Self-care and manual ability in preschool children with cerebral palsy: a longitudinal study
Andrea Burgess1, Roslyn N Boyd1, Jenny Ziviani2
1Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
Insights
Self-care development in children with cerebral palsy (CP) varies significantly with manual ability. Children with higher manual ability show greater self-care progress, while those with severe impairment, especially with epilepsy, have limited gains.
Area of Science:
- Pediatric rehabilitation
- Developmental pediatrics
- Neurology
Background:
- Cerebral palsy (CP) affects motor skills, impacting daily living activities.
- Understanding self-care development is crucial for independence in children with CP.
- Manual ability is a key factor influencing functional outcomes in CP.
Purpose of the Study:
- To describe the longitudinal development of self-care skills in children with CP from 18 months to 5 years.
- To examine the relationship between manual ability and self-care development across all functional levels.
- To identify distinct self-care developmental trajectories based on manual ability.
Main Methods:
- Prospective longitudinal population-based study of 290 children with CP.
- Self-care assessed using the Pediatric Evaluation of Disability Inventory (PEDI) at multiple time points (18-60 months).
- Manual Ability Classification System (MACS) used to categorize functional ability at 60 months; mixed-effects linear regression models for analysis.
Main Results:
- Self-care development by 60 months was negatively associated with manual ability impairment severity.
- Distinct self-care developmental trajectories were observed, with higher MACS levels showing slower progress.
- Children in MACS level V demonstrated the lowest self-care skills and no progress; those in MACS levels IV and V with epilepsy showed no significant change.
Conclusions:
- Self-care performance in preschool children with CP is closely linked to manual ability.
- Clinicians can utilize these developmental rates to predict and monitor self-care progress.
- PEDI trajectories and MACS levels aid in setting realistic independence goals for children with CP.
Aim:
To describe longitudinal development of self-care and its relationship to manual ability in children with cerebral palsy (CP) aged 18 months to 5 years across all functional abilities.
Method:
This was a prospective longitudinal population-based study of 290 children with CP (178 [61%] males, 112 [39%] females). Self-care was assessed using the Pediatric Evaluation of Disability Inventory (PEDI). At 60 months (n=242), children were classified using the Manual Ability Classification System (MACS); 113 in level I (47%), 61 in MACS level II (25%), 24 in MACS level III (10%), 14 in MACS level IV (6%), and 30 in MACS level V (12%). Measures were taken at 18 months, 24 months, 30 months, 36 months, 48 months, and 60 months of age. Longitudinal analyses were performed using mixed-effects linear regression models.
Results:
Self-care development achieved by 60 months was negatively associated with the severity of manual ability impairment. Distinct self-care developmental trajectories were found with estimated changes in PEDI self-care scaled scores per month: 0.61 for MACS level I, 0.46 for MACS levels II, 0.31 for MACS level III, 0.16 for MACS level IV, and 0.03 for MACS level V. Children classified in MACS level V had the lowest level of self-care skills at 18 months and showed no progress in self-care development.
Interpretation:
This study reports rate of self-care development in preschool children with CP. Self-care performance was highest in children with greatest manual ability. Clinicians may use rates of change to predict or monitor self-care performance. PEDI trajectories inform goal setting in discussions with families regarding expected levels of independence in self-care.
What This Paper Adds:
Distinct self-care developmental trajectories in children with cerebral palsy were found according to Manual Ability Classification System (MACS) levels. Children in MACS levels IV and V with epilepsy did not show any significant change in self-care. Children in MACS levels IV and V without epilepsy demonstrated small yet significant gains in self-care performance.
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