Development of bimanual performance in young children with cerebral palsy

Area of Science:

• Pediatric Rehabilitation
• Neurodevelopmental Disorders
• Motor Control

Background:

• Cerebral palsy (CP) significantly impacts bimanual performance in children.
• Understanding developmental trajectories is crucial for targeted interventions.
• Early assessment of manual ability and hand function is key.

Purpose of the Study:

• To describe the development of bimanual performance in young children with unilateral or bilateral CP.
• To compare developmental trajectories based on manual ability and early hand function.
• To investigate differences in development between symmetric and asymmetric hand use in bilateral CP.

Main Methods:

• A population-based sample of 102 children with CP was assessed half-yearly.
• The Assisting Hand Assessment (AHA) and Both Hands Assessment (BoHA) were used.
• Nonlinear mixed-effects models estimated developmental limits and rates, comparing trajectories across Manual Ability Classification System (MACS) levels and early AHA/BoHA scores.

Main Results:

• Higher Manual Ability Classification System (MACS) levels and earlier Assisting Hand Assessment/Both Hands Assessment (AHA/BoHA) scores correlated with higher performance limits.
• Children with bilateral CP showed smaller developmental changes compared to those with unilateral CP.
• Among children with bilateral CP, symmetric hand use led to higher performance limits than asymmetric use.

Conclusions:

• Manual Ability Classification System (MACS) levels and early Assisting Hand Assessment/Both Hands Assessment (AHA/BoHA) performance are significant predictors of hand use development in CP.
• Children with unilateral CP demonstrate greater improvement in bimanual performance than those with bilateral CP.
• Symmetric hand use in bilateral CP is associated with better outcomes than asymmetric use.