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Bimanual hand use in children and adolescents with unilateral spastic cerebral palsy: an exploratory study
Simone A Bueno1, Marisa C Mancini1, Rachel H S Oliveira1
1Graduate Program in Rehabilitation Sciences, Escola de Educação Física, Fisioterapia e Terapia Ocupacional- Av. Antônio Carlos, 6627, Cep: 31270-901 Belo Horizonte, MG, Brazil.
Insights
Children with unilateral spastic cerebral palsy (USCP) experience challenges in bimanual activities. Assistance and Manual Ability Classification System (MACS) level significantly impact hand use efficacy, time, and comfort.
Area of Science:
- Pediatric Rehabilitation
- Occupational Therapy
- Neuroscience
Background:
- Unilateral spastic cerebral palsy (USCP) frequently impairs hand function in daily activities.
- Difficulties in bimanual tasks are common for individuals with USCP.
Purpose of the Study:
- To identify factors affecting hand use during bimanual activities in children and adolescents with USCP.
- To analyze the influence of assistance and manual ability on performance outcomes.
Main Methods:
- Cross-sectional study of 102 participants (6-18 years) with USCP.
- Data collected on Manual Ability Classification System (MACS) level, age, affected side, and hand-use experience (CHEQ2.0).
- Cluster analysis and multiple linear regression used to assess factors influencing efficacy, time, and feeling bothered.
Main Results:
- Manual Ability Classification System (MACS) and assistance clusters explained significant variance in efficacy (R²=0.31) and time (R²=0.37).
- MACS level accounted for 22% of the variance in feeling bothered.
- Higher MACS levels and greater need for assistance correlated with lower efficacy, slower performance, and increased negative feelings.
Conclusions:
- Assistance and MACS level are key determinants of hand use efficacy, time, and comfort in bimanual activities for children with USCP.
- Interventions should address these factors to improve bimanual activity performance in daily routines.
Background:
Individuals with unilateral spastic cerebral palsy (USCP) often show difficulties using their hands during activities of daily living.
Objective:
To investigate the factors that interfere with hand use during bimanual activities in children and adolescents with USCP.
Methods:
We conducted a cross-sectional study with 102 children and adolescents with USCP, aged 6 to 18 years. We collected information with the caregivers about the classification of the child's manual ability, according to the Manual Ability Classification System (MACS); child's age; side of the involvement; Children's Hand-Use Experience Questionnaire- CHEQ2.0. Cluster analysis identified groups of children and adolescents who performed CHEQ activities with or without assistance. Multiple linear regression analyses identified the contribution of the factors: age, sex, MACS level, side of hemiparesis, and clusters of assistance, on the outcomes of efficacy, time, and feeling bothered.
Results:
MACS and clusters of assistance explained the variance in efficacy (p<0.05; R2=0.31) and time (p<0.05; R2=0.37). MACS explained 22% of the variance in feeling bothered. Children and adolescents with increased difficulty to perform activities that involve hand use (i.e., MACS III) and who receive assistance during most bimanual activities showed less efficacy of use, were slower in their performance, and presented greater feeling of being bothered.
Conclusion:
Assistance in bimanual activities and MACS level contributed to explain the efficacy of use, time, and feeling bothered in performing bimanual activities. Intervention strategies aimed at promoting the performance of bimanual activities in the daily routine of children with USCP should consider these outcomes.
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