Longitudinal development of hand use in children with unilateral spastic cerebral palsy from 18 months to 18 years
Ann-Christin Eliasson1, Linda Nordstrand2, Magnus Backheden3
1Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
Insights
Children with unilateral cerebral palsy (CP) show significant hand function development early in life. Their ability to use the affected hand in bimanual tasks stabilizes from age 7 to 18 years across all Manual Ability Classification System (MACS) levels.
Area of Science:
- Pediatrics
- Neurology
- Rehabilitation Medicine
Background:
- Unilateral cerebral palsy (CP) affects hand use in bimanual tasks.
- Understanding developmental trajectories is crucial for intervention.
- Longitudinal data on hand function development in CP is limited, especially during adolescence.
Purpose of the Study:
- To describe the developmental trajectory of affected hand use in bimanual tasks for children with unilateral CP.
- To analyze development from 18 months to 18 years, focusing on early development and adolescent progression.
- To confirm early developmental findings in a larger cohort and examine progression through adolescence.
Main Methods:
- 171 participants with unilateral CP (MACS levels I-III) were assessed repeatedly using the Assisting Hand Assessment (AHA).
- Developmental trajectories were modeled using nonlinear mixed-effects models, with linear mixed models applied for adolescent analysis.
- Data spanned from 18 months to 16 years at inclusion, with up to 16 repeated assessments per child.
Main Results:
- Developmental trajectories differed significantly in rate and limit between Manual Ability Classification System (MACS) levels.
- Individual variations in hand function development were substantial within each MACS level.
- Hand function development trajectories remained stable from 7 to 18 years across all MACS levels.
Conclusions:
- Children and adolescents with unilateral CP demonstrate considerable early-age development in affected hand use.
- Hand function ability in bimanual activities stabilizes from 7 to 18 years for all individuals with unilateral CP, regardless of MACS level.
- These findings highlight the importance of early intervention and provide a basis for understanding long-term functional outcomes.
Aim:
To describe the development of the use of the affected hand in bimanual tasks in children with unilateral cerebral palsy (CP) from 18 months to 18 years. Specifically, whether early development can be confirmed in a larger cohort and how development progresses during adolescence.
Method:
In total, 171 participants (95 males, 76 females; mean age 3 years 1 month [SD 3 years 8 months], range 18 months-16 years at inclusion) were classified in Manual Ability Classification System (MACS) levels I (n = 41), II (n = 91), and III (n = 39). Children were assessed repeatedly (median 7, range 2-16 times) with the Assisting Hand Assessment: in total 1197 assessments. Developmental trajectories were estimated using a nonlinear mixed effects model. To further analyse the adolescent period, a linear mixed model was applied.
Results:
The developmental trajectories were different between participants in MACS levels (MACS I-II, II-III) in both rate (0.019, 95% confidence interval [CI] 0.006-0.031, p = 0.034; 0.025, 95% CI 0.015-0.037, p < 0.001) and limit (19.9, 95% CI 16.6-23.3, p = 0.001; 7.2, 95% CI 3.3-11.2, p < 0.003). The individual variations were large within each level. The developmental trajectories were stable over time for all MACS levels between 7 and 18 years (p > 0.05).
Interpretation:
Children and adolescents with unilateral CP have considerable development at an early age and a stable ability to use their affected hand in bimanual activities from 7 to 18 years in all MACS levels.
