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Graduating with Honors: Hand Surgery for Cerebral Palsy

Diandra DiMonda is a straight-A student who recently graduated from West Islip High School on Long Island and will be heading to college in the fall. She was one of only two students to receive the school's prestigious "Triple C" award: recognition for outstanding commitment, courage and character.
 
In the past year, Diandra has reached two milestones in her life. In addition to her high school graduation with honors, she achieved an extraordinary personal goal that required the same determination.

A few years back, Diandra never would have thought she'd be able to use her right hand to shake hands at her graduation ceremony. Cerebral palsy affected the muscles of her hand, causing it to be clenched in a fist. But thanks to a delicate three-hour operation performed at Hospital for Special Surgery (HSS), Diandra was able to shake hands when she received her diploma.

Cerebral palsy, or CP, encompasses a number of neurological disorders that appear in infancy or early childhood and affect movement and muscle coordination. When Diandra was a baby, she was diagnosed with the most common form of CP that causes certain muscles to be stiff and permanently contracted. The condition often affects one side of the body and the upper or lower extremities. In Diandra's case, it was her hand, arm and elbow on her right side. 

Many activities we take for granted - holding, reaching, grabbing, lifting, waving - were impossible for Diandra to perform with her right hand. CP caused her wrist and arm to be rigid. She was unable to extend her elbow, and her right hand was permanently clenched in a fist so she could not see her thumb.

Last year, everything changed after a consultation with Michelle G. Carlson, MD, a hand surgeon and Director of the Children and Adolescent Hand and Arm (CHArm) Center at HSS. At the CHArm Center, a multi-disciplinary team of specialists offers the most advanced treatments, including surgical options. They educate young people and their families about conditions affecting the upper extremities.

The evaluation, treatment, and rehabilitation of the hand require special skills.  Diandra was referred to the Cerebral Palsy and Neurological Upper Extremity Program at the CHArm Center, which focuses on the orthopedic needs of people with cerebral palsy and other neurological disorders.

After a careful exam, evaluation and consultation with the family, Dr. Carlson performed delicate surgery to open up Diandra's hand and give her some function and mobility. The operation was a success. She was able to see her thumb for the first time without the use of a splint. Her hand is no longer closed tight and she can extend her elbow.

Diandra and her parents are very happy with the results. Debra and Frank DiMonda see a change in their daughter. "The way she carries herself, she has so much more confidence. Her hand looks beautiful," says Mrs. DiMonda. "For a young girl, that's incredibly important. It has helped add to her grace."

The DiMondas found out about HSS from health professionals on Long Island. Mrs. DiMonda says she is especially grateful to occupational therapist Jeanne Ganz at Island Therapies, who worked with her daughter since she was born and told her about HSS. The family's Long Island neurologist, Dr. Nirmala Mitra, also recommended Hospital for Special Surgery. "They said it was the place to go for this type of surgery."

It takes an hour to an hour and a half to drive to the hospital from the DiMonda's home in West Islip, and they say the trip is well worth it. "The hospital is amazing. I would not even think of going anywhere else. I can't say enough good things about the staff. They are so kind, they display so much humanism in medicine," Mrs. DiMonda says. "You don't always find that. You're not just another patient they're getting in and out the door."

Surgery for cerebral palsy is highly specialized. It often entails loosening tight muscles and releasing rigid joints. In Diandra's case, Dr. Carlson lengthened some of her arm muscles and released the muscles around her elbow, which allowed Diandra's arm and hand to become more relaxed and mobile. 

"Dr. Carlson and the Charm Center staff are very understanding. They were also very honest about what could be done and what expectations to have," Mrs. DiMonda notes.

Diandra can now use her right hand to push open doors and carry items such as books and gifts. She says it's easier to get dressed. She can now use both hands when opening bottles and tearing open packages or food wrappers.

"It was definitely worth it. Having the surgery has brought up my self-esteem. I feel like I have more flexibility, I can breathe," Diandra says. Like most teens, she was excited about attending her high school prom, and her confidence shows in the photos. HSS staff knew about the big event. "Everyone at the hospital has been so great. They all know my name, and they even asked to see my prom photos."

Dr. Carlson is accustomed to seeing patients not only from Long Island, but from all across the country and around the world. "We've had patients from Europe, Israel, Turkey and South America." She says it's a good feeling to see young people with more confidence and able to do more with their hands after surgery. "You feel like you're giving back to society, doing something special."

She recalls a two-page letter from a patient who flew in from Colorado for hand surgery. "He used to dread little things we take for granted, like birthday parties, because without the use of both hands he couldn't hold his cake plate and eat the cake at the same time. Now he can," Dr. Carlson says.

For Diandra, one of her biggest pleasures now is getting a manicure. "She has beautiful polished nails and lovely hands," her father says. "We're very proud of her."
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Hand Surgery for Cerebral Palsy

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