Hand function and self-care in children with cerebral palsy
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
Self-care skills are strongly linked to bimanual performance in children with cerebral palsy (CP). Both Hands Assessment (BoHA) showed a stronger association than the Assisting Hand Assessment (AHA) for children with CP.
Area of Science:
- Pediatric Rehabilitation
- Neuroscience
- Occupational Therapy
Background:
- Cerebral palsy (CP) significantly impacts motor function, affecting daily activities.
- Self-care and bimanual performance are crucial for independence in children with CP.
- Understanding the relationship between these abilities can inform targeted interventions.
Purpose of the Study:
- To investigate the association between self-care abilities and bimanual hand function in children aged 8-12 years with CP.
- To explore differences in this relationship based on CP type (unilateral vs. bilateral).
Main Methods:
- A cross-sectional study involving 74 children with CP (Manual Abilities Classification System levels I-III).
- Self-care was assessed using the Pediatric Evaluation of Disability Inventory-Computer Adaptive Test (PEDI-CAT).
- Bimanual performance was measured by the Assisting Hand Assessment (AHA) and Both Hands Assessment (BoHA), with cognitive and motor function also evaluated.
Main Results:
- Higher scores on both AHA and BoHA were significantly associated with higher PEDI-CAT self-care scores.
- Each unit increase in BoHA was linked to a 0.17 increase in PEDI-CAT scores, and each unit increase in AHA to a 0.12 increase.
- BoHA explained 57% of the variance in PEDI-CAT scores for bilateral CP, and BoHA plus cognition explained 68%; AHA explained 40% for unilateral CP, with no cognitive effect.
Conclusions:
- A strong positive relationship exists between self-care and bimanual performance in children with CP.
- The association between self-care and bimanual performance varies between unilateral and bilateral CP.
- Cognition plays a role in self-care for bilateral CP but not unilateral CP, highlighting the need for individualized approaches.
Aim:
To examine the relationship between self-care and bimanual performance in children aged 8 to 12 years with cerebral palsy (CP).
Method:
This was a cross-sectional study of 74 children with CP (unilateral n=30, bilateral n=44; 48 males, 26 females; median age 9y 8mo [25th, 75th centiles 9y 1mo, 10y 8mo], Manual Abilities Classification System level I=30, II=28, III=16). Self-care was measured using the Pediatric Evaluation of Disability Inventory-Computer Adaptive Test (PEDI-CAT), and bimanual performance using the Assisting Hand Assessment (AHA) and Both Hands Assessment (BoHA). Measures of cognition, behavioural regulation, inattention, and gross motor function were included. Analyses used a directed acyclic graph to select variables for linear regression modelling.
Results:
Higher AHA and BoHA scores were associated with higher PEDI-CAT scores. An increase of 1 AHA unit was associated with an increase of 0.12 PEDI-CAT scores, and a 1 BoHA unit increase was associated with an increase of 0.17 PEDI-CAT scores. The BoHA accounted for 57% of variance in PEDI-CAT scores for children with bilateral CP, while BoHA and cognition accounted for 68% of variance. The AHA accounted for 40% of variance in PEDI-CAT scores for unilateral CP with no effect of cognition on self-care.
Interpretation:
Self-care was strongly and positively associated with bimanual performance. Associations between self-care and bimanual performance differed for those with unilateral and bilateral CP.
What This Paper Adds:
There is a strong positive relationship between self-care and bimanual performance for unilateral and bilateral cerebral palsy (CP). Both Hands Assessment (BoHA) scores have a stronger association with self-care than Assisting Hand Assessment scores. BoHA scores also account for more variation in self-care. There is a strong positive relationship between self-care and cognition overall. The effect of cognition on self-care performance differed for bilateral and unilateral CP.
