Early developmental trajectories of the impaired hand in infants with unilateral cerebral palsy
Leanne Sakzewski1, Susan Greaves2, Ann-Christin Eliasson3
1Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia.
Insights
Infants with unilateral cerebral palsy (CP) show three hand function development paths. Boys and those born closer to term face higher risks of poor hand function, even with early therapy.
Area of Science:
- Pediatric neurology
- Developmental neuroscience
- Rehabilitation medicine
Background:
- Unilateral cerebral palsy (CP) significantly impacts infant hand function.
- Early intervention is crucial for managing developmental challenges in infants with CP.
Purpose of the Study:
- To identify distinct developmental trajectories of impaired hand function in infants with unilateral CP.
- To analyze factors influencing these trajectories.
Main Methods:
- Group-based trajectory modeling was used to analyze hand function data from 63 infants (3-15 months) with unilateral CP.
- The Hand Assessment for Infants (HAI) was administered longitudinally.
- Multinomial logistic regression examined demographic associations with trajectory groups.
Main Results:
- Three distinct trajectories were identified: 'low' (29%), 'moderate' (35%), and 'high' (36%) functioning.
- Each week closer to term gestational age increased the risk of being in the low or moderate functioning groups.
- Male infants had a significantly higher risk of being in the low functioning group.
Conclusions:
- Developmental trajectories for impaired hand function in unilateral CP are distinct.
- Male infants and those born closer to term are at higher risk for poorer hand function outcomes, irrespective of early intervention.
Aim:
To identify developmental trajectories of impaired hand function in infants aged 3 to 15 months with unilateral cerebral palsy (CP).
Method:
Sixty-three infants (37 male; median gestational age 37 weeks [interquartile range 30-39.1 weeks]) recruited as part of a randomized trial with a confirmed diagnosis of unilateral CP were included. All infants received early upper limb therapy. The Hand Assessment for Infants (HAI) was completed at baseline and until 12 to 15 months corrected age. Group-based trajectory modelling identified groups with similar trajectories of development of impaired hand function. Multinomial logistic regression determined associations between demographic variables and trajectory membership.
Results:
The three-group trajectory model comprised 'low' 29%, 'moderate' 35%, and 'high' 36% functioning groups. The relative risk ratio of being in the low or moderate relative to high group increased by 16% (95% confidence interval [CI] 1.02-1.32) and 14% (95% CI 1.01-1.29) respectively for each 1 week increase in gestational age. Males were more likely to be in the low relative to high group (relative risk ratio 7.22; 95% CI 1.6-32.5).
Interpretation:
Three distinct trajectories of development of the impaired hand were identified. Males and infants born closer to term age were at higher risk of being in a low group with little improvement over time, despite receiving early intervention.
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