Self-care performance in children with cerebral palsy: a longitudinal study
Andrea Burgess1, Roslyn N Boyd1, Mark D Chatfield1
1Faculty of Medicine, Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, QLD, Australia.
Insights
Children with cerebral palsy (CP) show varying self-care development based on manual ability. Higher function (MACS I-III) improves self-care, while severe impairment (MACS V) leads to decline.
Area of Science:
- Pediatric rehabilitation
- Developmental pediatrics
- Neurology
Background:
- Cerebral palsy (CP) affects motor skills, impacting daily activities.
- Understanding self-care development is crucial for children with CP.
- Manual Ability Classification System (MACS) categorizes functional ability.
Purpose of the Study:
- To examine self-care development trajectories in children with CP.
- To analyze development across all Manual Ability Classification System (MACS) levels.
- To identify factors influencing self-care progression in pediatric CP.
Main Methods:
- Prospective longitudinal population-based study of 71 children with CP (2.5 to 12 years).
- Utilized Pediatric Evaluation of Disability Inventory (PEDI) and PEDI-Computer Adaptive Test (PEDI-CAT) for self-care assessment.
- Employed multilevel mixed-effects regression modelling to analyze age and MACS interaction.
Main Results:
- Children in MACS levels I-III demonstrated consistent self-care progress (0.48-0.72 change/year).
- MACS level IV showed a non-significant upward trend in self-care (0.42 change/year).
- Children in MACS level V experienced a significant decline in self-care (-0.65 change/year).
Conclusions:
- Self-care attainment by late childhood correlates with manual ability severity in CP.
- The study highlights potential limitations of PEDI-CAT at the lower functional end.
- Recommendations include adding items to PEDI-CAT to mitigate floor effects in CP self-care assessment.
Aim:
To investigate self-care developmental trajectories in children with cerebral palsy (CP) across all functional ability levels, according to Manual Ability Classification System (MACS) levels.
Method:
This was a prospective longitudinal population-based study of 71 children aged from 2 years 6 months to 12 years, with CP (47 [66%] males, 24 [34%] females). Pediatric Evaluation of Disability Inventory (PEDI) measures were taken at 2 years 6 months, 3, 4, and 5 years, and the PEDI - Computer Adaptive Test (PEDI-CAT) between 8 and 12 years. At 8 to 12 years, children were classified in MACS levels I (21; 30%), II (22; 31%), III (16; 23%), IV (6; 8%), and V (6; 8%). Longitudinal analysis of the PEDI Functional Skills Scale self-care and PEDI-CAT daily activities domains used the published linking equation, and multilevel mixed-effects regression modelling with interaction between age and MACS.
Results:
Between 5 and 12 years of age, children classified in MACS levels I to III continued to show progress in self-care development (PEDI-CAT scaled scores estimated change per year: I, 0.72; II, 0.49; III, 0.48). Children classified in MACS level IV showed an upward non-significant trend between 5 and 8 to 12 years (estimated change 0.42; 95% confidence interval [CI] -0.04 to 0.88). Children in MACS level V showed a decline in self-care (estimated change: -0.65; 95% CI -1.16 to -0.14).
Interpretation:
Self-care development attained by 8 to 12 years of age was related to the severity of manual ability impairment. Application of the linking equation from PEDI to PEDI-CAT is somewhat uncertain at the extreme lower end of the scale. Our study supports recommendations for items to be added to the PEDI-CAT to address floor effect.
