Longitudinal development of hand function in children with unilateral spastic cerebral palsy aged 18 months to 12
Linda Nordstrand1, Ann-Christin Eliasson1, Marie Holmefur2
1Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
Insights
Children with unilateral cerebral palsy show rapid hand function development, reaching 90% of their potential by age 8. Early Assisting Hand Assessment (AHA) scores can predict future hand function in these children.
Area of Science:
- Pediatrics
- Neurology
- Rehabilitation Medicine
Background:
- Unilateral cerebral palsy (UCP) significantly impacts hand function, affecting bimanual task performance in children.
- Understanding the developmental trajectory of hand use is crucial for targeted interventions.
Purpose of the Study:
- To describe the developmental progression of hand function in children with UCP.
- To analyze the use of the affected hand during bimanual tasks from 18 months to 12 years.
- To explore predictive factors for hand function development.
Main Methods:
- Longitudinal assessment of 96 children with UCP using the Assisting Hand Assessment (AHA).
- Data analyzed using a nonlinear mixed effects model and a 'stable limit' development model.
- Subgroup analysis based on early AHA scores (18 months) and Manual Ability Classification System (MACS) levels.
Main Results:
- Children demonstrated rapid hand function development in early childhood, achieving 90% of their stable limit between 30 months and 8 years.
- Distinct developmental patterns emerged between subgroups defined by initial AHA scores and MACS levels.
- A total of 702 AHA sessions provided a robust dataset for analysis.
Conclusions:
- The Assisting Hand Assessment (AHA) at 18 months can serve as an early indicator for predicting future hand function development in children with UCP.
- Early functional assessment is valuable for anticipating developmental trajectories and tailoring therapeutic strategies.
Aim:
The aim of the study was to describe the development of hand function, particularly the use of the affected hand in bimanual tasks, among children with unilateral cerebral palsy aged 18 months to 12 years.
Method:
A convenience sample of 96 children (53 males, 43 females) was assessed with the Assisting Hand Assessment (AHA) at regular intervals from the ages of 18 months to 12 years. The children ranged from 17 to 127 months (median age 24mo) at recruitment. Subgroups were created to identify differences in development using the child's AHA at 18 months and the Manual Ability Classification System (MACS). A nonlinear mixed effects model was used to analyze data according to a 'stable limit' development model.
Results:
The results were based on 702 AHA sessions. The children showed a rapid development at a young age and reached 90% of their stable limit between 30 months and 8 years. The subgroups, based on the 18-month AHA and the MACS levels respectively, had distinctly different patterns of development.
Interpretation:
The AHA at 18 months may be used to make a crude prediction of future development.
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