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Event-related Potentials During Target-response Tasks to Study Cognitive Processes of Upper Limb Use in Children with Unilateral Cerebral Palsy
Published on: January 11, 2016
Arm and hand function in children with unilateral cerebral palsy: a one-year follow-up study
Katrijn Klingels1, Hilde Feys, Liesbet De Wit
1Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Katholieke Universiteit Leuven, Tervuursevest 101, 3001 Heverlee, Belgium. Katrijn.Klingels@faber.kuleuven.be
Insights
Arm and hand function in children with unilateral cerebral palsy (CP) shows limited improvement over one year, except for grip strength and manual dexterity. Etiology and Manual Ability Classification System (MACS) level influence dexterity changes.
Area of Science:
- Pediatric Rehabilitation
- Neuroscience
- Developmental Pediatrics
Background:
- Unilateral cerebral palsy (CP) significantly impacts arm and hand function in children due to motor and sensory deficits.
- Limited understanding exists regarding the developmental trajectory of upper limb function in this population over time.
Purpose of the Study:
- To track changes in upper limb function measures over a 12-month period in children with unilateral CP.
- To identify factors influencing the observed time trends in functional outcomes.
Main Methods:
- Eighty-one children with unilateral CP (ages 5-15) were assessed at baseline, 6, and 12 months.
- Evaluations included passive range of motion, muscle tone, grip strength, and manual dexterity (Jebsen-Taylor test).
- Predictive factors analyzed included age, gender, etiology, and Manual Ability Classification System (MACS) levels.
Main Results:
- Significant improvements were noted in grip strength and manual dexterity (Jebsen-Taylor test) over the year.
- Manual Ability Classification System (MACS) level and etiology significantly impacted the evolution of Jebsen-Taylor test scores.
- Other assessed measures of upper limb function did not show significant changes.
Conclusions:
- Except for grip strength, motor impairments and hand function in bimanual tasks do not spontaneously improve in one year for children with unilateral CP.
- Improvements in manual dexterity suggest potential for learning adaptive movement strategies.
- Etiology and MACS level are key factors influencing functional gains in manual dexterity.
Background:
In children with unilateral cerebral palsy (CP), development of arm and hand function is often compromised by the underlying motor and sensory impairments. However, knowledge about the evolution of arm and hand function in this population is limited.
Aim:
The aims were to map the evolution of scores on upper limb measures over one year in children with unilateral CP and to identify factors that influence time trends.
Methods:
Eighty-one children (43 males, 38 females; mean age 9y11mo (SD 3y3mo) range 5-15 y) were tested at baseline, at 6 and 12 months. According to the International Classification of Functioning, Disability and Health, body function measurements included passive range of motion, muscle tone, manual muscle strength and grip strength. Activity measurements included the Melbourne Assessment, the Jebsen-Taylor test, the Assisting Hand Assessment and the Abilhand-Kids questionnaire. Age, gender, etiology (congenital or acquired lesions) and Manual Ability Classification System (MACS) levels were analyzed as predictive factors, using mixed models.
Results:
Scores for grip strength (p = 0.001) and manual dexterity (Jebsen-Taylor test, p < 0.0001) increased significantly over time. MACS level (p = 0.03) and etiology (p = 0.02) had a significant influence on the time evolution of the Jebsen-Taylor scores. Other assessments showed no significant changes.
Conclusion:
Motor impairments, movement quality and hemiplegic hand use in bimanual tasks do not spontaneously improve over one year, except for an age-related change in grip strength. However, an improvement was observed in manual dexterity, suggesting that some children can learn more adaptive movement strategies.
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