Hand use at home and in clinical settings by children with cerebral palsy: a qualitative study.

The purpose of this study was to understand the physical, attitudinal, and assistive characteristics of the home and the therapeutic settings that enable and/or hinder hand use by children with spastic hemiparesis CP. A qualitative study with 7 children with CP, their caregivers, and therapists was conducted. Children were observed at home and in their therapeutic settings to understand the supports and barriers from these environments regarding their use of the affected hand. Semi-structured interviews were conducted with caregivers and therapists. The transcribed interviews and field diaries were used for content analysis. The following thematic categories were drawn from the data analyses: (1) use when needed: from consistent to nonuse of the affected extremity; (2) making decisions: choosing to use or not use the affected extremity; and (3) responsibilities with activities: from complete dependence to independent performance. Discrepancies between caregivers and therapists' attitudes and actions towards children's hands use highlight the specific features from each context that facilitated or hindered children with CP's engagement in functional activities. Recommendations for future studies include investigating the relationship between the identified facilitators and improvements in children's effective hand use in home and clinical settings.