we use in children and adolescents after brain injury that are beneficial for children and adolescents.

Keywords

• arm
• upper limb
• motor cortex
• corticospinal tract
• plasticity
• rehabilitation
• occupational therapy