The relationship between unimanual capacity and bimanual performance in children with congenital hemiplegia
Leanne Sakzewski1, Jenny Ziviani, Roslyn Boyd
1The University of Queensland, Queensland Cerebral Palsy and Research Rehabilitation Centre, School of Medicine, Brisbane, Australia. leanne.sakzewski@uqconnect.edu.au
Insights
Children with congenital hemiplegia show a strong link between their single-hand ability and two-hand task performance. However, improving single-hand function doesn't guarantee better bimanual skills in these children.
Area of Science:
- Pediatric Rehabilitation
- Neuroscience
- Occupational Therapy
Background:
- Congenital hemiplegia significantly impacts upper limb function in children.
- Understanding the relationship between unimanual capacity and bimanual performance is crucial for effective interventions.
Purpose of the Study:
- To explore the relationship between unimanual capacity and bimanual performance in children with congenital hemiplegia.
- To examine how upper limb impairments correlate with unimanual capacity and bimanual performance.
Main Methods:
- Cross-sectional study of 70 children (5-16 years) with congenital hemiplegia and 15 typically developing children.
- Assessed unimanual capacity (Melbourne Assessment of Unilateral Upper Limb Function, Jebsen-Taylor Hand Function Test) and bimanual performance (Assisting Hand Assessment).
- Measured upper limb impairments including stereognosis, two-point discrimination, spasticity, and grip strength.
Main Results:
- A strong positive correlation (r=0.83) was found between unimanual capacity and bimanual performance.
- Unimanual capacity and stereognosis explained 75% of the variance in bimanual performance.
- Sensory measures moderately correlated with both unimanual and bimanual function; age, sex, and grip strength were not significant factors.
Conclusions:
- Confirms a strong association between unimanual capacity and bimanual performance in children with congenital hemiplegia.
- The directionality of this relationship is unclear; improvements in unimanual capacity do not automatically translate to enhanced bimanual performance.
- Therapeutic strategies should consider this nuanced relationship when aiming to improve overall hand function.
Aim:
This study explores the relationship between unimanual capacity and bimanual performance for children with congenital hemiplegia aged 5 to 16 years. It also examines the relationship between impairments and unimanual capacity and bimanual performance.
Method:
Participants in this cross-sectional study attended a screening assessment before participating in a large, randomized trial. They comprised 70 children with congenital hemiplegia (39 males, 31 females; mean age 10 y 6 mo, SD 3 y); 18 were classified in the Manual Ability Classification System level I, 51 in level II, and one in level III. Eighteen were in Gross Motor Function Classification System, level I and 52 in level II. Sixty-five participants had spasticity and five had dystonia and spasticity. Fifteen typically developing children (7 males, 8 females; mean age 8 y 8 mo, SD 2 y 7 mo), matched to study participants for age and sex, were recruited as a comparison group for measures of sensation, grip strength, and movement efficiency. Outcome measures for unimanual capacity were the Melbourne Assessment of Unilateral Upper Limb Function (MUUL), and the Jebsen-Taylor Hand Function Test (JTHFT). The Assisting Hand Assessment (AHA) evaluated bimanual performance. Upper limb impairments were measured using assessments of stereognosis, moving two-point discrimination, spasticity, and grip strength.
Results:
There was a strong relationship between unimanual capacity (MUUL) and bimanual performance (AHA; r=0.83). Linear regression indicated MUUL and stereognosis accounted for 75% of the variance in AHA logit scores. Sensory measures were moderately correlated with unimanual capacity and bimanual performance. Age, sex, and grip strength did not significantly influence bimanual performance. There was no difference between children with right- and left-sided hemiplegia for motor performance.
Interpretation:
Findings of our study confirm a strong relationship between unimanual capacity and bimanual performance in a cohort of children with congenital hemiplegia. However, the directionality of the relationship is unknown and therapists cannot assume improvements in unimanual capacity will lead to gains in bimanual performance.
