Self-care and hand function in preschool children with unilateral or bilateral cerebral palsy: A cross-sectional
Hilde Bonden1, Reidun Birgitta Jahnsen2,3, Gunvor Lilleholt Klevberg2
1Children's and Youth Rehabilitation Section, Sarpsborg Clinic, Østfold Hospital Trust, Grålum, Norway.
Insights
Self-care capabilities in children with cerebral palsy (CP) were similar between unilateral (UCP) and bilateral (BCP) types. However, hand function significantly impacts self-care differently in BCP, highlighting the need for tailored interventions for each CP type.
Area of Science:
- Pediatric rehabilitation
- Neuroscience
- Developmental pediatrics
Background:
- Cerebral palsy (CP) affects motor skills, impacting daily self-care activities.
- Understanding the nuances between unilateral CP (UCP) and bilateral CP (BCP) is crucial for effective intervention.
- Self-care and hand function are key developmental milestones in children with CP.
Purpose of the Study:
- To describe and compare self-care capabilities in children with UCP and BCP.
- To explore the association between self-care and hand function in UCP and BCP groups separately.
- To inform targeted therapeutic strategies for children with different CP types.
Main Methods:
- Cross-sectional study using data from the Norwegian Quality and Surveillance Registry for Cerebral Palsy (NorCP).
- Included 87 children with CP (UCP: n=61; BCP: n=26) aged 4 years on average, classified by Manual Ability Classification System (MACS) levels I-III.
- Assessed self-care (Pediatric Evaluation of Disability Inventory, PEDI), manual abilities (MACS), and hand use (Assisting Hand Assessment, AHA; Both Hands Assessment, BoHA).
Main Results:
- No significant differences in overall self-care capabilities between UCP and BCP groups.
- Significant differences in self-care abilities were observed across MACS levels for the entire CP cohort.
- Hand function showed a stronger correlation with self-care in BCP (r=0.6) compared to UCP (r=0.3).
- Symmetric hand use in BCP correlated with higher self-care scores.
Conclusions:
- While overall self-care is comparable between UCP and BCP at MACS levels I-III, hand function's impact varies significantly.
- Distinct associations between hand use measures and self-care capabilities underscore the need to differentiate UCP and BCP.
- Tailored interventions addressing the specific hand function and self-care needs of UCP and BCP are recommended.
Aims:
To describe self-care capabilities among children with cerebral palsy (CP) and explore associations between self-care and hand function for children with unilateral cerebral palsy (UCP) and children with bilateral cerebral palsy (BCP) separately.
Method:
Cross-sectional data on self-care capabilities (Pediatric Evaluation of Disability Inventory, PEDI), manual abilities (Manual Ability Classification System, MACS) and hand use during bimanual performance (Assisting Hand Assessment, AHA; Both Hands Assessment, BoHA) were retrieved from the Norwegian Quality and Surveillance Registry for Cerebral Palsy (NorCP). Eighty-seven children with CP (UCP, n = 61, mean age 4 years 1 month, SD 1 year 3 months, range 56) or BCP (n = 26, mean age 4 years 4 months, SD 1 year, range 41), classified at MACS level I (n = 26), II (n = 40) or III (n = 21), were included.
Results:
No significant differences in self-care capabilities were found between children with UCP and children with BCP. Analysis of variance showed significant differences in self-care between MACS levels for the whole group. No significant differences in self-care between MACS levels were observed for children with UCP (p = 0.36), but significant differences were found for those with BCP (p < 0.001). Whereas a small correlation (r = 0.3) between PEDI and AHA scores was found for children with UCP, a large correlation (r = 0.6) was found for those with BCP. Children with BCP with symmetric hand use during bimanual performance (BoHA) had higher PEDI scores than children with asymmetric hand use.
Conclusion:
Though children with UCP and children with BCP who were classified at MACS I-III exhibited similar self-care capabilities, the limited hand use seems to contribute differently between the two groups. The two different measures of hand use exhibit different associations with self-care capabilities for young children with UCP and BCP, respectively, and illustrate the need to treat UCP and BCP as two distinct groups, each requiring tailored interventions according to their specific needs.
