APRIL 20, 2005 | For 14-year-old Chase Eppinette of Little Rock, the effects of cerebral palsy had robbed him of the ability to perform some of the simplest tasks, from feeding himself to throwing a ball.
The disorder, which limits muscle control, had confined him to a wheelchair and frozen his hands into an outward curl, rendering them virtually useless. His mother, Cindy Green, said she had heard that Randy Bindra, M.D., an orthopaedic surgeon at the
Bindra’s approach is to surgically rewire some of the muscles, moving some of the strong muscles to help the weaker ones. It is a procedure that Bindra said could help others with cerebral palsy who have similar problems.
In December, Bindra operated on the teen-ager’s right hand at ACH, disconnecting two muscles that run along the forearm. One was reattached at the back of the wrist while the other was wrapped around one of the bones. As a result, he can lift his hand off his wrist and rotate his hands toward his body.
“Chase previously had no function with his hands, just as support and one functioning index finger on the left to operate his wheel chair,” said Bindra, who is director of the Center for Hand and Upper Extremity Surgery at the University of Arkansas for Medical Sciences (UAMS) and an associate professor in the UAMS College of Medicine. “After we finish with both hands, I expect he will be able to use his hand for some basic broad-based activities such as feeding himself.”
In the past, Chase could feed himself somewhat by holding it between the backs of his hands. It was not always successful, his mother said, which is why the family has hopes the surgery will allow him to hold a utensil for the first time.
But the improvements from the first surgery alreadly have lifted his spirits. It gave him a feeling of normalcy, Green said, and also brought some unexpected benefits.
“He had never seen the palm of his hand before,” Green said. “He didn’t know there were lines on it.”
Chase continues to wear a therapeutic splint on his hand, which is intended to further straighten his hand. He also goes to hand therapy twice a week as well as occupational therapy.
His mother said that seeing him use his hand and straighten it was exciting for her and Chase.
“It was like seeing your child walk or crawl for the first time but that’s something I never got,” she said. “It was a milestone, but one that we had to wait 14 years for.”
Bindra is scheduled to operate on Chase’s left hand in May. The surgeon said the improvements of the surgery could also allow Chase to do one-finger typing with both hands and make it easier for other activities, such as being dressed, since his wrists won’t be tightly bent down.
“Holding and throwing a large ball is certainly a realistic goal,” Bindra said.
That’s good news for Chase, who is on the waiting list to receive an assistance dog to help with many daily tasks. “He wants to be able to throw a ball to his dog,” his mother said.
Bindra said the surgery can offer similar benefits for those cerebral palsy patients who have the same kind of hand problems. The final outcome, he said, varies depending on the severity of the condition.
“When you have no use from your hands, even the slightest movement is a big thing,” Bindra said. “Even those patients who have other disabilities as part of the cerebral palsy can benefit, as the surgery can help maintain hygiene, for example, by releasing fingers that are tightly clenched into the palm.
“I feel that every child who suffers from cerebral palsy or similar disorders should be regularly evaluated by an occupational therapist and once every few years by a hand surgeon during their early school years so that they always have access to new surgical developments and options.”
Bindra praised the team approach to treating children with cerebral palsy that includes neurologists, pediatricians, upper and lower limb specialists and spine surgeons, as well as physical and occupational therapists. Regular therapy is most important, he said, as therapists are able to pick up even the slightest loss in function and can refer the patients for surgical intervention.
“Fortunately, cerebral palsy is non progressive, meaning the patients will rarely get worse,” Bindra said. “Once they learn a new function or get some improvement from surgery, it can be expected to last forever.”
Center for Hand and Upper Extremity Surgery: http://www.uams.edu/ortho/hand.asp
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