Time Course of Upper Limb Function in Children with Unilateral Cerebral Palsy: A Five-Year Follow-Up Study
Katrijn Klingels1,2, Sarah Meyer1, Lisa Mailleux1
1KU Leuven, University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgium.
Insights
Children with unilateral cerebral palsy (CP) show decreased passive range of motion and bimanual performance over five years, despite improvements in grip strength and some activity measures. Younger children with CP maintained function, while older children experienced declines.
Area of Science:
- Pediatrics
- Neurology
- Rehabilitation Medicine
Background:
- Long-term upper limb function evolution in pediatric unilateral cerebral palsy (CP) is not well understood.
- Understanding functional changes is crucial for targeted interventions.
Purpose of the Study:
- To track the five-year changes in upper limb function in children with unilateral CP.
- To identify factors influencing these functional time trends.
Main Methods:
- Eighty-one children with unilateral CP were assessed at baseline and followed for five years.
- Evaluations included passive range of motion (PROM), tone, strength, and standardized activity assessments (Melbourne Assessment, Jebsen-Taylor, AHA, ABILHAND-Kids).
Main Results:
- Over five years, PROM and Assisting Hand Assessment (AHA) scores declined significantly (p < 0.001).
- Grip strength, Melbourne Assessment, Jebsen-Taylor test, and ABILHAND-Kids scores improved (p < 0.001).
- Age and Manual Ability Classification System (MACS) levels influenced AHA score evolution; children over 9 years and those with MACS II/III showed decreased bimanual performance.
Conclusions:
- Children with unilateral CP experience increasing PROM limitations over five years.
- While capacity measures improve, spontaneous use of the affected limb for bimanual tasks declines after age 9.
- Age and severity (MACS level) are key factors in functional trajectory.
Abstract:
Knowledge on long-term evolution of upper limb function in children with unilateral cerebral palsy (CP) is scarce. The objective was to report the five-year evolution in upper limb function and identify factors influencing time trends. Eighty-one children (mean age 9 y and 11 mo, SD 3 y and 3 mo) were assessed at baseline with follow-up after 6 months, 1, and 5 years. Passive range of motion (PROM), tone, muscle, and grip strength were assessed. Activity measurements included Melbourne Assessment, Jebsen-Taylor test, Assisting Hand Assessment (AHA), and ABILHAND-Kids. At 5-year follow-up, PROM (p < 0.001) and AHA scores (p < 0.001) decreased, whereas an improvement was seen for grip strength (p < 0.001), Melbourne Assessment (p = 0.003), Jebsen-Taylor test (p < 0.001), and ABILHAND-Kids (p < 0.001). Age influenced the evolution of AHA scores (p = 0.003), with younger children being stable over time, but from 9 years onward, children experienced a decrease in bimanual performance. Manual Ability Classification System (MACS) levels also affected the evolution of AHA scores (p = 0.02), with stable scores in MACS I and deterioration in MACS II and III. In conclusion, over 5 years, children with unilateral CP develop more limitations in PROM, and although capacity measures improve, the spontaneous use of the impaired limb in bimanual tasks becomes less effective after the age of 9 years.
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