Hand use development in children with unilateral cerebral palsy
Gunvor L Klevberg1, Reidun Jahnsen1,2, Sonja Elkjaer1
1Department of Neurosciences in Children, Cerebral Palsy Follow-up Program (CPOP), Oslo University Hospital, Oslo, Norway.
Insights
Children with unilateral cerebral palsy (CP) develop hand use following a stable pattern, reaching most of their potential by age six. Early hand function predicts long-term outcomes.
Area of Science:
- Pediatric Rehabilitation
- Neurodevelopmental Disorders
- Motor Control
Background:
- Unilateral cerebral palsy (CP) significantly impacts bimanual hand use development in children.
- Understanding the trajectory of hand function is crucial for targeted interventions.
Purpose of the Study:
- To describe the developmental patterns of hand use in children with unilateral CP from 18 months to 13 years.
- To identify factors influencing these developmental trajectories.
Main Methods:
- Longitudinal study of 166 children with unilateral CP using the Assisting Hand Assessment (AHA).
- Non-linear mixed effects models estimated developmental limits and rates.
- Developmental patterns analyzed by Manual Ability Classification System (MACS) levels and early AHA performance.
Main Results:
- Children with higher MACS levels (I-III) and better early hand function (AHA-18) showed distinct developmental trajectories.
- Most children reached 90% of their estimated hand use limit before age 6, with significant variation by MACS level.
- A stable limit model (SLM) demonstrated a better fit, suggesting sustained hand function development up to age 13.
Conclusions:
- Hand use development in unilateral CP follows a stable-limit pattern, with most children reaching their plateau by age 6.
- Manual Ability Classification System (MACS) levels delineate different developmental speeds and limits.
- Early hand use assessment is a key predictor of long-term hand function in children with unilateral CP.
Aim:
To describe the development of hand use during bimanual activities among children with unilateral cerebral palsy (CP).
Method:
A cohort of 166 children (79 females, 87 males; age range 18mo-13y, mean [SD] age at first assessment 37.6mo [20.5mo]) with unilateral CP, registered in the Norwegian CP Follow-up Program with two or more Assisting Hand Assessments (AHAs), were included in this longitudinal study comprising 524 AHAs. Developmental limits and rates were estimated by non-linear mixed effects models and compared between a stable limit model (SLM) and a peak and decline model. Development was described according to Manual Ability Classification System (MACS) levels and AHA performance at 18 months of age (AHA-18).
Results:
Children in MACS level I, or in the high AHA-18 group, reached highest limits and had the most rapid development (p<0.001). The developmental trajectories were different between MACS levels I, II, and III and between the high, moderate, and low AHA-18 groups. Seventy-five per cent of the children reached 90% of their estimated limit at 5 years 10 months or earlier. The SLM showed the best model fit (Akaike information criterion: 4008.99).
Interpretation:
Most children approached a steady performance limit before 6 years of age. Although children in MACS levels I and II reached 90% of the expected limit at 3 and 4 years respectively, the corresponding age was 8 years for children in MACS level III. The better model fit for the SLM indicates that children with unilateral CP maintain their attained limit of hand use to at least the age of 13 years. What this paper adds Development of hand use between 18 months and 13 years follows a stable-limit pattern. Most children reach a steady limit on the Assisting Hand Assessment before 6 years of age. Manual Ability Classification System levels I, II, and III represent distinct developmental trajectories, level III having a slower rise. Early hand use is an important indicator of future development.
