Hand Function in 8- to 12-Year-Old Children with Bilateral Cerebral Palsy and Interpretability of the Both Hands Assessment

Abstract

Aim To describe bimanual performance in a sample of Australian children with bilateral cerebral palsy (CP) and, examine the qualitative meaning (or interpretability) of scores on the Both Hands Assessment (BoHA). Methods Children with bilateral CP aged 8–12 years (n = 54) classified Manual Ability Classification System (MACS) level I = 20, II = 18, III = 16 were examined using the BoHA. Results Bimanual performance was significantly different across MACS levels I-III (p < 0.001). Mean (95%CI) BoHA-unit for each MACS level were I = 85 (81–89), II = 72 (68–76) and III = 53 (49–56). Children with asymmetrical hand use (≥ 20% difference between upper limbs, n = 10) were classified MACS levels II and III and had a mean (95%CI) BoHA-unit of 56 (51–62). Children with symmetrical hand use were classified in MACS level I-III and had a mean (95%CI) BoHA-unit of 74 (70–79). Conclusions The BoHA quantified observations of bimanual performance for children with bilateral CP, differentiated between MACS levels I-III and provided clinically meaningful information. The BoHA may facilitate tailoring of upper limb intervention. Future research is recommended to examine inter-rater and intra-rater reliability and responsiveness of the BoHA, as well as longitudinal studies of bimanual hand skill development in children with bilateral CP.